External Beam Radiotherapy for Dysphagia Palliation in Advanced Esophageal Cancer: A Prospective Study

Background: Esophageal cancer is a highly aggressive malignancy often associated with a poor prognosis because of locoregional failure and distant metastases. About 60–70 percent of the patients present at an advanced stage, have a median survival in the range of 6-10 months, and are not amenable to definitive treatment. Dysphagia is the most common complaint, seen in 80%–90% of patients. The priority for managing patients with advanced disease is dysphagia control, which in turn can improve nutritional intake and quality of life. External-beam radiotherapy (EBRT) is one of the major means of palliation. Objective: The primary goal of our study was to assess the efficacy of external beam radiotherapy in alleviating dysphagia in patients with esophageal cancer.Materials and method: This was a single arm prospective clinical study conducted in a tertiary care hospital in northeast India. The study comprised of 57 esophageal cancer patients, ineligible for definitive treatment. The patients received EBRT of 30 Gy in 10 fractions over two weeks. Dysphagia was graded using Modified Takita’s grading system. Patients were followed up at one-month intervals after treatment to assess dysphagia and acute toxicity. Results: Out of 57 patients in the study, subjective dysphagia relief was seen in 82.45%. The median dysphagia score decreased from 3 to 2 at the end of the 3-month post treatment period. (p < .001). In terms of treatment-related toxicity, treatment was well tolerated. No grade 4-5 toxicity was encountered. The most commonly encountered toxicity was radiation esophagitis, which affected 15 patients (26.31%).Conclusion: Radiation significantly improves dysphagia in esophageal cancer patients. It is an effective, non-invasive, and well-tolerated way to treat dysphagia in selected individuals with incurable esophageal cancer.