Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia

Abstract

Between 1993 and 2001, 106 patients with esophageal cancer were reviewed at a multidisciplinary clinic and treated with palliative intent by chemoradiation therapy. This study assesses the palliative benefit on dysphagia and documents the toxicity of this treatment. The study population comprised 72 men and 34 women with a median age of 69 years. Patients were treated with a median radiation dose of 35 Gy in 15 fractions with a concurrent single course of 5 FU-based chemotherapy. Dysphagia was measured at the beginning and completion of treatment and at monthly intervals until death, using a modified DeMeester (4-point) score. Treatment was well tolerated, with only 5% of patients failing to complete therapy. The treatment-related mortality was 6%. The median survival for the study population was 7 months. The median baseline score at presentation was 2 (difficulty with soft food). Following treatment, 49% of patients were assessed as having a dysphagia score of 0 (no dysphagia). Seventy-eight per cent had an improvement of at least one grade in their dysphagia score after treatment. Only 14% of patients showed no improvement with treatment. Fifty-one per cent maintained improved swallowing until the time of last follow-up or death. This single-institution study shows that chemoradiation therapy administered for the palliation of malignant dysphagia is well tolerated and produces a sustainable normalization in swallowing for almost half of all patients.

Clinical benefit of palliative radiation therapy in advanced gastric cancer

“…Nevertheless, the finding that palliation lasted for the majority of the patient's remaining life in the current study is consistent with that in the study by Tey et al Two studies have highlighted the benefits of palliative chemoradiation on malignant dysphagia in patients with advanced esophageal cancer. Harvey et al prospectively evaluated a cohort of 106 patients [11] offered palliative chemoradiation due to locally advanced or metastatic esophageal cancer, advanced age, or co-morbidity. Patients were scored based on their degree of dysphagia before and monthly after treatment, and evaluated for toxicity during and after therapy.…”

Upper Gastrointestinal Bleeding in Oncological Patients

“…External beam radiation therapy plays a well-defined role in the control of bleeding in patients with localized but unresectable tumors [50][51][52][53][54][55]. Palliative doses ranging from 8 Gy per single fraction to 40 Gy in 16 fractions can control the bleeding in approximately 80% of all patients [55].…”

Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer

“…While such palliative treatment may confer a small survival advantage over best supportive care, it is primarily directed towards symptom relief (Middleton and Cunningham, 1995;Pyrhonen et al, 1995). This however may sometimes be at the expense of toxicity (Ross et al, 2002;Harvey et al, 2004) and therefore the appropriate selection of patients, most likely to benefit is of considerable importance.…”