Improvement in Quality of Life and Dysphagia After Palliative External Beam Radiotherapy for Malignant Esophageal Stenosis of Esophageal Cancer.

IF 4.7 3区 医学 Q1 ONCOLOGY JCO oncology practice Pub Date : 2025-03-13 DOI:10.1200/OP.24.00429
Katsuyuki Sakanaka, Kota Fujii, Masaki Kokubo, Masakazu Ogura, Satoshi Itasaka, Takashi Sakamoto, Norio Araki, Takehisa Takagi, Yasuhiro Kosaka, Setsuko Okumura, Chikako Yamauchi, Hiroyuki Inoo, Hiroyasu Abe, Hideki Ishikawa, Takashi Mizowaki
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Abstract

Purpose: This multi-institutional prospective cohort trial aimed to demonstrate the changes in physician-evaluated dysphagia and patient-reported outcomes (PROs) after palliative external beam radiotherapy (EBRT) in patients with incurable esophageal cancer presenting with dysphagia.

Materials and methods: We evaluated the rates of freedom from physician-evaluated dysphagia progression and improvement along with longitudinal changes in PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of Life-Core 30 Questionnaire [QLQ-C30] and OES-18) after palliative EBRT. Multivariate analysis was used to identify the factors associated with freedom from physician-evaluated dysphagia progression at week 13.

Results: A total of 519 patients with esophageal cancer were screened; the full analysis set comprised 93 patients with a baseline median dysphagia score of 2 (IQR, 1-3) whose possible range was 1-4. Squamous cell carcinoma accounted for 94% of the full analysis set. The median prescribed dose of palliative EBRT was 40 Gy (IQR, 37.5-50). The rates of freedom from physician-evaluated dysphagia progression and improvement at 13 weeks were 76% (95% CI, 66 to 85) and 50% (95% CI, 39 to 60), respectively. Multivariate analysis suggested that high-dose palliative EBRT was more effective in preventing deterioration of physician-evaluated dysphagia than the low-dose one. Role functioning, fatigue, dyspnea, and appetite were worsened at week 4 but recovered at week 13. Patient-reported dysphagia, as represented in EORTC OES-18, demonstrated clinically significant improvement from weeks 13 through 52, relieving dysphagia-associated symptoms and enhancing global health.

Conclusion: Palliative EBRT could relieve physician-evaluated and patient-reported dysphagia and dysphagia-associated symptoms and enhance global health in patients with incurable esophageal cancer, especially for squamous cell carcinoma despite transient dysfunction and aggravations of symptoms attributable to acute toxicity from palliative EBRT.

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目的:这项多机构前瞻性队列试验旨在证明,对于出现吞咽困难的无法治愈的食管癌患者,姑息性外照射放疗(EBRT)后医生评估的吞咽困难和患者报告结果(PROs)的变化:我们评估了姑息性外照射放疗后经医生评估的吞咽困难缓解率和改善率,以及PROs(欧洲癌症研究和治疗组织[EORTC]生活质量核心30问卷[QLQ-C30]和OES-18)的纵向变化。多变量分析用于确定与第13周时医生评估的吞咽困难进展无关的因素:共有 519 名食道癌患者接受了筛查;全部分析集包括 93 名患者,其基线吞咽困难中位评分为 2(IQR,1-3),可能范围为 1-4。鳞状细胞癌占全部分析集的 94%。姑息性 EBRT 的中位处方剂量为 40 Gy(IQR,37.5-50)。13周时,经医生评估的吞咽困难无进展率和无改善率分别为76%(95% CI,66-85)和50%(95% CI,39-60)。多变量分析表明,高剂量姑息性 EBRT 在防止医生评估的吞咽困难恶化方面比低剂量 EBRT 更有效。角色功能、疲劳、呼吸困难和食欲在第 4 周恶化,但在第 13 周恢复。患者报告的吞咽困难(以 EORTC OES-18 为代表)从第 13 周到第 52 周均有显著改善,缓解了吞咽困难相关症状,提高了整体健康水平:姑息性EBRT可缓解医生评估和患者报告的吞咽困难和吞咽困难相关症状,并提高无法治愈的食管癌患者(尤其是鳞癌患者)的整体健康水平,尽管姑息性EBRT的急性毒性会导致短暂的功能障碍和症状加重。
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来源期刊
CiteScore
6.40
自引率
7.50%
发文量
518
期刊最新文献
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