Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Radiotherapiegroep, Deventer, The Netherlands.
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
J Thorac Oncol. 2020 Aug;15(8):1361-1368. doi: 10.1016/j.jtho.2020.04.032. Epub 2020 May 11.
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.
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.
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.
Short-course EBRT appears at least as effective as brachytherapy in the palliation of dysphagia in patients with esophageal cancer.
短程外照射放疗（EBRT）和腔内近距离放疗都是治疗无法治愈的食管癌患者吞咽困难的可接受治疗方法。我们比较了这两种治疗方法的效果，这些结果来自两项前瞻性研究。
我们进行了一项多中心前瞻性队列研究，纳入 2016 年 9 月至 2019 年 3 月间需要缓解吞咽困难的转移性或其他无法治愈的食管癌患者。患者接受 EBRT，共 5 个疗程，每个疗程 4 Gy。我们将数据与 SIREC（无法切除的食管癌支架或腔内放疗）试验中所有接受单次腔内近距离放疗 12 Gy 的患者进行比较，包括原始队列之间和 1:1 倾向评分匹配队列之间的比较。主要终点是在无再次干预的情况下，3 个月时吞咽困难改善。次要终点包括毒性和起效时间。
共有 115 例接受 EBRT 和 93 例接受近距离放疗的患者符合分析条件。在原始队列中，EBRT 治疗后 79%的患者吞咽困难得到改善，而近距离放疗后 64%的患者吞咽困难得到改善（p=0.058）。倾向评分匹配后，每个队列各有 69 例患者，基线时均衡。EBRT 治疗后 83%的患者吞咽困难得到改善，而近距离放疗后 64%的患者吞咽困难得到改善（p=0.048）。在有反应的患者中，EBRT 治疗后 2 周时 67%的患者吞咽困难得到改善，而近距离放疗后 35%的患者吞咽困难得到改善，最大疗效分别在 4 周时 55%和 33%的患者中达到。EBRT 治疗后 3%的患者发生严重毒性，而近距离放疗后 13%的患者发生严重毒性。
短程 EBRT 在缓解食管癌患者吞咽困难方面似乎至少与近距离放疗同样有效。
