Statement of Search Strategies Used and Sources of Information

Introduction

The Clinical Evidence for Brachytherapy as a Treatment for Dysphagia

Cost Comparison of Brachytherapy and Stent Insertion

Why is Brachytherapy so Infrequently Used and Should it be Used More?

Conclusions and Recommendations

References

Abstract

ysphagia in people with advanced oesophageal cancer can be treated by oesophageal stents, external beam radiotherapy (EBRT) and intraluminal brachytherapy. Despite guidelines recommending brachytherapy for patients with a predicted life expectancy exceeding 3 months, its uptake in the UK has been limited. Here we examine the strength of the evidence supporting the use of brachytherapy compared with oesophageal stents and EBRT and possible reasons for its limited uptake. Trials and observational studies suggest brachytherapy alone confers a benefit to patients, but its impact is less immediate than oesophageal stents; the evidence on effectiveness and value-for-money is limited. Moreover, stronger evidence will probably be insufficient to increase uptake, due to the extra complexity of delivery compared with stents and EBRT and a lack of experience among specialists.

Introduction

People with oesophageal cancer often have a poor prognosis because they are diagnosed with advanced disease or are too frail to undergo curative treatment. For these reasons, oesophageal cancer is the seventh most common cause of death due to cancer in the UK despite being the 13th most common type of tumour [1]. Most patients are unsuitable for curative treatment and the aim of their treatment is primarily either to extend life expectancy or reduce the impact of symptoms on quality of life, although the latter is perhaps the dominant consideration. Among patients with stage IV cancer, recent population-based figures show life expectancy remains poor, with 1-year relative survival rates of 25.3 and 21.3% for squamous cell and adenocarcinoma tumours, respectively [2]. Dysphagia is a common, debilitating symptom among patients with advanced oesophageal cancer and can present with various stages of severity, such as restricting patients to eating specific solids, to swallowing only liquids or preventing anything from being ingested orally. Various therapies are available to alleviate dysphagia, including oesophageal stent insertion, external beam radiotherapy (EBRT), brachytherapy, laser therapy, photodynamic therapy and argon plasma coagulation [3].