MSS07 Presentation Time: 4:15 PM: National Trends in Palliative Esophageal Radiotherapy: External Beam Radiotherapy versus Brachytherapy

Abstract

<h3>Purpose</h3> In patients with incurable esophageal cancer, dysphagia secondary to an advanced primary is a common occurrence. Different palliative treatment options exist including stenting, laser therapy, and radiotherapy, both in the form of external beam radiotherapy (EBRT), as well as, intraluminal brachytherapy. The optimal palliative approach remains a matter of debate and often varies based on institutional preference. In regard to randomized data, the Dutch SIREC trial (reported in 2004) compared single fraction HDR brachytherapy to metal stent placement and found better long term dysphagia relief and quality-of-life associated with receipt of brachytherapy. Despite these results, practice patterns in the United States regarding palliative radiotherapy utilization for esophageal cancer remain poorly defined. To better characterize management approaches and associated clinicopathologic factors in the United States, we analyzed the national cancer database (NCDB). <h3>Materials/Methods</h3> We queried the NCDB for patients diagnosed with esophageal carcinoma receiving either brachytherapy or palliative doses of EBRT (30 Gy in 10 fractions or 20 Gy in 5 fractions). Patients were grouped according to year of treatment receipt (2004-2007; 2008-2011; 2012-2015). Multivariable logistic regression was performed to identify clinicopathologic variables associated with each treatment modality (Brachytherapy vs EBRT). <h3>Results</h3> Ultimately 140,238 patients with esophageal cancer were identified, of which 2,624 patients met inclusion criteria. Of the included patients, 8% (n=204) received brachytherapy versus 92% (n=2,420) received EBRT. Median age was 67 years old and 72% were male and 28% were female with the following T stage breakdown: T1/T2=17%, T3=30%, T4=15%, unknown T stage=38%. Node positive disease was documented in 38%, while 26% of patients were N0 and 36% had unknown nodal status. Of the 204 brachytherapy patients, 53% (n=109) received treatment from 2004-2007, 30% (n=60) received treatment from 2008-2011, and 17% (n=35) received treatment from 2012-2015. Comparatively, of the 2,420 EBRT patients, 25% (n=606) received treatment from 2004-2007, 29% (n=698) received treatment from 2008-2011, and 46% (n=1,116) received treatment from 2012-2015. Of these patients 13% (n=315) received 20Gy in 5 fractions whereas 87% (n=2,105) received 30 Gy in 10 fractions. When examining the receipt of treatment by year grouping: 2004-2007 (n=715) 15% received brachytherapy vs 84% received EBRT 2008-2011 (n=758) 8% received brachytherapy vs 92% received EBRT 2012-2015 (n=1,151)3% received brachytherapy vs 97% received EBRT On multivariable logistic regression, brachytherapy receipt was associated with greater distance to treatment facility, absence of nodal disease, non-metastatic disease, <cT4 disease, more recent treatment year, white race (p<0.05 for all). <h3>Conclusion</h3> Compared to palliative EBRT, brachytherapy utilization in the United States for palliative esophageal treatment has decreased significantly since 2004 and likely represents <5% of palliative radiation treatments nationwide.