The effect of external beam irradiation after endoscopic palliation of esophageal carcinoma

The aim of this study was to verify the value of additional external beam i rradiation (EBR) after endoscopic palliation, regarding quality of life and survival rate. From January 1988 to December 1995, 99 patients with esopha geal carcinoma (squamous cell carcinoma 61; adenocarcinoma 38) were reviewe d, there were 84 males (mean age: 67 years) and 16 females (mean age: 65 ye ars). Seventeen patients were in stage IIb, 45 stage III and 37 patients in stage IV. HDR-brachyradiotherapy (mean: 14.7 Gy) was carried out in all pa tients. Additional EBR (mean: 47.8 Gy) after endoluminal palliation was don e in 51 cases. At 6-months follow-up swallowing of a semi-solid diet at lea st was possible in all patients and dysphagia was found with significant di fference in favour to EBR only in stage IV (p=0.011). The Karnovsky perform ance status showed a difference in favour of EBR for stage III and IV (p=0. 040 and p=0.049, respectively). The median overall survival for EBR compare d to no EBR was 10 and 7 months, with a 12 months survival rate of 60% and 16% (p=0.0012). However, considering different stages and EBR versus no EBR a significant difference in survival could only be found for stage IIb (p= 0.031), a trend in favour of EBR could be found for stage III (p=0.0985) an d stage IV (p=0.0543). Tumor regrowth 6-12 months after treatment occurred in 31 cases and was successfully treated with Nd-YAG laser in 25 and stenti ng in 6 cases. Postirradiation fibrotic stenosis occurred in 12 cases. Impr oved survival rates after additional EBR can only be expected in stage IIb. However, in case of advanced esophageal carcinoma and fair performance sta tus, EBR after endoluminal palliation help to maintain quality of life.