Abstract
Background: In patients with advanced oesophageal carcinoma, palliation of dysphagia is important to maintain a reasonable quality of life.Aim: To determine the dysphagia progression-free survival (DPFS) in patients with advanced oesophageal carcinoma treated with palliative radiotherapy (RT).Setting: Groote Schuur Hospital, Cape Town, between January 2015 and December 2016.Methods: The medical records of all patients with oesophageal carcinoma were reviewed, and patients who were not candidates for curative treatment and received palliative RT were selected. For these patients, the dysphagia score (DS) was recorded prior to RT, six weeks after RT and at each follow-up visit. The DPFS was calculated as the time from completion of RT to worsening of DS by ≥ 1 point or until death. Other outcomes measured were objective change in DS and survival post RT.Results: The study population comprised 84 patients. Squamous cell cancer was the primary histological subtype (93%). The median duration of DPFS after RT was 73 days, with approximately two-thirds of remaining patients able to swallow at least liquids and soft diet until death. The difference in median duration of DPFS was not statistically significant in stented versus non-stented patients (54 days vs 83 days, p = 0.224). The mean change in DS was 0.45 ± 0.89 points following RT and the post-RT survival was significantly shorter in patients with stent insertion (81 days vs 123 days, p = 0.042).Conclusion: Palliative RT can successfully be used to prolong DPFS in patients with locally advanced and metastatic squamous cell cancer of the oesophagus.
Highlights
In 2018, approximately 572 000 new cases of oesophageal cancer were diagnosed worldwide, and this was the seventh most common cancer diagnosed in South Africa.[1,2,3] Approximately 70% of cases in England, Scotland and Northern Ireland in 2014 were diagnosed at a late stage.[1]
One retrospective study conducted in South Africa by Dandara et al.[4] examining all patients presenting with oesophageal cancer over a 30-year period reported that 76% of patients presented with advanced disease and poor clinical condition requiring palliative care.[4]
A total of 84 patients presenting to the gastro-oesophageal carcinoma clinic between the period January 2015 and December 2016 met the inclusion criteria for the study
Summary
In 2018, approximately 572 000 new cases of oesophageal cancer were diagnosed worldwide, and this was the seventh most common cancer diagnosed in South Africa.[1,2,3] Approximately 70% of cases in England, Scotland and Northern Ireland in 2014 were diagnosed at a late stage.[1]. Dysphagia is documented as the most common presenting symptom, prompting patients with oesophageal cancer to seek medical care and has a substantial impact on quality of life which becomes more significant in advanced disease.[6,7] One large study conducted by the American College of Surgeons[8] reported dysphagia in 74% of the 5044 patients enrolled. Palliation of this symptom is crucial to maintain an acceptable quality of life in these patients.[9,10,11]. In patients with advanced oesophageal carcinoma, palliation of dysphagia is important to maintain a reasonable quality of life
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