Use of early radiation therapy in the palliative local treatment of stage IV esophageal cancer.

Abstract

198 Background: Palliating local symptoms in stage IV esophageal cancer remains a challenge with no clear optimal initial intervention. Therapeutic options include radiation therapy (RT), chemotherapy (chemo), stent, or a combination of these treatments. We hypothesized that early initial RT would result in the best palliation of local symptoms in stage IV esophageal cancer patients. Methods: The study cohort included 72 patients with locally symptomatic stage IV esophageal cancer treated at the University of Pennsylvania from 2006-2012 and was split into those who received RT as part of their initial treatment (n = 42) versus those who did not (n=30; chemo alone, n = 18; chemo and stent, n = 9; stent alone, n=3). Demographics, baseline disease characteristics, treatment details, and clinical outcomes were analyzed. Results: Patient demographics and baseline characteristics were well balanced between the groups, except the RT group was less likely to have liver metastases (p=0.001). The RT group included both concurrent chemoRT (n=31) and RT alone (n=11, with or without sequential chemo). Median RT dose was 50.4 Gy (range 21 – 70 Gy). Chemotherapy regimens included 5-FU based or Carboplatin/Paclitaxel. Presenting symptoms included dysphagia (n=69, median grade 2), odynophagia (n=3, median grade 1), bleeding (n=5, median grade 3), and chest pain (n=3, median grade 2). No difference was noted in symptom improvement (median grade improvement = 1; p=0.25) or ECOG status (median improvement = 0; p=0.24) between the groups. However, patients who received upfront RT were less likely to have local symptom progression (% not having symptom progression: 69.1% [RT] v 43.3% [no RT]; p=0.003) and less likely to need repeat local intervention (% not requiring repeat local intervention: 81.0% [RT] v 33.3% [no RT]; p<0.0001). There was no difference in median time to first progression (11 mo [RT] v 11 mo [no RT]) or median survival (9.8 mo [RT] v 10.7 mo [no RT]). Conclusions: Early use of RT in locally symptomatic stage IV esophageal cancer patients results in effective palliation of local symptoms that may be more sustained compared to chemo alone or stent placement.