Palliative Radiotherapy for Dysphagia in Esophageal Cancer: Short-Term Benefits and Late Toxicity Risks

TL;DR

Palliative radiotherapy helps most esophageal cancer patients with swallowing issues, but those with advanced disease face higher risks of serious side effects.

Contribution

This study provides insights into the short-term benefits and late toxicity risks of palliative radiotherapy for dysphagia in esophageal cancer.

Findings

78% of patients experienced short-term improvement in dysphagia after radiotherapy.

T4b disease patients had a 36% risk of late grade 2-3 fistulas, compared to 6.7% in T3 cases.

Dysphagia recurrence occurred in 38% of patients, with a median survival of 1.2 months after recurrence.

Abstract

Introduction

Esophageal cancer is often diagnosed at an advanced stage, with dysphagia being the most common and distressing symptom that significantly impairs quality of life (QOL). Palliative radiotherapy is frequently used to relieve dysphagia, but its benefits and risks remain unclear. This study aimed to evaluate short-term dysphagia improvement and treatment-related toxicities in patients with esophageal cancer receiving palliative radiotherapy.

Materials and methods

We retrospectively analyzed 58 patients with esophageal cancer and dysphagia treated with palliative radiotherapy (30-40 Gy in 10-20 fractions) between April 2016 and March 2024. Of these, four patients (7%) received radiotherapy alone, while the remaining 54 (93%) underwent concurrent chemotherapy. Dysphagia scores were assessed before radiotherapy and one month after. Overall survival (OS) and treatment-related toxicities were also evaluated.

Results

Following radiotherapy, 45 of 58 patients (78%) experienced improvement in dysphagia, with a median time to symptom relief of 35 days. Among these 45 patients, recurrent dysphagia occurred in 17 (38%), with a median time from improvement to recurrence of 4.3 months (interquartile range (IQR), 2.2 to 6.0 months) and a median survival of 1.2 months after recurrence (IQR, 0.6 to 2.0 months). Across all patients, those who received concurrent chemotherapy tended to have higher rates of dysphagia improvement, suggesting that combination treatment may further alleviate esophageal obstruction. In patients with T3 disease or earlier, palliative radiotherapy was generally safe, and symptom relief contributed to improved oral intake and potential QOL benefits. In contrast, patients with T4b disease had a high incidence of late grade 2 to 3 esophageal or bronchial fistulas (36%), significantly more frequent than in T3 cases (6.7%). Acute toxicities were generally mild, but the risk of serious late adverse events in advanced disease highlights the need for careful patient selection.

Conclusion

Palliative radiotherapy can improve short-term dysphagia in most patients with esophageal cancer; however, patients with T4b disease face a higher risk of serious late adverse events, necessitating careful selection. While symptom relief may temporarily improve QOL, clinicians should weigh these risks carefully and discuss them with patients before proceeding. Patients should be counseled not only about the potential for short-term symptom relief but also about the risks of dysphagia recurrence and serious late adverse events to support shared decision-making.

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