3407 - Improving Dysphagia Relief and Patient Throughput in Advanced Esophageal Cancer with Brachytherapy in Resource-Limited Settings

Purpose/Objective(s): Dysphagia, one of the most common symptoms, affects 80% to 90% of esophageal cancer patients during their clinical course. Treatment options include external beam radiation therapy (EBRT), intraluminal brachytherapy (ILBT), or stent placement in the palliative setting. We compared the combination of short-course EBRT with ILBT to the standard regimen of palliative EBRT alone to observe onset and duration of dysphagia relief. The study's aim was to see if a similar or better or more durable dysphagia relief can be achieved with the combination of ILBT and short-course EBRT compared to EBRT alone. If comparable results are seen with combination treatment, this would reduce the number of hospital visits and workload on the Linear Accelerator machines which can be used to treat other patients in resource constraint settings.

Materials/Methods: A prospective, comparative, interventional two-arm study was conducted between May 2023 and June 2024, enrolling 30 patients of advanced thoracic esophageal cancer unfit for curative treatment with a KPS of 40 to 90, with high-grade dysphagia and a tumor length of less than 10 cm, without fistula or stent in situ extending up to the GE junction. They were assigned in a 1:1 ratio to either the EBRT arm (30 Gy/10 fractions/2 weeks) or the short-term EBRT (12 Gy/3 fractions/3days) with ILBT arm (2 fractions 6 Gy each). Relief of dysphagia with change in grade was observed 2 weekly up to 12 weeks. EBRT alone arm required 10 hospital visits while EBRT + ILBT needed 5 hospital visits. Dysphagia relief was compared using the Chi-square test or Fisher Exact test. Survival results were compared using Kaplan Meier curve.

Results: Sixty-five patients with advanced esophageal cancer were screened, of whom 30 were found eligible. Patients receiving EBRT and ILBT improved their swallowing ability earlier than those who received EBRT alone. After 2 weeks (p=0.02) and 4 weeks (p=0.04), a statistically significant improvement in dysphagia was seen. After 6 weeks, there was no statistically significant dysphagia relief between the two arms [0.27-0.46]. The mean dysphagia-free survival duration for EBRT patients was 23 weeks (95% CI: 8.5 – 37.1 weeks), and for EBRT f/b ILBT patients was 25 weeks (95% CI: 14.2 – 36.5 weeks).

Conclusion: The combined EBRT and ILBT treatment showed better and more durable dysphagia relief as compared to EBRT alone with improvement in dysphagia-free survival. A shorter course of EBRT + ILBT treatment with fewer hospital visits can help reduce the workload on the Linear Accelerator machine, increase patient throughput, and decrease hospital visits for patients, thereby reducing logistical expenses. The study's limitation is being single institutional with few patients and lack of randomization in patient treatment allotment. A prospective multicentric, randomized double blinded study is recommended to confirm the results.