| Popis: |
The prognosis of esophageal cancer remains poor with a five year overall survival (OS) of 22%. Medically inoperable patients or patients with irresectable tumors can be treated with definitive chemoradiation (dCRT) to improve locoregional control and overall survival. For various subgroups of patients the efficacy of dCRT is not clear. In this thesis, we investigated the efficacy of definitive chemoradiation in specific subgroups of patients with esophageal cancer. We found that in esophageal cancer, an involved supraclavicular lymph node did not affect survival in patients treated with dCRT. For patients with a locoregional lymph node recurrence, dCRT is an effective salvage treatment, but for patients with a recurrence at the anastomosis, results after salvage dCRT were poor. In patients with small cell carcinoma of the esophagus treated with dCRT, recurrences occur frequently at distant sites and usually within 1 year after treatment, while brain metastases occurred rarely. We further investigated the effectiveness of short-course External Beam Radiotherapy (EBRT) in the palliation of dysphagia in esophageal cancer and compared results to treatment with single dose brachytherapy. Short-course EBRT appears at least as effective as brachytherapy in the palliation of dysphagia. Dysphagia improved more often and more rapidly after EBRT than after brachytherapy. Toxicity after EBRT is less than after brachytherapy, there are clear advantages in logistics for EBRT and Quality of Life 3 months after treatment are similar or better for EBRT. We recommend inclusion of short course EBRT in clinical practice guidelines. |
