Palliative radiotherapy in patients with esophageal carcinoma: A retrospective review.

Palliative radiotherapy has traditionally been used as a noninvasive means of palliating dysphagia in patients with incurable esophageal cancer. Insertion of an esophageal stent is a traditional alternative and newer treatment modalities such as brachytherapy and laser therapy are being increasingly investigated and employed. There are few large series in the literature which examine the role of short palliative radiotherapy regimens in this patient group. This retrospective review aims to demonstrate the useful role that external beam radiotherapy can have in the palliation of patients with incurable esophageal carcinoma.
One hundred forty-eight patients with histologically proven esophageal cancer, who were unsuitable for radical treatment, were identified. Notes were reviewed to determine baseline characteristics, indications for radiotherapy, response to treatment, need for further intervention, time to further intervention, and survival.
The median age of patients who received palliative radiotherapy was 74 years (range, 31-91). Forty-nine percent of patients (n = 73) were performance status 2 or 3, 70% (n = 103) had adenocarcinoma, 58% (n = 86) had locally advanced disease, and 28% (n = 41) had metastatic disease. Ninety-three percent of patients (n = 138) complained of dysphagia prior to radiotherapy. Eighty-nine percent of patients (n = 132) received a dose of 20 Gy in 5 fractions. Only 2 patients (1%) failed to complete the prescribed course of treatment. Following radiotherapy, 75% of patients experienced an improvement in dysphagia and 25% of patients gained weight. Twenty-six percent of patients (n = 38) required subsequent insertion of an esophageal stent and a further 3% (n = 5) received retreatment with radiotherapy. The median stent (and retreatment)-free survival was 4.9 months. Median overall survival was 6.1 months.
Despite a lack of randomized comparison to other modalities, external beam radiotherapy remains an effective, noninvasive, and generally well-tolerated means to palliate dysphagia in selected patients with incurable esophageal carcinoma.
AuthorsLouise Janet Murray, Omar Sadeeq Din, Varadarajan Senthil Kumar, Lynne Melanie Dixon, Jonathan Charles Wadsley
JournalPractical radiation oncology (Pract Radiat Oncol) 2012 Oct-Dec Vol. 2 Issue 4 Pg. 257-64 ISSN: 1879-8500 [Print] United States
PMID24674161 (Publication Type: Journal Article)
CopyrightCopyright © 2012 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

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