Palliation of advanced/metastatic carcinoma esophagus with radiotherapy

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
R. K. Spartacus, Rajan Paliwal, Pradeep Gaur.
Background: Esophageal carcinoma carries an overall poor prognosis. Most patients present with lo¬cally advanced, unresectable or metastatic disease. The main objective in advanced disease is the palliation of dysphagia. Treatment options include surgery (bypass, resection), laser, stent placement, external beam radiotherapy (EBRT), brachytherapy and systemic chemotherapy. We have focused on our experience with EBRT followed by brachytherapy. Methods: From January 2013 to December 2014, 29 patients of advanced/metastatic esophageal cancer were treated by HDR Brachytherapy following EBRT. All patients received 2# of 5Gy HDR brachytherapy. EBRT was 40Gy/20# (18 patients) and 36Gy/12# (11 patients). Disease remission and relief of dysphagia along with toxicity assessment were carried out at 1, 3 and 6 months after completion of treatment. Results: Evaluation at 1 month after brachytherapy showed complete remission (CR) of the disease in 6 patients, partial remission (PR) in 17 patients and no remission (NR) in 6. Overall improvement in swallowing status was seen in 22(75.86%) patients. 7 patients showed no improvement and 1 reported worsening of dysphagia score at 1 month after ILRT. The improvement in swallowing was maintained by 55.17% of patients at 6 months. Strictures had developed in 5 patients, ulceration in 3 patients and fistula in 1. Conclusions: A combination of EBRT and HDR brachytherapy affords effective palliation in advanced esophageal cancer with acceptable toxicity.


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