The role of palliative interventional radiotherapy (brachytherapy) in esophageal cancer: An AIRO (Italian Association of Radiotherapy and Clinical Oncology) systematic review focused on dysphagia-free survival |
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| Affiliation: | 1. Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy;2. Faculty of Medicina e Psicologia, Sant''Andrea Hospital, Department of Radiation Oncology, University of Rome “La Sapienza”, Rome, Italy;3. Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy;4. Department of Radiation Oncology, Centro di Riferimento Oncologico Regionale, Rionero in Vulture, Potenza, Italy;5. Brachytherapy Section, Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy;6. Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy;7. Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Department of Health Science, University of Genoa, Genoa, Italy;8. Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy |
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| Abstract: | PurposeThe aim of this review was to examine efficacy of palliative interventional radiotherapy (IRT) in esophageal cancer compared with other treatment in terms of dysphagia-free survival (DyFS) and safety.Methods and MaterialA systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles evaluating the efficacy of IRT as palliation in patients with esophageal cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. We analyzed only clinical study as full text of patients with symptomatic esophageal cancer treated with IRT alone or in combination with other treatment. Conference paper, survey, letter, editorial, book chapter, and review were excluded. Time restriction (1990–2018) as concerns the years of the publication was considered. The primary outcome was the duration of dysphagia relief (DyFS) after brachytherapy vs. other treatment (external-beam radiotherapy, photodynamic therapy, argon plasma coagulation, stent, and laser) during followup. Secondary outcomes included overall survival and adverse event rates.ResultsThe literature search resulted in 554 articles. Sixty-six articles were assessed via full text for eligibility. Of these, 59 articles were excluded for various reasons, leaving seven randomized studies. The number of evaluated patients was 905 patients, and median age was 70.5 years. In the IRT group, the median DyFS was 99 days, the most relevant G3–G4 toxicity were fistula development and stenosis reported, respectively, in 8.3% and 12.2%; the overall median survival was 175.5 days.ConclusionIn conclusion, we provided evidence-based support that IRT is an effective and safe treatment option; therefore, its underuse is no longer justified. |
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| Keywords: | Esophageal cancer Interventional radiotherapy Brachytherapy Palliative |
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