Patient-reported outcomes after external beam radiotherapy versus brachytherapy for palliation of dysphagia in esophageal cancer: A matched comparison of two prospective trials. (February 2021)

• Record Type: Journal Article
• Authors: van Rossum, Peter S.N.; Jeene, Paul M.; Rozema, Tom; Braam, Pètra M.; Lips, Irene M.; Muller, Karin; van Kampen, Daphne; Vermeulen, Bram D.; Homs, Marjolein Y.V.; Oppedijk, Vera; Berbée, Maaike; Hulshof, Maarten C.C.M.; Siersema, Peter D.; El Sharouni, Sherif Y.
• Is Part Of: Radiotherapy and oncology. Volume 155(2021)
• Page Start: 73
• Page End: 79
• Publication Date: 2021-02
• Subjects: Esophageal cancer -- Palliation -- Dysphagia -- Brachytherapy -- EBRT -- Quality of life -- Patient-reported outcomes; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2020.10.009
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Brachytherapy is an underused standard treatment for malignant dysphagia. Short course external beam radiotherapy (EBRT) is an understudied alternative. A previous matched comparison showed at least similar dysphagia relief after EBRT. Effects on patient-reported outcomes appear mostly similar or favoring EBRT. The findings support EBRT and its inclusion in clinical practice guidelines. Abstract: Background and purpose: A matched comparison of external beam radiotherapy (EBRT) versus brachytherapy recently demonstrated that EBRT appears at least as effective for palliating dysphagia in patients with incurable esophageal cancer. The aim of this analysis was to compare patient-reported outcomes (PROs) after EBRT versus brachytherapy. Materials and methods: In a multicenter prospective cohort study, patients with incurable esophageal cancer requiring palliation of dysphagia were included to undergo EBRT (20 Gy in 5 fractions). This EBRT cohort was compared to the single-dose 12 Gy brachytherapy cohort of the previously reported SIREC-trial. Propensity score matching was applied to adjust for baseline imbalances. The primary endpoint of dysphagia improvement was reported previously. PROs were secondary outcomes and assessed at baseline and 3 months after treatment using EORTC QLQ-C30 and QLQ-OES18 questionnaires. Results: A total of 115 enrolled EBRT patients and 93 brachytherapy patients were eligible. After matching, 69 well-balanced pairs remained. At follow-up, significant deteriorations in functioning (i.e. physical, role, social), pain, appetite loss, and trouble with taste were observed after brachytherapy. In the EBRT group, such deterioration was observed only for role functioning, while significant improvements in trouble with eating and pain were found. Between-group comparison showed mostly comparable PRO changes, but significantly favored EBRT with regard to nausea, vomiting, pain, and appetite loss. Conclusion: Short course EBRT results in similar or better PROs at 3 months after treatment compared to single-dose brachytherapy for the palliation of malignant dysphagia. These findings further support its use and inclusion in clinical practice guidelines.