Low dose versus high dose radiotherapy for the palliation of dysphagia from esophageal cancer: a multicenter retrospective cohort study
Menée aux Pays-Bas auprès de 292 patients atteints d'un cancer de l'œsophage inopérable ou de stade métastatique, cette étude de cohorte rétrospective évalue l'efficacité, du point de vue du soulagement à 6 semaines d'une dysphagie, d'une radiothérapie à visée palliative, à faibles ou hautes doses de rayonnements
Background and purpose : Clinical evidence regarding optimal radiation dose for palliation of dysphagia from esophageal cancer is generally lacking. In an effort to investigate optimal radiation dose, we assessed two different radiation schedules for palliation of dysphagia. Materials and methods : We performed a multicenter, retrospective study comparing low dose radiotherapy (LR: 5x4Gy external beam radiotherapy [EBRT]) with high dose radiotherapy (HR: 10x3Gy EBRT and 12Gy single-dose intra-luminal brachytherapy) for palliation of dysphagia in patients with inoperable or metastasized esophageal cancer. Primary outcome was improvement of dysphagia at 6 weeks after start of radiotherapy. Additional outcomes were persistent/recurrent dysphagia during patients’ remaining life, severe adverse events (SAE) and survival. Results : In total, 292 patients (LR, n=117; HR, n=175) were included in this study. After matching, 144 patients (72 in each group) were compared. Improvement of dysphagia at 6 weeks was achieved in 50% of patients after LR and in 66% after HR (p=0.071). Persistent/recurrent dysphagia occurred in 64% of patients after LR and in 42% after HR (p=0.012). No difference in SAE rate was found (p=0.889). Median survival was 88 days (95%CI 64–112) after LR and 177 days (95%CI 131–223) after HR (p<0.001). Conclusion : This study shows that both LR and HR were well tolerated and effective in short-term relief of dysphagia in patients with inoperable or metastasized esophageal cancer. HR was associated with better long-term relief of dysphagia when compared with LR. Our findings suggest that HR could be considered for patients with a longer life-expectancy but prospective studies are required.