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Radiotherapy without chemotherapy may be better at dysphagia

28 December 2017 16:53

According to the study Cancer Center in Australia, palliative radiotherapy is less effective but also less toxic compared with palliative chemoradiation, with dysphagia in patients with esophageal cancer in the later stages.

"The findings suggest that radiotherapy - is a secure tool palliative treatment that is well tolerated by patients with symptoms of advanced esophageal cancer," - said the scientists.

Malignant dysphagia treated with chemotherapy alone, endoscopic resection or stenting, as well as radiotherapy or a combination of methods, which include chemoradiotherapy.

Scientists compared the profile of efficacy and toxicity of chemoradiotherapy alone with radiotherapy for the treatment of malignant dysphagia in randomizable controlled study, which was attended by 220 patients with advanced esophageal cancer in 22 Australian hospitals.

To determine the success in the treatment of dysphagia scientists used Mellow scale. The majority of patients in the chemoradiotherapy group (45%) showed improvement of symptoms up to one point on a scale Mellow, compared with radiotherapy group (35%). In this case, complete relief of dysphagia (score - zero points) experienced 29% of participants from the group of chemoradiotherapy and 24% in the radiotherapy group.

The estimated median progression-free survival of dysphagia were similar in the two groups: only 5% in chemoradiotherapy group and 7% in the radiotherapy group a year later.

However, patients undergoing chemoradiotherapy, twice as frequently experienced acute toxic side effects grade 3-4 (36% vs. 16%). Later toxic adverse effects did not differ between the randomized groups among patients who survived more than 90 days.

"Our analysis showed that in patients with minimal loss of body weight, with or without metastases them, palliative radiotherapy or chemoradiotherapy for 2-3 weeks provides relief of dysphagia in approximately 50% of cases, and the average survival is about 11 months. However, cancer patients with weight loss of 5% or more, and metastatic disease have a worse prognosis (dysphagia relief - 34%, and median survival of about 5 months), which emphasizes the importance of individualization of treatment in this patient segment "- the researchers reported.

"Despite a certain role in the radical and medical conditions, chemoradiotherapy has little influence on key palliative end points, including relief of dysphagia, due to the high toxicity, - scientists noted. - In further tests need to consider new agents and strategies in the treatment of patients with advanced primary tumors without metastasis, and to consider more radical methods of treatment. "

"Modern radiation therapy may have minimal toxicity and cause minimal disruption to the patient's life in a number of palliative care units. We hope that other clinicians will conduct research in the field of palliative, focusing on the feelings of the patient, rather than longevity, as an indicator of success in the group of patients where the control of the symptoms is often their primary treatment. "

Scientists have pointed out that before them lies a long way before reaching the "Holy Grail" of personalized oncology - choosing the right treatment for each patient at the right time.

Source: https://www.medscape.com/viewarticle/890559

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