Vol 27, No 1 (2022)
Research paper
Published online: 2021-12-10

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Palliative radiotherapy and quality of life in patients with locally advanced thoracic esophageal cancer: a single centre experience from Central India

Kamal Bandhate1, Ashok Diwan1
Rep Pract Oncol Radiother 2022;27(1):104-112.

Abstract

Background: Patients with locally advanced esophageal squamous cell carcinoma (LAESCC) have decreased quality of life (QoL) and, thus, require palliative external beam radiotherapy (EBRT). The present study was performed to evaluate the QoL in patients with LAESCC undergoing palliative EBRT.

Materials and methods: This was a prospective, observational study performed over a period of 18 months (from December 2018 to May 2020) in the Department of Radiation Oncology. Seventy patients with LAESCC received EBRT (30 Gy in 10 fractions, at 3 Gy per fraction over 2 weeks). Patients were followed-up at monthly intervals for 3 months. The dysphagia and odynophagia scores were calculated at baseline and follow-up visits. The QoL was assessed with 18-item EORTC QLQ-OES questionnaire at baseline and 3 months.

Results: Over the study period, significant decrease in mean dysphagia and odynophagia score was observed (p-value < 0.0001). On post-hoc analysis, significant decrease in both dysphagia and odynophagia score was observed between baseline and at the end of study and between various follow-up visits (p-value < 0.0001). Moreover, there was a significant increase in mean body weight (p-value < 0.0001). At 3 months, there was a significant decrease in dysphagia (p-value < 0.0001), eating (p-value < 0.0001), reflux (p-value = 0.005), pain (p-value < 0.0001), and saliva (p-value = 0.01) domains of EORTC QLQ-OES18 questionnaire.

Conclusion: In patients with LAESCC, EBRT leads to significant decrease in dysphagia and odynophagia, and increase in body weight. These changes indirectly lead to improved QoL.

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References

  1. Esophageal cancer: epidemiology, pathogenesis and prevention. Nat Clin Pract Gastroenterol Hepatol. 2008; 5(9): 517–526.
  2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  3. GBD 2017 Oesophageal Cancer Collaborators. The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020; 5(6): 582–597.
  4. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013. http://www.globocan.iarc.fr (2017 Apr 24).
  5. Choksi D, Kolhe KM, Ingle M, et al. Esophageal carcinoma: An epidemiological analysis and study of the time trends over the last 20 years from a single center in India. J Family Med Prim Care. 2020; 9(3): 1695–1699.
  6. Arnold M, Laversanne M, Brown LM, et al. Predicting the Future Burden of Esophageal Cancer by Histological Subtype: International Trends in Incidence up to 2030. Am J Gastroenterol. 2017; 112(8): 1247–1255.
  7. Cherian JV, Sivaraman R, Muthusamy AK, et al. Carcinoma of the esophagus in Tamil Nadu (South India): 16-year trends from a tertiary center. J Gastrointestin Liver Dis. 2007; 16: 245–249.
  8. Short MW, Burgers KG, Fry VT. Esophageal Cancer. Am Fam Physician. 2017; 95(1): 22–28.
  9. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65(2): 87–108.
  10. Dai Y, Li C, Xie Y, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev. 2014(10): CD005048.
  11. Sreedharan A, Harris K, Crellin A, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev. 2009(4): CD005048.
  12. Ramakrishnaiah VP, Malage S, Sreenath GS, et al. Palliation of Dysphagia in Carcinoma Esophagus. Clin Med Insights Gastroenterol. 2016; 9: 11–23.
  13. Prasad NR, Karthigeyan M, Vikram K, et al. Palliative radiotherapy in esophageal cancer. Indian J Surg. 2015; 77(1): 34–38.
  14. Welsch J, Kup PG, Nieder C, et al. Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer. J Cancer. 2016; 7(2): 125–130.
  15. Jeene PM, Vermeulen BD, Rozema T, et al. POLDER Study Group. Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials. J Thorac Oncol. 2020; 15(8): 1361–1368.
  16. van Rossum PSN, Jeene PM, Rozema T, et al. Patient-reported outcomes after external beam radiotherapy versus brachytherapy for palliation of dysphagia in esophageal cancer: A matched comparison of two prospective trials. Radiother Oncol. 2021; 155: 73–79.
  17. Dysphagia Score. http://www.mactheknife.org/Scoring_systems/Dysphagia (22nd January 2021).
  18. Visual Analogue Scale. https://assessmentmodule.yale.edu/im-palliative/visual-analogue-scale (22nd January 2021).
  19. Blazeby JM, Conroy T, Hammerlid E, et al. European Organisation for Research and Treatement of Cancer Gastrointestinal and Quality of Life Groups. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer. 2003; 39(10): 1384–1394.
  20. Indian Council of Medical Research. Consensus Document for Management of Esophageal Cancer 2017. https://main.icmr.nic.in/sites/default/files/guidelines/Esophagus%20final%20IC MR2014_0.pdf (22nd January 2021).
  21. Javle M, Ailawadhi S, Yang GY, et al. Palliation of malignant dysphagia in esophageal cancer: a literature-based review. J Support Oncol. 2006; 4(8): 365–73, 379.
  22. Murray LJ, Din OS, Kumar VS, et al. Palliative radiotherapy in patients with esophageal carcinoma: A retrospective review. Pract Radiat Oncol. 2012; 2(4): 257–264.
  23. Suzuki G, Yamazaki H, Aibe N, et al. Palliative Radiotherapy in the Local Management of Stage IVB Esophageal Cancer: Factors Affecting Swallowing and Survival. Anticancer Res. 2017; 37(6): 3085–3092.
  24. al-Sarraf M, Martz K, Herskovic A, et al. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol. 1997; 15(1): 277–284.
  25. Smith T, Ryan L, Douglass H, et al. Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys. 1998; 42(2): 269–276.
  26. Herskovic A, Martz K, al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992; 326(24): 1593–1598.
  27. Penniment MG, De Ieso PB, Harvey JA, et al. TROG 03.01/CCTG ES.2 group. Palliative chemoradiotherapy versus radiotherapy alone for dysphagia in advanced oesophageal cancer: a multicentre randomised controlled trial (TROG 03.01). Lancet Gastroenterol Hepatol. 2018; 3(2): 114–124.
  28. Walterbos NR, Fiocco M, Neelis KJ, et al. Effectiveness of several external beam radiotherapy schedules for palliation of esophageal cancer. Clin Transl Radiat Oncol. 2019; 17: 24–31.
  29. Hanna WC, Sudarshan M, Roberge D, et al. What is the optimal management of dysphagia in metastatic esophageal cancer? Curr Oncol. 2012; 19(2): e60–e66.
  30. Fleischman EH, Kagan AR, Bellotti JE, et al. Effective palliation for inoperable esophageal cancer using intensive intracavitary radiation. J Surg Oncol. 1990; 44(4): 234–237.
  31. Wang J, Liu F, Gao H, et al. The symptom-to-treatment delay and stage at the time of treatment in cancer of esophagus. Jpn J Clin Oncol. 2008; 38(2): 87–91.
  32. Cavallin F, Scarpa M, Cagol M, et al. Time to diagnosis in esophageal cancer: a cohort study. Acta Oncol. 2018; 57(9): 1179–1184.
  33. Grotenhuis BA, van Hagen P, Wijnhoven BPL, et al. Delay in diagnostic workup and treatment of esophageal cancer. J Gastrointest Surg. 2010; 14(3): 476–483.
  34. Rothwell JF, Feehan E, Reid I, et al. Delay in treatment for oesophageal cancer. Br J Surg. 1997; 84(5): 690–693.



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