Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

Zhan, Peter L.; Canavan, Maureen; Ermer, Theresa; Pichert, Matthew D.; Li, Andrew X.; Maduka, Richard C.; Kaminski, Michael F.; Johung, Kimberly L.; Boffa, Daniel J.

doi:10.1016/j.jtocrr.2022.100429

Cited by 2 publications

(4 citation statements)

References 46 publications

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“…Some advantages of cryotherapy over radiation include faster improvement, lower AE rate, lack of maximal dose, and no need to withhold chemotherapy. Although the median survival in our study was 16.4 months compared with 9.9 months in the study mentioned above 28 , future head-to-head comparative studies are needed to draw conclusions about the merit of one modality over another.…”

Section: Discussioncontrasting

confidence: 60%

“…Most centers have limited the radiation to lower palliative doses and typically withhold chemotherapy, as combining palliative radiation with chemotherapy has been shown to increase AEs without added benefits [27]. The most recent and largest study on radiation for stage 4 disease showed no survival benefit, with a median survival of 9.9 months [28]. It can takes weeks after radiation therapy before improvement in dysphagia is seen and sometimes dysphagia worsens before it improves.…”

Section: Discussionmentioning

confidence: 99%

“…▶ Table 3 shows univariable analysis for change in QoL and dysphagia scores across the different categories of predictor variables for a total of 175 cryotherapy treatments. Only tumor ▶ Freeze time, median (range), seconds/cycle 20 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) stage was significantly (statistically but not clinically) associated with an improvement in QoL. None of the evaluated factors were associated with an improvement in dysphagia.…”

Section: Cryotherapy Treatment-level Datamentioning

confidence: 92%

“…The most recent and largest study on radiation for stage 4 showed no survival benefit with a median survival of 9.9 months [25]. Radiation can take weeks to cause improvement and is sometimes associated with worsening before improvement.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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A prospective multicenter study to evaluate the impact of cryotherapy on dysphagia and quality of life in patients with inoperable esophageal cancer

Kachaamy,

Sharma,

Shah

et al. 2023

Endoscopy

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Background and Study Aims: Dysphagia palliation in inoperable esophageal cancer continues to be a challenge. Self-expanding metal stents have been the mainstay for endoscopic palliation but have a significant risk of adverse events (AE). Liquid nitrogen spray cryotherapy is an established modality that can be used with systemic therapy (ST). This study reports the outcomes of cryotherapy including dysphagia and quality of life (QoL) in patients on ST. Materials and Methods: A prospective multicenter cohort study of 55 adult inoperable esophageal cancer patients undergoing cryotherapy. Changes in QoL and dysphagia between pre- and post-cryotherapy were evaluated. Results: 55 patients received a total of 175 cryotherapy procedures. After a mean of 3.2 cryotherapy sessions, the mean QoL improved from 34.9 at baseline to 29 at last follow-up (p<0.001) while mean dysphagia improved from 1.85 to 1.25 (p=0.004). Patients receiving more intensive cryotherapy (at least 2 treatments within 3 weeks) showed a significantly greater improvement in dysphagia compared to those who didn’t (1.2 versus 0.21 points; p=0.003). 13 (21.8%) patients received another intervention (1 botox, 2 stent, 3 radiation, 7 dilation) for dysphagia palliation. Within the 30-day post-procedure period, there were 3 non-cryo related, >grade 3 AE (all deaths). The median overall survival was 16.4 months. Discussion: In patients with inoperable esophageal cancer receiving concurrent systemic therapy, adding liquid nitrogen spray cryotherapy was safe and associated with improvement in dysphagia and QoL without causing reflux. More intensive treatment showed a greater improvement in dysphagia and should be considered as the preferred approach.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%