Effectiveness of several external beam radiotherapy schedules for palliation of esophageal cancer.

Autor:	Walterbos NR; Department of Radiation Oncology, Leiden University Medical Center, Postzone K0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands., Fiocco M; Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Postzone S5-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands.; Mathematical Institute, Leiden University, P.O. Box 9512, 2300 RA Leiden, The Netherlands., Neelis KJ; Department of Radiation Oncology, Leiden University Medical Center, Postzone K0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands., van der Linden YM; Department of Radiation Oncology, Leiden University Medical Center, Postzone K0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands.; Center of Expertise Palliative Care, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands., Langers AMJ; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Postzone C4-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands., Slingerland M; Department of Medical Oncology, Leiden University Medical Center, Postzone B3-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands., de Steur WO; Department of Surgery, Leiden University Medical Center, Postzone K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands., Peters FP; Department of Radiation Oncology, Leiden University Medical Center, Postzone K0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands., Lips IM; Department of Radiation Oncology, Leiden University Medical Center, Postzone K0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Jazyk:	angličtina
Zdroj:	Clinical and translational radiation oncology [Clin Transl Radiat Oncol] 2019 Apr 24; Vol. 17, pp. 24-31. Date of Electronic Publication: 2019 Apr 24 (Print Publication: 2019).
DOI:	10.1016/j.ctro.2019.04.017
Abstrakt:	Background and Purpose: Although external beam radiotherapy (EBRT) is frequently used for palliative treatment of patients with incurable esophageal cancer, the optimal schedule for symptom control is unknown. This retrospective study evaluated three EBRT schedules for symptom control and investigated possible prognostic factors associated with second intervention and overall survival (OS). Material and Methods: Patients with esophageal cancer treated with EBRT with palliative intent between January 2009 and December 2015 were evaluated. Univariate and multivariate Cox regression models estimated the effect of treatment schedule (20 Gy in 5 fractions, 30 Gy in 10 fractions or 39 Gy in 13 fractions) on OS. To study the effect of prognostic factors on time to second intervention (repeat EBRT, intraluminal brachytherapy or stent placement) a competing risk model with death as competing event was used. Results: 205 patients received 20 Gy (31%), 30 Gy (38%) or 39 Gy (32%). Improvement of symptoms was observed in 72% with no differences between schedules. Median OS after 20 Gy, 30 Gy and 39 Gy was 4.6 months (95%CI 2.6-6.6), 5.2 months (95%CI 3.7-6.7) and 9.7 months (95%CI 6.9-12.5), respectively. Poor performance status (HR 2.25 (95%CI 1.53-3.29)), recurrent esophageal cancer (HR 1.69 (95%CI 1.15-2.47)) and distant metastasis (HR 1.73 (95%CI 1.27-2.35)) were significantly related to worse OS. Treatment with 30 Gy and 39 Gy was related to longer time to second intervention compared to 20 Gy (adjusted cause specific HR 0.50 (95%CI 0.25-0.99) and 0.27 (95%CI 0.13-0.56), respectively). Conclusions: Palliative EBRT provides good symptom control in patients with symptomatic esophageal cancer. A higher dose schedule was related to a longer time to second intervention. Hence, selection based on life expectancy is vital to prevent unnecessary long treatment schedules in patients with expected short survival, and limit the chance of second intervention when life expectancy is longer.
Databáze:	MEDLINE
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