IMPACT OF HYPOFRACTIONATED RADIOTHERAPY IN INOPERABLE CARCINOMA ESOPHAGUS PATIENTS WITH LOW PERFORMANCE STATUS ON: DYSPHAGIA, TOXICITY PROFILE AND QUALITY OF LIFE

BACKGROUND:More than 50% of esophagus cancerpatients present with locally advanced stage or distant metastases.Dysphagia is the most common symptom, leading to nutritional compromise, pain, reduced performance status and deterioration of quality of life. Radiotherapy is a potent local treatment option, which can provide symptom relief and prolongation of survival. OBJECTIVES:  To assess the impact of hypofractionated radiotherapy on dysphagia relief. To look for the Toxicity profile of the patients. To note the improvement in Quality of life post treatment. STUDY DESIGN: An Observational study PARTICIPANTS:  88 patients with ECOG PS >= Grade I, histologically confirmed squamous cell or adenocarcinoma of the esophagus, stage III-IV with or without metastasis, medically unsuitable for radical treatment and  dysphagia score of 1-4 METHODS:  Baseline investigation were done. Performance status was assessed using ECOG Performance status.The grade of dysphagia and Quality of Life  were assessed at diagnosis. Toxicity was assessed using RTOG criteria.Radiotherapy consisted of EBRT with 35Gy/15 fractions @2.33Gy/#, 5 fractions per week, 5 days a week by two anteroposterior/ posteroanterior portals. Response was measured in terms of dysphagia relief, toxicity profile and improvement in quality of life. RESULTS: Off 88, 71 patients completed the treatment. The mean age was 69.4±10.53 (28-90). All 71(100%) patients had dysphagia relief following radiotherapy. 66 (93%) had grade I dysphagia followed by grade 2  in 5 (7%) patients post treatment in comparison to Grade 3 seen in 53.4% and Grade 2 seen in 38.6% pretreatment. Acute toxicities were seen in 18 (22.5%) patients, of which 11 (61.11%) had Grade I/II  and 7 (38.88%) had Grade 3/4. Late toxicities were seen in 4 (5.6%) patients. All 4 (5.6%) patients had late esophageal grade III toxicity. There was significant improvement in quality of life post treatment. CONCLUSION:EBRT remains an effective, noninvasive, and well-tolerated means to palliate dysphagia in selected patients with incurable esophageal carcinoma. Hypofractionated regimen delivers a high biological dose in  short time, with minimal toxicity, while offering a favourable response profile. IMPLICATIONS: Hypofractionated radiotherapy gives significant relief of dysphagia and improves QoL without significant increase in toxicities.