title: Palliative radiotherapy in patients with esophageal carcinoma: A retrospective review.
abstract: OBJECTIVE
  Palliative radiotherapy has traditionally been used as a noninvasive means of palliating dysphagia in patients with incurable esophageal cancer. Insertion of an esophageal stent is a traditional alternative and newer treatment modalities such as brachytherapy and laser therapy are being increasingly investigated and employed. There are few large series in the literature which examine the role of short palliative radiotherapy regimens in this patient group. This retrospective review aims to demonstrate the useful role that external beam radiotherapy can have in the palliation of patients with incurable esophageal carcinoma.
  
  
  METHODS
  One hundred forty-eight patients with histologically proven esophageal cancer, who were unsuitable for radical treatment, were identified. Notes were reviewed to determine baseline characteristics, indications for radiotherapy, response to treatment, need for further intervention, time to further intervention, and survival.
  
  
  RESULTS
  The median age of patients who received palliative radiotherapy was 74 years (range, 31-91). Forty-nine percent of patients (n = 73) were performance status 2 or 3, 70% (n = 103) had adenocarcinoma, 58% (n = 86) had locally advanced disease, and 28% (n = 41) had metastatic disease. Ninety-three percent of patients (n = 138) complained of dysphagia prior to radiotherapy. Eighty-nine percent of patients (n = 132) received a dose of 20 Gy in 5 fractions. Only 2 patients (1%) failed to complete the prescribed course of treatment. Following radiotherapy, 75% of patients experienced an improvement in dysphagia and 25% of patients gained weight. Twenty-six percent of patients (n = 38) required subsequent insertion of an esophageal stent and a further 3% (n = 5) received retreatment with radiotherapy. The median stent (and retreatment)-free survival was 4.9 months. Median overall survival was 6.1 months.
  
  
  CONCLUSIONS
  Despite a lack of randomized comparison to other modalities, external beam radiotherapy remains an effective, noninvasive, and generally well-tolerated means to palliate dysphagia in selected patients with incurable esophageal carcinoma.
authors.affiliation: Department of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom. Electronic address: lmurray@doctors.org.uk.
authors.forename: Louise Janet
authors.initials: LJ
authors.lastname: Murray
authors.affiliation: Department of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom.
authors.forename: Omar Sadeeq
authors.initials: OS
authors.lastname: Din
authors.affiliation: Department of Clinical Oncology, Royal Preston Hospital, Preston, United Kingdom.
authors.forename: Varadarajan Senthil
authors.initials: VS
authors.lastname: Kumar
authors.affiliation: Department of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom.
authors.forename: Lynne Melanie
authors.initials: LM
authors.lastname: Dixon
authors.affiliation: Department of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom.
authors.forename: Jonathan Charles
authors.initials: JC
authors.lastname: Wadsley