title: Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer.
abstract: OBJECTIVE
  The aim of this study was to assess the 6-months dysphagia-free survival, improvement in swallowing function, complication rate, and overall survival in patients with incurable esophageal cancer treated with palliative radiotherapy.
  
  
  METHODS
  We retrospectively reviewed data from 139 patients (median age 72 years) with advanced/recurrent incurable esophageal cancer, who were referred to 3 German radiation oncology centers for palliative radiotherapy between 1994 and 2014. Radiotherapy consisted of external beam radiotherapy (EBRT) with 30 - 40.5 Gy/2.5 - 3 Gy per fraction, brachytherapy alone (BT) with 15 - 25 Gy/5 - 7Gy per fraction/weekly and EBRT + BT (30 - 40.5 Gy plus 10 - 14 Gy with BT) in 65, 46, and 28 patients, respectively. Dysphagia-free survival (Dy-PFS) was defined as the time to worsening of dysphagia for at least one point, a new loco-regional failure or death of any cause.
  
  
  RESULTS
  Median follow-up time was 6 months (range 1-6 months). Subjective symptom relief was achieved in 72 % of patients with median response duration of 5 months. The 1-year survival rate was 30%. The 6-months Dy-PFS time for the whole group was 73 ± 4%. The 6-months Dy-PFS was 90 ± 4% after EBRT, 92 ± 5% after EBRT + BT and 37 ± 7% after BT, respectively (p<0.001). Five patients lived for more than 2 years, all of them were treated with EBRT ± BT. Ulceration, fistula and stricture developed in 3, 6 and 7 patients, respectively.
  
  
  CONCLUSIONS
  Radiotherapy leads to symptom improvement in the majority of patients with advanced incurable esophageal cancer. The present results favor EBRT ± BT over BT alone. Due to the retrospective nature of this study, imbalances in baseline characteristics might have contributed to this finding, and further trials appear necessary.
authors.affiliation: 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Welsch
authors.affiliation: 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
authors.forename: Philipp Günther
authors.initials: PG
authors.lastname: Kup
authors.affiliation: 2. Department of Oncology and Palliative Medicine, Nordland Hospital Bodø, Norway; 3. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Norway.
authors.forename: Carsten
authors.initials: C
authors.lastname: Nieder
authors.affiliation: 4. Department of Surgery, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
authors.forename: Veria
authors.initials: V
authors.lastname: Khosrawipour
authors.affiliation: 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Bühler
authors.affiliation: 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.; 5. Department of Radiation Oncology, Sankt Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.; 6. Department of Radiation Oncology, Ev-Krankenhaus Witten, Academic Hospital of the Witten/Herdecke University, Witten, Germany.
authors.forename: Irenäus A
authors.initials: IA
authors.lastname: Adamietz
authors.affiliation: 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.; 5. Department of Radiation Oncology, Sankt Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Fakhrian
keywords: Brachytherapy; Complications; Dysphagia-free survival; Esophageal cancer; External beam radiation therapy; Palliation
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