Predictors of outcome of single-dose brachytherapy for the palliation of dysphagia from esophageal cancer.
BACKGROUND
Single-dose brachytherapy is a commonly used palliative treatment modality for esophageal carcinoma, however, a considerable number of patients need additional treatment for persistent or recurrent dysphagia. Our aim was to establish predictors of an unfavorable outcome after single-dose brachytherapy.


METHODS
Between December 1999 and July 2002, 95 patients with dysphagia from inoperable esophageal carcinoma were treated with single-dose (12 Gy) brachytherapy. Patients were followed-up prospectively by monthly home visits by a specialized research nurse. We investigated the patient and tumor characteristics that influence the risk of persistent dysphagia (continuing dysphagia within 4 weeks after treatment necessitating a second treatment) or recurrent dysphagia (occurring more than 4 weeks after treatment) after single-dose brachytherapy, using logistic and Cox regressions.


RESULTS
At 4 weeks after brachytherapy, the dysphagia score was improved in 62/84 (74%) patients. Major complications occurred in 11/95 (12%) patients. In total, 42/95 (44%) patients were treated for persistent (n = 18) and/or recurrent dysphagia (n = 28). Persistent dysphagia (n = 18) was caused by persisting obstructing tumor confirmed at endoscopy, and these patients were treated with stent placement. Patients needing dilation before treatment had a higher risk of persistent dysphagia (odds ratio = 4.1; 95% CI 1.3-12). There was a trend toward a higher risk of persistent dysphagia for patients previously treated with chemotherapy (odds ratio = 3.2; 95% CI 0.81-12). In total, 34 events of recurrent dysphagia occurred in 28 patients, caused by obstructing tumor regrowth (n = 26), food bolus obstruction (n = 5), or other reasons (n = 3). None of the investigated patient and tumor characteristics had a significant association with the risk of developing recurrent dysphagia. Of all patients needing additional treatment (42/95), those who needed dilation before treatment had a higher risk of persistent and/or recurrent dysphagia (hazard ratio = 2.1; 95% CI 1.1-4.1).


CONCLUSIONS
Patients with stenotic esophageal tumors that cannot be bypassed or who previously underwent chemotherapy are poor candidates for single-dose brachytherapy. For these patients, a higher and/or fractionated dose of brachytherapy or alternative palliative treatment modalities should be considered.
Homs
Marjolein Y V
MY
Department of Gastroenterology and Hepatology, Erasmus Medical Center/University Medical Center Rotterdam, The Netherlands.
Steyerberg
Ewout W
EW
Eijkenboom
Wilhelmina M H
WM
Siersema
Peter D
PD
D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002277:Carcinoma / Q000150:complications / Q000532:radiotherapy*; D003680:Deglutition Disorders / Q000209:etiology / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D004938:Esophageal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome