Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia.
Between 1993 and 2001, 106 patients with esophageal cancer were reviewed at a multidisciplinary clinic and treated with palliative intent by chemoradiation therapy. This study assesses the palliative benefit on dysphagia and documents the toxicity of this treatment. The study population comprised 72 men and 34 women with a median age of 69 years. Patients were treated with a median radiation dose of 35 Gy in 15 fractions with a concurrent single course of 5 FU-based chemotherapy. Dysphagia was measured at the beginning and completion of treatment and at monthly intervals until death, using a modified DeMeester (4-point) score. Treatment was well tolerated, with only 5% of patients failing to complete therapy. The treatment-related mortality was 6%. The median survival for the study population was 7 months. The median baseline score at presentation was 2 (difficulty with soft food). Following treatment, 49% of patients were assessed as having a dysphagia score of 0 (no dysphagia). Seventy-eight per cent had an improvement of at least one grade in their dysphagia score after treatment. Only 14% of patients showed no improvement with treatment. Fifty-one per cent maintained improved swallowing until the time of last follow-up or death. This single-institution study shows that chemoradiation therapy administered for the palliation of malignant dysphagia is well tolerated and produces a sustainable normalization in swallowing for almost half of all patients.
Harvey
J A
JA
Combined Upper Gastrointestinal Oncology Clinic, Princess Alexandra Hospital, Woolloongabba, Australia. J.Harvey@mailbox.uq.edu.au
Bessell
J R
JR
Beller
E
E
Thomas
J
J
Gotley
D C
DC
Burmeister
B H
BH
Walpole
E T
ET
Thomson
D B
DB
Martin
I
I
Doyle
L
L
Burmeister
E
E
Smithers
B M
BM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000145:classification / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D011829:Radiation Dosage; D018714:Radiotherapy, Adjuvant; D015607:Stents; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil