title: A non-randomized comparison of two radiotherapy protocols in inoperable squamous cell carcinoma of the oesophagus.
abstract: We report an audit of two different telebrachytherapy schedules in inoperable carcinoma of the oesophagus. Between October 1990 and December 1996, 108 patients with a Karnofsky performance status > or = 50 were selected from our database on the basis of intention to treat by telebrachytherapy. Teletherapy in the low dose group L (55 patients) consisted of 35 Gy in 15 fractions over 3 weeks, while that in the high dose group H (53 patients) consisted of 50 Gy in 25 fractions over 5 weeks. The choice of teletherapy dose was based on physician preference. The high dose rate intraluminal radiotherapy that followed 2 weeks later was identical in both groups and consisted of two applications of 6 Gy, a week apart. The pretreatment disease characteristics of the patients in both arms were similar. Relief of dysphagia was obtained in 49% of the patients in group L and in 75% of those in group H (chi2: P = 0.004). The median dysphagia-free interval was 0 and 7 months in groups L and H respectively (log-rank: P = 0.06), while the median overall survival was identical at 8 months (log-rank: P = 0.21) for both groups. The probability of survival at 1, 2 and 5 years was 34.8% versus 35.8%, 14.5% versus 13.9% and 0% versus 10% for groups L and H respectively. Morbidity in the form of ulcers, strictures and fistulae were observed in 9%, 7% and 5% of patients in group L compared with 8%, 8% and 13% in groups H respectively. This audit suggests that the protocol used in group H, when compared with group L, results in a greater proportion of patients being rendered dysphagia free, with a statistical trend towards a greater sustainment of dysphagia relief on follow-up.
authors.affiliation: Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: N R
authors.initials: NR
authors.lastname: Datta
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Nangia
authors.forename: S
authors.initials: S
authors.lastname: Hukku
authors.forename: S
authors.initials: S
authors.lastname: Ayyagari
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D003680:Deglutition Disorders / Q000532:radiotherapy; D004307:Dose-Response Relationship, Radiation; D004938:Esophageal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010166:Palliative Care; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome