Combination RT offers hope to late-stage esophageal cancer patients

By Sarah Guy, medwireNews Reporter

Just over half of patients with advanced-stage esophageal cancer who are unsuitable for standard curative treatment survive for a year after receiving a combination of external beam radiotherapy (EBRT) and high-dose rate brachytherapy (BRT), report researchers.

Participants in their study were elderly and had comorbidities that made them inappropriate candidates for surgery or chemoradiotherapy - the two typical curative treatments for the condition.

The 2- and 3-year survival rates after dual radiotherapy were also good enough for the researchers to suggest the approach could improve on standard palliative therapy protocols used in this population.

"This regimen is well tolerated and has improved survival outcomes when compared to other more intensive fractionated radical radiotherapy regimens incorporating a brachytherapy boost," said lead author Ajay Aggarwal (Mount Vernon Cancer Center, London, England) in a press release.

"It provides effective palliation in patients with advanced age and significant comorbidity. The median survival exceeds by several months that seen in patients treated palliatively," he added.

Aggarwal and colleagues, who presented their results at the 2013 Gastrointestinal Cancers Symposium in San Francisco, California, USA, evaluated survival outcomes in 59 esophageal cancer patients treated between 2000 and 2011 with EBRT (either 27 Gy administered in six fractions or 30 Gy in 10 fractions) and BRT (10 or 15 Gy).

Patients were aged a median of 77 years, and half (50%) had an Adult Comorbidity Score of 2 or 3, indicating moderate or severe comorbidity. The majority of patients had tumor stage 2 (43%) or 3 (32%) disease.

The median estimated overall survival rate was 373 days, with 1-, 2-, and 3-year survival rates of 51%, 19%, and 7%, respectively, report the researchers in their presentation abstract.

Patients with stage 1 disease (20%) survived for a median of 16 months compared with 10 months for those with stage 3 disease.

"This is a cost-effective treatment, potentially offering a survival advantage comparable to radical combined radiotherapy in early-stage disease," said Aggarwal.

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