title: Brachytherapy for the palliation of dysphagia owing to esophageal cancer: A systematic review and meta-analysis of prospective studies.
abstract: The management of dysphagia owing to esophageal cancer is challenging. Brachytherapy has been proposed as an alternative option to stent placement. We performed a systematic review to examine its efficacy and safety in the resolution of dysphagia.
  
  
  
  Prospective studies recruiting at least 20 patients with malignant dysphagia and published up to April 2016 were eligible. The dysphagia-free survival (DFS) and adverse event rates were pooled by means of a random effect model.
  
  
  
  Six studies for a total of 9 treatment arms (623 patients) were eligible for inclusion. After 1month since treatment, the DFS rate was 86.9% [95%CI: 76.0-93.3%]; after 3months, it was 67.2% [95%CI: 56.1-76.7%]; after 6months, it was 47.4% [95%CI: 38.5-56.5%]; after 9months, it was 37.6% [95%CI:30.0-45.9%]; and, finally, after 12months, it was 29.4% [95%CI: 21.6-38.7%]. The heterogeneity between studies was high at 1-, 3- and 6-month assessment; the values of I2were 86.3%, 80.0% and 57.8%, respectively. The meta-regression analysis showed total radiation dose and number of fractions as the only positively influencing factors. Severe adverse event rate was 22.6% (95%CI 19.4-26.3). The main reported adverse events were brachytherapy-related stenosis (12.2%) and fistula development (8.3%). Two cases (0.3%) of deaths were reported due to esophageal perforation.
  
  
  
  Brachytherapy is a highly effective and relatively safe treatment option therefore its underuse is no longer justified. Further studies should investigate the optimal radiation dose and number of fractions able to achieve the highest DFS rates.
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy. Electronic address: lorenzofuccio@gmail.com.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fuccio
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Mandolesi
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Farioli
authors.affiliation: Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Frazzoni
authors.affiliation: Division of Radiation Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Guido
authors.affiliation: Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: de Bortoli
authors.affiliation: Fondazione di Ricerca e Cura "Giovanni Paolo II", Catholic University "Sacro Cuore", Campobasso, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Cilla
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pierantoni
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Violante
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
authors.affiliation: Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano (MI), Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.affiliation: Division of Radiation Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Alessio Giuseppe
authors.initials: AG
authors.lastname: Morganti
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D003680:Deglutition Disorders / Q000209:etiology* / Q000532:radiotherapy*; D004938:Esophageal Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies
keywords: Brachytherapy; Dysphagia; Esophageal cancer