Combined Brachytherapy and External Beam Radiation: an Effective Approach for Palliation in Esophageal Cancer

Overview

Journal J Contemp Brachytherapy

Date 2016 Jan 28

PMID 26816502

Citations 10

Authors

Sarbani Ghosh Laskar

Shirley Lewis

Jai Prakash Agarwal

Shagun Mishra

Shaesta Mehta

Prachi Patil

Affiliations

Soon will be listed here.

Abstract

Purpose: Palliation of dysphagia is a challenge in advanced esophageal cancer. The addition of external beam radiotherapy (EBRT) to intraluminal brachytherapy (ILBT) has shown significant improvement in dysphagia relief and symptom scores. The aim of the present study was to evaluate the efficacy of combined use of ILBT and EBRT.

Material And Methods: The medical records of 148 patients with advanced/metastatic esophageal cancer were screened from January 2008 to April 2014, and 74 patients were found eligible for the analysis. All patients received two fractions of 8 Gy each of ILBT, followed by EBRT. Patients were assessed for the symptom scores of dysphagia, odynophagia, regurgitation, and chest pain and weight was recorded periodically.

Results: For a median follow-up of 6 months, the median OS was 9.5 months (95% CI: 7.5-10.5). The median dysphagia free survival was 6 months (95% CI: 4.8-7.1). The scores for dysphagia significantly improved after completion of 1(st) ILBT (p = 0.000), 2(nd) ILBT (p = 0.000), and at 3 months after EBRT compared to ILBT (p = 0.02). Overall 47% had improvement in dysphagia scores and 35% maintained the improvement of scores till last follow up. There was significant improvement in weight after completion of ILBT (p = 0.001) and at 3 months after completion of EBRT (p = 0.00). Twenty nine (39%) patients required nasogastric (NGT) insertions and 12 (16%) needed hospitalization for supportive care. 36.4% had complications in the form of stricture (27%), fistula (5.4%), and bleeding (4%).

Conclusions: Palliative radiotherapy is an effective alternative for palliation of dysphagia with improvement in symptom scores being evident and sustained. The results of this clinical audit were comparable with those from the trial setting.

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References

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M . Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014; 136(5):E359-86. DOI: 10.1002/ijc.29210. View

Besharat S, Jabbari A, Semnani S, Keshtkar A, Marjani J . Inoperable esophageal cancer and outcome of palliative care. World J Gastroenterol. 2008; 14(23):3725-8. PMC: 2719235. DOI: 10.3748/wjg.14.3725. View

Harvey J, Bessell J, Beller E, Thomas J, Gotley D, Burmeister B . Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia. Dis Esophagus. 2004; 17(3):260-5. DOI: 10.1111/j.1442-2050.2004.00420.x. View

Amdal C, Jacobsen A, Sandstad B, Warloe T, Bjordal K . Palliative brachytherapy with or without primary stent placement in patients with oesophageal cancer, a randomised phase III trial. Radiother Oncol. 2013; 107(3):428-33. DOI: 10.1016/j.radonc.2013.04.008. View

Aoki T, Osaka Y, Takagi Y, Okada R, Shinohara M, Tsuchida A . Comparative study of self-expandable metallic stent and bypass surgery for inoperable esophageal cancer. Dis Esophagus. 2002; 14(3-4):208-11. DOI: 10.1046/j.1442-2050.2001.00186.x. View

Sharma V, Mahantshetty U, Dinshaw K, Deshpande R, Sharma S . Palliation of advanced/recurrent esophageal carcinoma with high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2002; 52(2):310-5. DOI: 10.1016/s0360-3016(01)01822-3. View

Ilson D . Esophageal cancer chemotherapy: recent advances. Gastrointest Cancer Res. 2009; 2(2):85-92. PMC: 2630822. View

Konigsrainer A, Riedmann B, De Vries A, Ofner D, Spechtenhauser B, Aigner F . Expandable metal stents versus laser combined with radiotherapy for palliation of unresectable esophageal cancer: a prospective randomized trial. Hepatogastroenterology. 2000; 47(33):724-7. View

El-Rayes B, Shields A, Zalupski M, Heilbrun L, Jain V, Terry D . A phase II study of carboplatin and paclitaxel in esophageal cancer. Ann Oncol. 2004; 15(6):960-5. DOI: 10.1093/annonc/mdh230. View

10.

Rosenblatt E, Jones G, Sur R, Donde B, Salvajoli J, Ghosh-Laskar S . Adding external beam to intra-luminal brachytherapy improves palliation in obstructive squamous cell oesophageal cancer: a prospective multi-centre randomized trial of the International Atomic Energy Agency. Radiother Oncol. 2010; 97(3):488-94. DOI: 10.1016/j.radonc.2010.09.001. View

11.

Javle M, Ailawadhi S, Yang G, Nwogu C, Schiff M, Nava H . Palliation of malignant dysphagia in esophageal cancer: a literature-based review. J Support Oncol. 2006; 4(8):365-73, 379. View

12.

Lindenmann J, Matzi V, Neuboeck N, Anegg U, Baumgartner E, Maier A . Individualized, multimodal palliative treatment of inoperable esophageal cancer: clinical impact of photodynamic therapy resulting in prolonged survival. Lasers Surg Med. 2012; 44(3):189-98. DOI: 10.1002/lsm.22006. View

13.

Grunberger B, Raderer M, Schmidinger M, Hejna M . Palliative chemotherapy for recurrent and metastatic esophageal cancer. Anticancer Res. 2007; 27(4C):2705-14. View

14.

Lettmaier S, Strnad V . Intraluminal brachytherapy in oesophageal cancer: defining its role and introducing the technique. J Contemp Brachytherapy. 2014; 6(2):236-41. PMC: 4105652. DOI: 10.5114/jcb.2014.43780. View

15.

Murray L, Din O, Kumar V, Dixon L, Wadsley J . Palliative radiotherapy in patients with esophageal carcinoma: A retrospective review. Pract Radiat Oncol. 2014; 2(4):257-264. DOI: 10.1016/j.prro.2011.12.002. View

16.

Eroglu A, Turkyilmaz A, Subasi M, Karaoglanoglu N . The use of self-expandable metallic stents for palliative treatment of inoperable esophageal cancer. Dis Esophagus. 2009; 23(1):64-70. DOI: 10.1111/j.1442-2050.2009.00978.x. View

17.

Rustgi A, El-Serag H . Esophageal carcinoma. N Engl J Med. 2014; 371(26):2499-509. DOI: 10.1056/NEJMra1314530. View

18.

Sur R, Donde B, Levin V, Mannell A . Fractionated high dose rate intraluminal brachytherapy in palliation of advanced esophageal cancer. Int J Radiat Oncol Biol Phys. 1998; 40(2):447-53. DOI: 10.1016/s0360-3016(97)00710-4. View

19.

Hanna W, Sudarshan M, Roberge D, David M, Waschke K, Mayrand S . What is the optimal management of dysphagia in metastatic esophageal cancer?. Curr Oncol. 2012; 19(2):e60-6. PMC: 3320233. DOI: 10.3747/co.19.892. View

20.

Sur R, Donde B, Falkson C, Ahmed S, Levin V, Nag S . Randomized prospective study comparing high-dose-rate intraluminal brachytherapy (HDRILBT) alone with HDRILBT and external beam radiotherapy in the palliation of advanced esophageal cancer. Brachytherapy. 2004; 3(4):191-5. DOI: 10.1016/j.brachy.2004.09.004. View