Adding external beam to intra-luminal brachytherapy improves palliation in obstructive squamous cell oesophageal cancer: a prospective multi-centre randomized trial of the International Atomic Energy Agency.
BACKGROUND
Whether the combination of high dose-rate brachytherapy (HDRBT) and External Beam Radiation Therapy (EBRT) is superior to HDRBT alone for the palliation of oesophageal cancer has only been explored in a previous IAEA pilot randomized trial.


METHODS
Two hundred and nineteen patients were randomized to adding EBRT or not, after receiving two fractions of HDRBT within 1 week. Each HDRBT consisted of 8 Gy prescribed at 1cm from source centre. Patients randomized to EBRT received 30 Gy in 10 fractions. The primary outcome was dysphagia-relief experience (DRE). Additional outcomes included various scores, performance status, weight and adverse events. A majority of charts, imaging and radiotherapy plans were externally audited.


RESULTS
Median follow-up was 197 days, with a median OS of 188 days and an 18% survival rate at 1 year. DRE was significantly improved with combined therapy, for an absolute benefit of +18% at 200 days from randomization (p=0.019). In longitudinal regression analyses, scores for dysphagia (p=0.00005), odynophagia (p=0.006), regurgitation (p=0.00005), chest pain (p=0.0038) and performance status (p=0.0015) were all significantly improved. In contrast, weight, toxicities and overall survival were not different between study arms.


CONCLUSIONS
Symptom improvement occurs with the addition of EBRT to standard HDRBT. The combination is well tolerated and relatively safe.
Rosenblatt
Eduardo
E
International Atomic Energy Agency, Vienna, Austria. e.rosenblatt@iaea.org
Jones
Glenn
G
Sur
Ranjan K
RK
Donde
Bernard
B
Salvajoli
Joao V
JV
Ghosh-Laskar
Sarbani
S
Frobe
Ana
A
Suleiman
Ahmed
A
Xiao
Zefen
Z
Nag
Subir
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D003680:Deglutition Disorders / Q000209:etiology; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology; D015996:Survival Rate; D055815:Young Adult