Feasibility of Hypofractionated Radiotherapy for Locally Advanced Cancer Esophagus

Context: Concurrent chemo radiotherapy is standard of care for locally advanced cancer esophagus despite showing 50% local failures. Protocols with higher dose of conventional radiotherapy, altered radiotherapy fractionation regimens, various boost techniques, neoadjuvant chemotherapy proved less efficacious. This study prospectively evaluated evidence for dose de-escalated Hypofractionated Radiotherapy with concurrent chemotherapy. Aims: To compare therapeutic effect, toxicity profile and quality of life parameter ‘Dysphagia’ using EORTC OES 18 questionnaire in study population. Settings and Design: Hospital Based Prospective Randomized Concurrent Parallel Open Labelled Two Arm Study. Methods and Material: Sixty eligible patients were enrolled to receive either conventional radiotherapy (CRT) or hypofractionated radiotherapy (HRT) on Cobalt-60 Unit. 30 patients received CRT with total dose of 63Gy/35 fractions for 7 weeks and 30 patients received HRT with total dose of 48 Gy/16fractions for 3 1⁄2 weeks. Concurrent chemotherapy comprised of weekly cisplatin. Statistical analysis: Statistical software STATA 10.1 (2010), unpaired t-test, Paired ttest. Results: Both Arms in study were comparable in demographic parameters and Clinical parameters related to disease i.e. type of growth, length of lesion, TNM group staging. Improvement in weight, Overall survival and disease free survival were significantly better significantly better in CRT arm at follow up period of ≈1 1⁄2 years. On Critical assessment of Quality of Life parameter ‘Dysphagia’, significantly better results were seen in CRT Arm. Patients requiring feeding gastrostomy/jejunostomy during treatment were significantly higher in HRT arm. However, overall (tumor) response was similar in both arms. Conclusion: This study evaluated feasibility of HRT in locally advanced cancer esophagus, results of the study indicate CRT arm being more effective as compared to HRT.