Abstract
BackgroundCommon symptoms of oesophageal cancer are dysphagia, pain, and bleeding. These symptoms can be relieved with palliative radiotherapy. The aim of this study was to analyse the outcome of two different palliative radiotherapy schedules.MethodsWe conducted a retrospective cohort study on palliative radiotherapy for oesophageal cancer given at Karolinska University Hospital. Patients included were treated with either short-course (20 Gy in 4 Gy fractions daily, 5 consecutive workdays) or long-course (30–39 Gy in 3 Gy fractions, 10–13 consecutive workdays) palliative external beam radiotherapy between January 2009 and December 2013. The primary endpoint was dysphagia relief and secondary endpoints were adverse events, re-interventions, and overall survival. Cox regression analyses were used to estimate the effect of treatment schedule on survival.ResultsA total of 128 patients received external beam radiotherapy under the study period, of these 75 (58.6%) received short-course radiotherapy and 53 (41.4%) long-course radiotherapy. Sixteen (30.8%) patients experienced dysphagia relief after short-course radiotherapy and 9 (22.0%) patients after long-course radiotherapy (p = 0.341). Acute toxicity was less frequent after short-course radiotherapy than after long-course radiotherapy, particularly oesophagitis (35.4% vs. 56.0%, p = 0.027) and nausea/emesis (18.5% vs. 36.0% p = 0.034). Re-interventions tended to be more common after short-course radiotherapy (32.0%) than after long-course radiotherapy (18.9%) (p = 0.098). There was no difference in overall survival between the two groups.ConclusionsShort- and long-course palliative radiotherapy for oesophageal cancer were equally effective to relieve dysphagia and no difference was seen in overall survival. Acute toxicity was, however, more frequent and more severe after long-course radiotherapy. Our results suggest that short-course radiotherapy is better tolerated with equal palliative effects as long-course radiotherapy.
Highlights
Common symptoms of oesophageal cancer are dysphagia, pain, and bleeding
Radiotherapy alone for dysphagia relief is as effective as concomitant palliative radio- and chemotherapy, the latter comes at the cost of increased toxicity [11]
A tendency was seen towards older age, increased frequency of squamous cell carcinoma (SCC) and a lower T-stage in the Long-course radiotherapy (LR) group
Summary
Common symptoms of oesophageal cancer are dysphagia, pain, and bleeding. These symptoms can be relieved with palliative radiotherapy. The aim of this study was to analyse the outcome of two different palliative radiotherapy schedules. Radiotherapy alone for dysphagia relief is as effective as concomitant palliative radio- and chemotherapy, the latter comes at the cost of increased toxicity [11]. The aim of this study was to analyse the effectiveness of two different palliative EBRT schedules: short-course radiotherapy; 4 Gy daily given 5 workdays in a row (SR) and long-course radiotherapy; 3 Gy daily for 10—13 consecutive workdays (LR), at a single institution, Karolinska University Hospital, which serves the whole Stockholm county
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