title: A phase I/II study to evaluate the toxicity and efficacy of accelerated fractionation radiotherapy for the palliation of dysphagia from carcinoma of the oesophagus.
abstract: OBJECTIVE
  We hypothesised that accelerated fractionated radiotherapy may provide a good palliative approach for dysphagia relief in patients with incurable oesophageal cancer, significantly reducing the overall duration of treatment, while providing symptom response with an acceptable toxicity profile. A phase I/II accelerated fractionation study was conducted to evaluate the efficacy and toxicity of this approach.
  
  
  METHODS
  Patients with incurable oesophageal cancer, symptomatic with dysphagia, Eastern Cooperative Oncology Group performance status<or=3, without fistula or oesophageal stent in situ, were eligible. Treatment consisted of 40 Gy in 20 fractions, twice a day (2 Gy per fraction, >or=6 h apart), 5 days a week, over 2 weeks.
  
  
  RESULTS
  Of the 39 evaluable patients, the dysphagia response rate was 69% (27/39) with a median response duration of 5.5 months. The median time to response was 4 weeks. Twenty-eight per cent (11/39) of patients had transient worsening in their dysphagia scores. Acute toxicity (weeks 1-8) occurred in 41% (16/39) of patients. An improvement in global quality of life by week 8 was seen in 42% of patients. There were no late neurological sequelae. The median overall survival was 8 (range 1.7-58+) months.
  
  
  CONCLUSIONS
  The ideal palliative regimen should be relatively short, with minimal toxicity, while offering a favourable response profile. Accelerated fractionation fulfils these criteria and is a suitable treatment alternative for the palliation of dysphagia, especially if the goal is to deliver a higher total biological dose within a shorter (2 week) period of time.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada.
authors.forename: Z
authors.initials: Z
authors.lastname: Kassam
authors.forename: R K S
authors.initials: RK
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Ringash
authors.forename: Y
authors.initials: Y
authors.lastname: Ung
authors.forename: J
authors.initials: J
authors.lastname: Kamra
authors.forename: G
authors.initials: G
authors.lastname: DeBoer
authors.forename: M
authors.initials: M
authors.lastname: O'Brien
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.forename: D A
authors.initials: DA
authors.lastname: Loblaw
authors.forename: S
authors.initials: S
authors.lastname: Wong
authors.forename: B
authors.initials: B
authors.lastname: Cummings
authors.forename: P
authors.initials: P
authors.lastname: Davey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011788:Quality of Life; D011832:Radiation Injuries; D012062:Relative Biological Effectiveness