Palliation of Dysphagia in Locally Advanced Carcinoma Esophagus- Exploration of Two Different Radiotherapy Schedules

Abstract

Esophageal cancer is the seventh most common cancer constituting 3.2% of all cancer cases and sixth most common cause of mortality constituting 5.3% cases worldwide in 2018. Most common presenting symptom is dysphagia which is seen in 80–90% of patients. Most patients present in locally advanced stage and because of extensive local disease palliative radiotherapy plays a significant role. Aim and objectivesAim of the study was to compare two palliative radiotherapy schedules- 30 Gy in 10 fractions over 2- weeks versus 20 Gy in 5 fractions over 1-week in locally advanced carcinoma esophagus. Objectives were to compare above schedules based upon symptomatic relief and tolerability by the patient. Material and methodsThe study was a randomized control study done from July 2017 - December 2018 on 60 previously untreated, histo-pathologically proven patients of squamous cell carcinoma esophagus (locally advanced) reporting in the Department of Radiation oncology, Pandit B. D. Sharma PGIMS, Rohtak, where palliative radiotherapy was indicated as the treatment. Patients were divided into two groups of 30 patients each; Study group received- 30 Gy in 10 fractions over 2-weeks and Control group received 20 Gy in 5 fractions over 1- week. The symptomatic relief was assessed according to dysphagia score at 1- month after completion of radiation treatment. A reduction of at least 1 point in dysphagia score was depicted as improvement of dysphagia. Observations and resultDysphagia was the most common presenting symptom seen in all the patients followed by chest pain and weight loss. 80% patients in study group and 76.6% patients in control group showed improvement in dysphagia. 25% patients in study group and 43.4% in control group developed recurrent dysphagia. The mean duration of development of recurrent dysphagia in study group was 2.5 months and 5.6 months in control group. It was concluded that both the radiotherapy schedules were comparable in providing symptomatic relief; both radiotherapy schedules were tolerable by the patients.