Palliative radiotherapy to the oesophagus: Less is just as good.


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Shefali Parikh1,Oliver Coen1,Rebecca Goody1,Ganesh Radhakrishna2,Paul Hatfield1,Mohan Hingorani1
1Leeds Cancer Centre,2The Christie, Manchester

Abstract

Background

Purpose: To analyse survival and symptom relief following palliative radiotherapy to the oesophagus, comparing 20Gy/5 fractions (BEDα/β10  28Gy) and 30Gy/10 fractions (BEDα/β10  39Gy).

Method

Methods and Materials: A single U.K. centre retrospective study of 91 consecutive patients with oesophageal cancer treated with first course of palliative external beam radiotherapy from 2012-2018.

Results

Results: Median age was 74 years. Forty-eight patients were treated with 20Gy/5 fractions (Group 1) and 43 patients with 30Gy/10 fractions (Group 2). Group 2 had a higher proportion of poor performance status of 2-3 (51% vs 29%). However, patients in Group 1 were more likely to have metastatic disease (35% vs 14%).

Documented improvement in dysphagia was 52% vs 60%, median time to deterioration of swallowing was 4.5 months vs 3.9 months, and median overall survival was 6.2 months vs 6.9 months (p = 0.8) in Group 1 and 2 respectively. A subset of 10% of patients with localised disease in both groups, survived more than 21 months. In group 2, 7% suffered Grade 3 toxicities (vs 0% in group 1). Median time to stent insertion was 4.6 months in Group 1 (25% of patients) vs 3.9 months in group 2 (37% of patients).

Conclusion

Conclusions: Response rates, overall survival and symptom control was similar in both groups. A subset of patients had a long prognosis irrespective of regimen. In this cohort 20 Gy/5 fractions was non-inferior to 30Gy/10 fractions.