Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials

Paul M. Jeene; Bram D. Vermeulen; Tom Rozema; Petra M. Braam; Irene Lips; Karin Muller; Daphne van Kampen; Marjolein Y. V. Homs; Vera Oppedijk; Maaike Berbee; Peter S. N. van Rossum; Sherif el Sharouni; Peter D. Siersema; Maarten C. C. M. Hulshof; POLDER Study Group

doi:10.1016/j.jtho.2020.04.032

Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials

Paul M. Jeene^*, Bram D. Vermeulen, Tom Rozema, Petra M. Braam, Irene Lips, Karin Muller, Daphne van Kampen, Marjolein Y. V. Homs, Vera Oppedijk, Maaike Berbee, Peter S. N. van Rossum, Sherif el Sharouni, Peter D. Siersema, Maarten C. C. M. Hulshof, POLDER Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Introduction: Short-course external beam radiotherapy (EBRT) and intraluminal brachytherapy are both accepted treatments for the palliation of dysphagia in patients with incurable esophageal cancer. We compared the effects of both treatments from two prospective studies.

Methods: We performed a multicenter prospective cohort study of patients with metastasized or otherwise incurable esophageal cancer requiring palliation of dysphagia from September 2016 to March 2019. Patients were treated with EBRT in five fractions of 4 Gy. Data were compared with all patients treated with a single brachytherapy dose of 12 Gy in the SIREC (Stent or Intraluminal Radiotherapy for inoperable Esophageal Cancer) trial, both between the original cohorts and between 1:1 propensity score-matched cohorts. The primary end point was an improvement of dysphagia at 3 months without reintervention. The secondary end points included toxicity and time-to-effect.

Results: A total of 115 patients treated with EBRT and 93 patients who underwent brachytherapy were eligible for analysis. In the original cohorts, dysphagia improved after EBRT in 79% of patients compared with 64% after brachytherapy (p = 0.058). Propensity score matching resulted in 69 patients in each cohort well-balanced at baseline. Improvement of dysphagia was observed in 83% after EBRT versus 64% after brachytherapy (p = 0.048). In responding patients, improvement of dysphagia at 2 weeks was observed in 67% after EBRT compared with 35% after brachytherapy, and the maximum effect was reached after 4 weeks in 55% and 33%, respectively. Severe toxicity occurred in 3% of patients after EBRT compared with 13% after brachytherapy.

Conclusions: Short-course EBRT appears at least as effective as brachytherapy in the palliation of dysphagia in patients with esophageal cancer. (C) 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

Original language	English
Pages (from-to)	1361-1368
Number of pages	8
Journal	Journal of Thoracic Oncology
Volume	15
Issue number	8
DOIs	https://doi.org/10.1016/j.jtho.2020.04.032
Publication status	Published - Aug 2020

Keywords

Dysphagia
Esophageal cancer
Palliation
Brachytherapy
External beam radiotherapy
SINGLE-DOSE BRACHYTHERAPY
CARCINOMA
FRACTIONATION
MANAGEMENT

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Jeene, P. M., Vermeulen, B. D., Rozema, T., Braam, P. M., Lips, I., Muller, K., van Kampen, D., Homs, M. Y. V., Oppedijk, V., Berbee, M., van Rossum, P. S. N., el Sharouni, S., Siersema, P. D., Hulshof, M. C. C. M., & POLDER Study Group (2020). Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials. Journal of Thoracic Oncology, 15(8), 1361-1368. https://doi.org/10.1016/j.jtho.2020.04.032

@article{94163e4c53334994affe37a28ad4e395,

title = "Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials",

abstract = "Introduction: Short-course external beam radiotherapy (EBRT) and intraluminal brachytherapy are both accepted treatments for the palliation of dysphagia in patients with incurable esophageal cancer. We compared the effects of both treatments from two prospective studies.Methods: We performed a multicenter prospective cohort study of patients with metastasized or otherwise incurable esophageal cancer requiring palliation of dysphagia from September 2016 to March 2019. Patients were treated with EBRT in five fractions of 4 Gy. Data were compared with all patients treated with a single brachytherapy dose of 12 Gy in the SIREC (Stent or Intraluminal Radiotherapy for inoperable Esophageal Cancer) trial, both between the original cohorts and between 1:1 propensity score-matched cohorts. The primary end point was an improvement of dysphagia at 3 months without reintervention. The secondary end points included toxicity and time-to-effect.Results: A total of 115 patients treated with EBRT and 93 patients who underwent brachytherapy were eligible for analysis. In the original cohorts, dysphagia improved after EBRT in 79% of patients compared with 64% after brachytherapy (p = 0.058). Propensity score matching resulted in 69 patients in each cohort well-balanced at baseline. Improvement of dysphagia was observed in 83% after EBRT versus 64% after brachytherapy (p = 0.048). In responding patients, improvement of dysphagia at 2 weeks was observed in 67% after EBRT compared with 35% after brachytherapy, and the maximum effect was reached after 4 weeks in 55% and 33%, respectively. Severe toxicity occurred in 3% of patients after EBRT compared with 13% after brachytherapy.Conclusions: Short-course EBRT appears at least as effective as brachytherapy in the palliation of dysphagia in patients with esophageal cancer. (C) 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc.",

keywords = "Dysphagia, Esophageal cancer, Palliation, Brachytherapy, External beam radiotherapy, SINGLE-DOSE BRACHYTHERAPY, CARCINOMA, FRACTIONATION, MANAGEMENT",

author = "Jeene, {Paul M.} and Vermeulen, {Bram D.} and Tom Rozema and Braam, {Petra M.} and Irene Lips and Karin Muller and {van Kampen}, Daphne and Homs, {Marjolein Y. V.} and Vera Oppedijk and Maaike Berbee and {van Rossum}, {Peter S. N.} and {el Sharouni}, Sherif and Siersema, {Peter D.} and Hulshof, {Maarten C. C. M.} and {POLDER Study Group}",

note = "Publisher Copyright: {\textcopyright} 2020 International Association for the Study of Lung Cancer",

year = "2020",

month = aug,

doi = "10.1016/j.jtho.2020.04.032",

language = "English",

volume = "15",

pages = "1361--1368",

journal = "Journal of Thoracic Oncology",

issn = "1556-0864",

publisher = "Elsevier Science",

number = "8",

}

Jeene, PM, Vermeulen, BD, Rozema, T, Braam, PM, Lips, I, Muller, K, van Kampen, D, Homs, MYV, Oppedijk, V, Berbee, M, van Rossum, PSN, el Sharouni, S, Siersema, PD, Hulshof, MCCM & POLDER Study Group 2020, 'Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials', Journal of Thoracic Oncology, vol. 15, no. 8, pp. 1361-1368. https://doi.org/10.1016/j.jtho.2020.04.032

TY - JOUR

T1 - Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer

T2 - A Matched Comparison of Two Prospective Trials

AU - Jeene, Paul M.

AU - Vermeulen, Bram D.

AU - Rozema, Tom

AU - Braam, Petra M.

AU - Lips, Irene

AU - Muller, Karin

AU - van Kampen, Daphne

AU - Homs, Marjolein Y. V.

AU - Oppedijk, Vera

AU - Berbee, Maaike

AU - van Rossum, Peter S. N.

AU - el Sharouni, Sherif

AU - Siersema, Peter D.

AU - Hulshof, Maarten C. C. M.

AU - POLDER Study Group

PY - 2020/8

Y1 - 2020/8

N2 - Introduction: Short-course external beam radiotherapy (EBRT) and intraluminal brachytherapy are both accepted treatments for the palliation of dysphagia in patients with incurable esophageal cancer. We compared the effects of both treatments from two prospective studies.Methods: We performed a multicenter prospective cohort study of patients with metastasized or otherwise incurable esophageal cancer requiring palliation of dysphagia from September 2016 to March 2019. Patients were treated with EBRT in five fractions of 4 Gy. Data were compared with all patients treated with a single brachytherapy dose of 12 Gy in the SIREC (Stent or Intraluminal Radiotherapy for inoperable Esophageal Cancer) trial, both between the original cohorts and between 1:1 propensity score-matched cohorts. The primary end point was an improvement of dysphagia at 3 months without reintervention. The secondary end points included toxicity and time-to-effect.Results: A total of 115 patients treated with EBRT and 93 patients who underwent brachytherapy were eligible for analysis. In the original cohorts, dysphagia improved after EBRT in 79% of patients compared with 64% after brachytherapy (p = 0.058). Propensity score matching resulted in 69 patients in each cohort well-balanced at baseline. Improvement of dysphagia was observed in 83% after EBRT versus 64% after brachytherapy (p = 0.048). In responding patients, improvement of dysphagia at 2 weeks was observed in 67% after EBRT compared with 35% after brachytherapy, and the maximum effect was reached after 4 weeks in 55% and 33%, respectively. Severe toxicity occurred in 3% of patients after EBRT compared with 13% after brachytherapy.Conclusions: Short-course EBRT appears at least as effective as brachytherapy in the palliation of dysphagia in patients with esophageal cancer. (C) 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

AB - Introduction: Short-course external beam radiotherapy (EBRT) and intraluminal brachytherapy are both accepted treatments for the palliation of dysphagia in patients with incurable esophageal cancer. We compared the effects of both treatments from two prospective studies.Methods: We performed a multicenter prospective cohort study of patients with metastasized or otherwise incurable esophageal cancer requiring palliation of dysphagia from September 2016 to March 2019. Patients were treated with EBRT in five fractions of 4 Gy. Data were compared with all patients treated with a single brachytherapy dose of 12 Gy in the SIREC (Stent or Intraluminal Radiotherapy for inoperable Esophageal Cancer) trial, both between the original cohorts and between 1:1 propensity score-matched cohorts. The primary end point was an improvement of dysphagia at 3 months without reintervention. The secondary end points included toxicity and time-to-effect.Results: A total of 115 patients treated with EBRT and 93 patients who underwent brachytherapy were eligible for analysis. In the original cohorts, dysphagia improved after EBRT in 79% of patients compared with 64% after brachytherapy (p = 0.058). Propensity score matching resulted in 69 patients in each cohort well-balanced at baseline. Improvement of dysphagia was observed in 83% after EBRT versus 64% after brachytherapy (p = 0.048). In responding patients, improvement of dysphagia at 2 weeks was observed in 67% after EBRT compared with 35% after brachytherapy, and the maximum effect was reached after 4 weeks in 55% and 33%, respectively. Severe toxicity occurred in 3% of patients after EBRT compared with 13% after brachytherapy.Conclusions: Short-course EBRT appears at least as effective as brachytherapy in the palliation of dysphagia in patients with esophageal cancer. (C) 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

KW - Dysphagia

KW - Esophageal cancer

KW - Palliation

KW - Brachytherapy

KW - External beam radiotherapy

KW - SINGLE-DOSE BRACHYTHERAPY

KW - CARCINOMA

KW - FRACTIONATION

KW - MANAGEMENT

U2 - 10.1016/j.jtho.2020.04.032

DO - 10.1016/j.jtho.2020.04.032

M3 - Article

C2 - 32407795

SN - 1556-0864

VL - 15

SP - 1361

EP - 1368

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

IS - 8

ER -