Lorenzo Fuccio1, Daniele Mandolesi2, Andrea Farioli2, Cesare Hassan3, Leonardo Frazzoni2, Alessandra Guido4, Nicola de Bortoli5, Savino Cilla6, Chiara Pierantoni2, Francesco Saverio Violante2, Franco Bazzoli2, Alessandro Repici7, Alessio Giuseppe Morganti4. 1. Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy. Electronic address: lorenzofuccio@gmail.com. 2. Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy. 3. Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy. 4. Division of Radiation Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Italy. 5. Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Italy. 6. Fondazione di Ricerca e Cura "Giovanni Paolo II", Catholic University "Sacro Cuore", Campobasso, Italy. 7. Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano (MI), Italy.
Abstract
BACKGROUND: The management of dysphagia owing to esophageal cancer is challenging. Brachytherapy has been proposed as an alternative option to stent placement. We performed a systematic review to examine its efficacy and safety in the resolution of dysphagia. METHODS: Prospective studies recruiting at least 20 patients with malignant dysphagia and published up to April 2016 were eligible. The dysphagia-free survival (DFS) and adverse event rates were pooled by means of a random effect model. RESULTS: Six studies for a total of 9 treatment arms (623 patients) were eligible for inclusion. After 1month since treatment, the DFS rate was 86.9% [95%CI: 76.0-93.3%]; after 3months, it was 67.2% [95%CI: 56.1-76.7%]; after 6months, it was 47.4% [95%CI: 38.5-56.5%]; after 9months, it was 37.6% [95%CI:30.0-45.9%]; and, finally, after 12months, it was 29.4% [95%CI: 21.6-38.7%]. The heterogeneity between studies was high at 1-, 3- and 6-month assessment; the values of I2 were 86.3%, 80.0% and 57.8%, respectively. The meta-regression analysis showed total radiation dose and number of fractions as the only positively influencing factors. Severe adverse event rate was 22.6% (95%CI 19.4-26.3). The main reported adverse events were brachytherapy-related stenosis (12.2%) and fistula development (8.3%). Two cases (0.3%) of deaths were reported due to esophageal perforation. CONCLUSION: Brachytherapy is a highly effective and relatively safe treatment option therefore its underuse is no longer justified. Further studies should investigate the optimal radiation dose and number of fractions able to achieve the highest DFS rates.
BACKGROUND: The management of dysphagia owing to esophageal cancer is challenging. Brachytherapy has been proposed as an alternative option to stent placement. We performed a systematic review to examine its efficacy and safety in the resolution of dysphagia. METHODS: Prospective studies recruiting at least 20 patients with malignant dysphagia and published up to April 2016 were eligible. The dysphagia-free survival (DFS) and adverse event rates were pooled by means of a random effect model. RESULTS: Six studies for a total of 9 treatment arms (623 patients) were eligible for inclusion. After 1month since treatment, the DFS rate was 86.9% [95%CI: 76.0-93.3%]; after 3months, it was 67.2% [95%CI: 56.1-76.7%]; after 6months, it was 47.4% [95%CI: 38.5-56.5%]; after 9months, it was 37.6% [95%CI:30.0-45.9%]; and, finally, after 12months, it was 29.4% [95%CI: 21.6-38.7%]. The heterogeneity between studies was high at 1-, 3- and 6-month assessment; the values of I2 were 86.3%, 80.0% and 57.8%, respectively. The meta-regression analysis showed total radiation dose and number of fractions as the only positively influencing factors. Severe adverse event rate was 22.6% (95%CI 19.4-26.3). The main reported adverse events were brachytherapy-related stenosis (12.2%) and fistula development (8.3%). Two cases (0.3%) of deaths were reported due to esophageal perforation. CONCLUSION: Brachytherapy is a highly effective and relatively safe treatment option therefore its underuse is no longer justified. Further studies should investigate the optimal radiation dose and number of fractions able to achieve the highest DFS rates.
Authors: Natasja R Walterbos; Marta Fiocco; Karen J Neelis; Yvette M van der Linden; Alexandra M J Langers; Marije Slingerland; Wobbe O de Steur; Femke P Peters; Irene M Lips Journal: Clin Transl Radiat Oncol Date: 2019-04-24
Authors: Amin Doosti-Irani; Mohammad Ali Mansournia; Abbas Rahimi-Foroushani; Peiman Haddad; Kourosh Holakouie-Naieni Journal: PLoS One Date: 2017-10-02 Impact factor: 3.240