Palliative radiotherapy and chemoradiotherapy in stage IVA/B esophageal cancer patients with dysphagia

BackgroundPalliative therapeutic strategies in esophageal squamous cell carcinoma (ESCC) patients with dysphagia remain controversial. Only few studies have assessed therapeutic effect factors related to improvement in dysphagia score and nutrition-support-free survival (NSFS).ObjectiveThe present study assessed the efficacy and therapeutic effect factors related to the use of palliative radiotherapy (RT) and chemoradiotherapy (CRT) in ESCC patients with dysphagia.MethodsWe retrospectively evaluated 70 patients with stage IVA/B ESCC. Patients received RT of 30Gy in 10 fractions or concurrent CRT using 5-fluorouracil plus cisplatin of 40Gy in 20 fractions. The change in the dysphagia score from before to after treatment was assessed, and NSFS was evaluated.ResultsThe median follow-up duration was 6 months (range 1-41 months). The overall rate of improvement in the dysphagia score was 60%. The median NSFS was 7.5 months. Craniocaudal tumor length<6cm, tumor circumference<3/4, and CRT of 40Gy in 20 fractions were associated with a significant improvement in the dysphagia score (p=0.0036, p=0.0069, and p=0.03, respectively). NSFS was significantly longer with CRT than with RT (p=0.048).ConclusionPalliative RT and CRT are effective treatment options for ESCC patients with dysphagia. Craniocaudal tumor length<6cm, tumor circumference<3/4, and CRT of 40Gy in 20 fractions may improve dysphagia. CRT of 40Gy in 20 fractions may improve NSFS.