title: Measuring relief of dysphagia in locally advanced esophageal carcinoma patients submitted to high-dose-rate brachytherapy.
abstract: OBJECTIVE
  Esophageal neoplasm has a poor prognosis, and palliative care remains an important goal of treatment. The purpose of this study was to assess the ability of high-dose-rate brachytherapy (HDRB) to improve dysphagia in 115 patients treated at our institution.
  
  
  METHODS
  Patients previously submitted to external beam radiotherapy that at least, 1 month after, presented with residual disease and persistent dysphagia, were given HDRB as palliative treatment. Patients with tumors extending to the level of cardia and those with cervical esophageal lesions were also eligible. HDRB consisted of three fractions of 500 cGy given weekly. Dysphagia was assessed using a food texture-based scale classified according to the type of food patients were able to swallow (absent, solid, pasty, or liquid). At the end of treatment, a single-category shift in dysphagia classification was scored as +1 (e.g., liquid to pasty) or -1 (e.g., solid to pasty), and a dual-category shift was scored as +2 (e.g., liquid to solid) or -2 (e.g., absent to pasty).
  
  
  RESULTS
  Most patients (51.1%) had improvement of dysphagia, and 55.3% of this group experienced one-point improvement. Procedural complications included stricture (38.2%), bleeding (7%), and fistula (8.7%). In the present study, 13 patients with cervical esophageal lesions underwent HDRB without fistula formation.
  
  
  CONCLUSIONS
  Esophageal HDRB effectively reduces dysphagia. Tumor location was not related to development of complications.
authors.affiliation: Department of Radiation Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. Electronic address: rgrazziotin@gmail.com.
authors.forename: Rachele
authors.initials: R
authors.lastname: Grazziotin Reisner
authors.affiliation: Department of Radiation Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Márcio Lemberg
authors.initials: ML
authors.lastname: Reisner
authors.affiliation: Department of Endoscopy, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Ferreira
authors.affiliation: Department of Radiation Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Arthur Accioly
authors.initials: AA
authors.lastname: Rosa
authors.affiliation: Department of Radiation Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Igor Moreira
authors.initials: IM
authors.lastname: Veras
authors.affiliation: Department of Radiation Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Túlio Meneses
authors.initials: TM
authors.lastname: Carneiro
authors.affiliation: Department of Radiation Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Bettina
authors.initials: B
authors.lastname: Wolff
authors.affiliation: Department of Radiation Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Célia Maria Pais
authors.initials: CM
authors.lastname: Viégas
authors.affiliation: Department of Radiation Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Carlos Manoel
authors.initials: CM
authors.lastname: Mendonça de Araújo
authors.affiliation: Department of Radiology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Marchiori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000532:radiotherapy*; D003680:Deglutition Disorders / Q000209:etiology / Q000532:radiotherapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Cervical esophagus; Dysphagia; Esophageal neoplasm; High-dose-rate brachytherapy; Palliative care