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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn advanced esophageal cancer, 90% of patients have dysphagia as their predominant symptom. Although chemotherapy has demonstrated benefits in curing esophageal cancer, the only data on appropriate palliative treatment are from small, retrospective trials. The Advanced Oesophageal Cancer Study to Compare Quality of Life and Palliation of Dysphagia [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00193882\u0026amp;atom=%2Fspmdc%2F14%2F31%2F9.1.atom\u0022\u003ENCT00193882\u003C\/a\u003E] aims to establish effective and minimally toxic treatments for relief of dysphagia in advanced esophageal cancer and to determine the effects of common cancer treatments on quality of life.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiation Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiation Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EWhile much focus is on exciting advancements in the cure of cancer, there is a group of patients who cannot be cured and who need effective treatment with minimal toxicity for their predominant symptoms. In advanced esophageal cancer, 90% of patients have dysphagia as their predominant symptom. Although chemotherapy has demonstrated benefits in curing esophageal cancer, the only data on appropriate palliative treatment are from small, retrospective trials.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EMichael G. Penniment, MD, MBA, Royal Adelaide Hospital, Adelaide, Australia, directed the Advanced Oesophageal Cancer Study to Compare Quality of Life and Palliation of Dysphagia [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00193882\u0026amp;atom=%2Fspmdc%2F14%2F31%2F9.1.atom\u0022\u003ENCT00193882\u003C\/a\u003E], the aims of which were to establish effective and minimally toxic treatments for relief of dysphagia in advanced esophageal cancer and to determine the effects of common cancer treatments on quality of life (QoL). The primary protocol end point of this randomized phase 3 trial was the relief of dysphagia, defined as improvement of \u2265 1 point on the 5-point Mellow scale for dysphagia 9 weeks after starting radiation therapy (RT) and maintained until week 13. A secondary end point was dysphagia progression-free survival (PFS), measured from randomization to the time of first progression of dysphagia, which was defined as an increase of \u2265 1 point on the Mellow scale, stricture requiring intervention, or death.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe 220 patients (median age, 65 years; range, 37\u201388 years) recruited for the study were nearly evenly divided between those from Australia and New Zealand and those from Canada and the United Kingdom. Of these, \u0026gt; 80% were men and almost 70% presented with adenocarcinoma vs squamous cell carcinoma. Patients in Australia and New Zealand received RT of 35 Gy in 15 fractions, whereas those in Canada and the United Kingdom received 30 Gy in 10 fractions. The 111 patients randomized to chemotherapy received 5-fluorouracil 800 mg\/m\u003Csup\u003E2\u003C\/sup\u003E\/day on days 1 to 4 and cisplatin at either 80 mg\/m\u003Csup\u003E2\u003C\/sup\u003E IV at day 1 or 20 mg\/m\u003Csup\u003E2\u003C\/sup\u003E on days 1 to 4. Toxicity was measuring using Common Terminology Criteria for Adverse Events v2, whereas QoL was graded using the OES-18 module of the European Organisation for Research and Treatment of Cancer QLQ30 questionnaire.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ENo statistically significant difference was seen in the 9-week dysphagia response or in the maintained response at week 13 between patients receiving RT alone and those receiving RT plus chemotherapy. There was also no significant difference between the 2 treatment arms for either dysphagia PFS or for overall survival (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). However, there was statistically significant increased toxicity (nausea and vomiting) in patients randomized to chemotherapy plus RT (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01). Despite increased toxicity, there was no significant difference between the arms on QoL analysis.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/31\/9.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Overall Survival Comparing Radiotherapy With Chemoradiotherapy\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-350306008\u0022 data-figure-caption=\u0022Overall Survival Comparing Radiotherapy With Chemoradiotherapy\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/31\/9.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/31\/9.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/31\/9.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11928\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EOverall Survival Comparing Radiotherapy With Chemoradiotherapy\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from MG Penniment, MD, MBA.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EIn summary, in Dr Penniment\u0027s assessment, this trial must be considered negative because there was no significant improvement in dysphagia when chemotherapy was added to RT, and the trial was not powered to show equivalence. In addition, chemotherapy added to the RT did not improve QoL compared with RT alone. He concluded that treatment with RT alone should remain the standard of care for palliation of dysphagia in patients with advanced esophageal cancer.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/31\/9.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm01q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm01q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}