title: Randomized prospective study comparing high-dose-rate intraluminal brachytherapy (HDRILBT) alone with HDRILBT and external beam radiotherapy in the palliation of advanced esophageal cancer.
abstract: OBJECTIVE
  HDRILBT is one of the best methods of palliation for advanced esophageal cancer (AEC) by improving dysphagia-free survival (DFS) and overall survival (OS). This study examines if the addition of EBRT would further improve the outcome by improving DFS in AEC.
  
  
  METHODS
  Patients with inoperable AEC were entered into a randomized prospective study. HDRILBT of 16 Gy/2 fractions/3 days was given initially to all patients. Following treatment, patients were randomized to receive no further treatment (Group A) or additional EBRT of 30 Gy/10 fractions/2 weeks (Group B) and were followed for 1 year. Statistical analysis of the data was done using the SAS statistical software package (SAS Institute, Cary, NC). Prognostic variables were analyzed using the chi(2) and log-rank tests and survival curves were drawn using the Kaplan-Meier method. Multivariate survival analysis was done using the Cox proportional hazards model.
  
  
  RESULTS
  Sixty patients were entered into the study. Patient and tumor characteristics were comparable among the groups. Of 30 patients in Group B, 2 refused additional EBRT (no dysphagia). At 6 months, >50% had DFS in both groups and this was comparable. There was no difference statistically (p >0.05) in the DFS and OS between the two groups at the end of 12 months. Median survival for Group A was 7.23 months and 7.5 months for Group B. Additional EBRT did not improve DFS or OS. Eleven patients developed strictures related to radiotherapy and were dilated successfully (Group A, 7; Group B, 4; p >0.05). Four patients had progressive luminal disease which progressed to fistula (Group A, 3; Group B, 1; p >0.05). There was no effect of any patient or treatment parameter on DFS. Presenting weight and ECOG score had an impact on OS.
  
  
  CONCLUSIONS
  From the preliminary analysis, additional EBRT to HDRILBT does not improve DFS or outcomes in inoperable AEC.
authors.affiliation: Radiation Oncology Division, Department of Medicine, McMaster University, Hamilton, Ontario L8V 5C2, Canada. ranjan.sur@hrcc.on.ca
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sur
authors.forename: Bernard
authors.initials: B
authors.lastname: Donde
authors.forename: Conrad
authors.initials: C
authors.lastname: Falkson
authors.forename: Sheikh Nisar
authors.initials: SN
authors.lastname: Ahmed
authors.forename: Victor
authors.initials: V
authors.lastname: Levin
authors.forename: Subir
authors.initials: S
authors.lastname: Nag
authors.forename: Raimond
authors.initials: R
authors.lastname: Wong
authors.forename: Glenn
authors.initials: G
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D003680:Deglutition Disorders / Q000209:etiology / Q000532:radiotherapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010166:Palliative Care; D010865:Pilot Projects; D011446:Prospective Studies; D011882:Radiotherapy, High-Energy; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed