Patient-reported outcomes evaluating palliative radiotherapy and chemotherapy in patients with oesophageal cancer: A systematic review

Figures & data

Figure 1. PRISMA search flow diagram.

Table I. Characteristics of patient-reported outcome (PRO) studies (n = 28).

Patient reported outcome^a	Total number of studies	References	Type of study		Treatment			Quality assessment of PRO
			Randomised controlled trial	Phase II or observational study	Chemo-therapy	Radio-therapy	Chemo-radio-therapy	Validated questionnaire	Baseline compliance reported	Time of assessment reported	Missing data reported	Sufficient standard
HRQL	21	[11–15, 17–19,21,25, 27,29–32,34, 35,38,40–42]	11	10	14	6	1	19	16	21	15	14
Dysphagia only	7	[16,22–24,28, 33,37]	1	6	2	4	1	4	4	6	5	4

HRQL, health related quality of life; Sufficient standard: validated questionnaire used, baseline compliance, time of assessment and missing data reported.

^a In addition, toxicity was reported in all studies.

Table II. Health related quality of life (HRQL) studies of sufficient standard (n = 14).

First author (year of publication) (references)	Total number of patients (number with oesophageal cancer)	Treatment	Study design	Treatment details	HRQL instrument	Baseline compliance	Time of assessment	Toxicity assessment
Rao (2010) [31]	72 (41)	Chemo-therapy	Randomised phase II	matuzumab + ECX vs. ECX	EORTC QLQ-C30 EORTC QLQ-OES18 study-specific questions	84%	Baseline, 4th chemotherapy cycle, end of treatment	NCI-CTC version 3
Curran (2009) Dank (2008) [19,20]	333 (65)	Chemo-therapy	Randomised phase III	IF vs. CF	EORTC QLQ-C30 EQ-5D	86%	Baseline, every 8 weeks until progression, every 3 months until death	NCI-CTC
Cunningham (2008) Sumpter (2005) [18,36]	1002 (581) 204 (133)	Chemo-therapy	Randomised phase III	ECF vs. ECX vs. EOF vs. EOX	EORTC QLQ-C30	96%	Baseline, every 3 months until 12 months	NCI-CTC version 2
Ajani (2007) van Cutsem (2006) [12,39]	445 (98)	Chemo-therapy	Randomised phase III	DCF vs. CF	EORTC QLQ-C30 EQ-5D	88%	Baseline, every 8 weeks until progression, every 3 months until death	NCI-CTC version 1 Karnofsky performance status
Ross (2002) [32]	580 (218)	Chemo-therapy	Randomised phase III	ECF vs. MCF	EORTC QLQ-C30	68%	Baseline, every 3 months until 12 months	NCI-CTC version 1 Observer rated symptom response and weight change
Webb (1997) [41]	274 (111)	Chemo-therapy	Randomised phase III	ECF vs. FAMTX	EORTC QLQ-C30	73%	Baseline, week 12, week 24	NCI-CTC version 1 Observer rated symptom response and weight change
van Meerten (2007) [40]	51 (51)	Chemo-therapy	Non-randomised phase II	oxaliplatin + capecitabine	EORTC QLQ-C30 EORTC QLQ-OES18	92%	Baseline, every other chemotherapy cycle, end of treatment	NCI-CTC version 3
Conroy (2002) [17]	71 (71)	Chemo-therapy	Non-randomised phase II	vinorelbine + cisplatin	EORTC QLQ-C30	83%	Baseline, 2nd and 4th chemotherapy cycles	SWOG toxicity criteria Dysphagia
Bamias (1995) [13]	235 (119)	Chemo-therapy	Non-randomised phase II	ECF	EORTC QLQ-C30	31%	Baseline, week 14, week 26	NCI-CTC version 1 Observer rated symptom response and weight change
Kassam (2008) [30]	47 (47)	Radio-therapy	Non-randomised phase II	Accelerated fractionation 2 Gy × 20 (10d)	EORTC QLQ-C30 EORTC QLQ-OES24	100%	Baseline, week 8, time of progression	RTOG toxicity criteria
Homs (2005) Homs (2004) [25,26]	209 (209)	Radio-therapy	Randomised phase III	Stent vs. brachytherapy	EORTC QLQ-C30 EORTC QLQ-OES24 EQ-VAS and EQ-5D	100%	Baseline, 2 weeks every month until 1 year after treatment	Dysphagia Complications listed
Bergquist (2005) [14]	65 (65)	Radio-therapy	Randomised phase III	Stent vs. brachytherapy	EORTC QLQ-C30 EORTC QLQ-OES18	100%	Baseline, 1 month, every 3 months until 12 months	Dysphagia Karnofsky performance status Complications listed
Burmeister (2005) [15]	46 (46) 24^a	Chemo-radio-therapy	Non-randomised phase II	3 Gy × 10–15 + concomitant fluorouracil	EORTC QLQ-C30 EORTC QLQ-OES18	100%	Baseline, every 3 month until 12 months, 18 months, 24 months	NCI-CTC version 2 Weight loss and dysphagia
O’Hanlon (1995) [42]	69 (69) 43^a	Radio-therapy	Observation	No details	Rotterdam symptom checklist	88%	Baseline, week 6, week 16	Symptom score

CF, cisplatin + fluorouracil; DCF, docetaxel + cisplatin + fluorouracil; ECF, epirubicin + cisplatin + fluorouracil; ECX, epirubicin + cisplatin + capecitabine; EOF, epirubicin + oxaliplatin + fluorouracil; EORTC QLQ-C30, EORTC Quality of Life Questionnaire Core 30-item version; EORTC QLQ-OES24, EORTC oesophagus cancer module 24-item version; EOX, epirubicin + oxaliplatin + capecitabine; EQ-5D, EuroQoL generic questionnaire; FAMTX, fluorouracil + doxorubicin + methotrexate; IF, irinotecan + fluorouracil + folic acid; MCF, mitomycin + cisplatin + fluorouracil; NCI-CTC, National Cancer Institute-Common Toxicity Criteria; RTOG, Radiation Therapy Oncology Group; SWOG, South West Oncology Group.

^aPatients treated with palliative intent.

Table III. Outcome of health related quality of life (HRQL) studies of sufficient standard (n = 14).

First author (references)	Endpoints		Results			Authors conclusion
	Primary	Other	Clinical response	HRQL	Non-haematologic toxicity (> grade 2) and symptoms
Rao [31]	Tumour response	Overall survival, progression free survival, HRQL	Addition of matuzumab to ECX did not improve tumour response or median overall survival (9.4 vs. 12.2 months)	No difference in global health status (no other scales reported)	No difference in grade 3/4 Increased skin disorders (any grade) with matuzumab (66% vs. 31%)	No increase in response or survival with matuzumab, no further evaluation of this treatment is warranted
Curran Dank [19,20]	Time to progression	Overall survival, safety, time to 5% deterioration of global health status	No difference in time to progression (5.0 vs. 4.2 months) or median survival (9.0 vs. 8.7 months)	No difference in time to 5% deterioration of global health status	No difference in time to deterioration of KPS, weight or appetite Higher rate of diarrhoea with IF (22% vs. 7%), less stomatitis (2% vs. 17%) and neurological toxicity (0% vs. 4%)	IF did not provide longer time to progression or better overall survival, but had another toxicity profile and better outcome on some HRQL scales. Recommended as an alternative to CF
Cunningham Sumpter [18,36]	Non-inferiority in overall survival	Progression-free survival, response rates, safety and HRQL	No difference in overall survival (9.9 vs. 9.9 vs. 9.3 vs. 11.2 months) between treatment arms	No difference in mean scores of global health status at 12 weeks	More diarrhoea (11%/12% vs. 3%) and peripheral neuropathy (8%/4% vs. 3%) with EOF/EOX vs. ECF hand-foot syndrome increased (10% vs. 4%) with ECX vs. ECF	Regimens with oxaliplatin and capecitabine were as effective as ECF. Recommended non-inferior treatment option
Ajani van Cutsem [12,39]	Time to progression	Overall survival, safety, time to 5% deterioration of global health status	DCF longer time to progression (5.6 vs. 3.7 months) and overall survival (9.2 vs. 8.6 months)	Time to 5% deterioration of global health status longer for DCF.	Longer time to deterioration of KPS with DCF, diarrhoea increased (19% vs. 8%) with DCF vs. CF	DCF provided longer time to progression, better HRQL but more toxicity compared to CF
Ross [32]	1-year survival	Failure free survival, response, safety, HRQL	No difference in median survival (9.4 vs. 8.7 months) or median failure free survival (7 months)	Global health status and physical and emotional functioning was maintained with ECF, declined with MCF at 3 and 6 months.	No difference in symptomatic response or weight loss, more alopecia (88% vs. 39%), less plantar-palmar erythema (30% vs. 43%) with ECF vs. MCF	No difference in survival or response Better HRQL with ECF than MCF. ECF reference treatment
Webb [41]	1-year survival	Response, toxicity, HRQL	ECF improved median overall (8.9 vs. 5.7 months) and failure free survival (7.4 vs. 3.4 months)	Global health status better with ECF than FAMTX at 24 weeks	Significantly more nausea (17% vs. 5%) with ECF vs. FAMTX, no difference in symptomatic response	ECF superior to FAMTX for patients with advanced oesophagogastric cancer
van Meerten [40]		Tumour response toxicity, HRQL survival	Overall response 19/49 (39%). Median survival 8 months	Physical function declined, emotional function improved. Less pain, more dry mouth.	Low toxicity, all < 10%. (nausea/vomiting 8%, lethargy 6%)	Oxaliplatin and capecitabine outpatient treatment, preserved HRQL, probably less toxicity than cisplatin
Conroy [17]		Tumour response toxicity, survival, HRQL	Overall response 24/71 (34%). Median survival 6.8 months	Improvement of global health status and physical function.	No improvement in dysphagia after treatment 22% fatigue 19%, anorexia 11%, vomiting 10%, other < 10%	Vinorelbine and cisplatin shorter treatment and probably less toxic than CF. HRQL data inconclusive
Bamias [13]		Tumour response, toxicity, symptomatic response, HRQL, survival	Overall response 135/220 (61%) median survival 8.4 months	Physical and role functioning maintained, pain decreased, global health scale improved	Nausea and vomiting 13%, other < 10%	ECF is effective with low toxicity and no negative impact on HRQL
Kassam [30]		Dysphagia relief toxicity, HRQL	Dysphagia score improved in 27/39 (67%), median survival 8 months	Improvement in emotional function and global health scale	Only 1% grade 3 toxicity (anorexia and nausea) Radiation induced oesophagitis any grade 18%	Accelerated fractionation radiotherapy offers a favourable response profile with minimal toxicity and short treatment time
Homs [25,26]	Dysphagia relief	Complications, HRQL, treatment for persistent dysphagia, cost	Dysphagia score improved more rapidly with stent than brachytherapy. No difference at 30 days median survival 5.5 months	Brachytherapy was more beneficial over time on most of the HRQL scales	Complications more frequent after stent than brachytherapy total (33% vs. 21%), haemorrhage (13% vs. 5%), pain (11% vs. 6%)	Brachytherapy gave better long-term relief of dysphagia, better HRQL and fewer complications than stent. Recommended as treatment of choice.
Bergquist [14]	HRQL	Level of dysphagia control	Dysphagia improved more rapidly with stent vs. brachytherapy (1 month vs. 3 months) median survival 5.0 months vs. 5.2 months	HRQL more stable for the brachytherapy group than in the stent group	No difference in time to deterioration of KPS, weigh, dysphagia or in rate of complications	Stent initially more effective, brachytherapy offers better long-term HRQL
Burmeister^a [15]		Toxicity, HRQL (dysphagia and physical function), survival	Complete dysphagia relief 16/24 (67%) median survival 9 months	Dysphagia scores improved and physical function maintained for 12 months	Low toxicity, oesophagitis 8%	Radiotherapy with concomitant fluorouracil gave good response with low toxicity and maintained HRQL
O’Hanlon [42]	HRQL	Relief of dysphagia	Dysphagia score improved significantly at 6 weeks	The HRQL parameters deteriorated for palliative group	Not stated	HRQL assessment useful for assessing patients well-being after treatment

Bold text, patient-reported outcome as primary endpoint. CF, cisplatin + fluorouracil; DCF, docetaxel + cisplatin + fluorouracil; ECF, epirubicin + cisplatin + fluorouracil; ECX, epirubicin + cisplatin + capecitabine; EOF, epirubicin +oxaliplatin + fluorouracil; EOX, epirubicin + oxaliplatin + capecitabine; FAMTX, fluorouracil + doxorubicin + methotrexate; HRQL, health related quality of life; IF, irinotecan + fluorouracil + folic acid; KPS, Karnofsky performance status; MCF, mitomycin + cisplatin + fluorouracil.

^aResults of the palliative treatment group shown.

Table IV. Patient-reported dysphagia studies of sufficient standard.

First author (year of publication) [reference(s)]	Total number of patients (number with oesophageal cancer)	Treatment	Study design	Treatment details	Dysphagia assessment	Baseline compliance	Time of assessment	Toxicity assessment
Cho (2005) [16]	32 (32)	Chemo-therapy	Non-randomised phase II	paclitaxel + cisplatin	DeMeester symptom scores	100%	Baseline, end of treatment	NCI-CTC
Jatoi (2002) [28]	46 (46)	Chemo-therapy	Non-randomised phase II	docetaxel + irinotecan	Barr and Krasner questionnaire	100%	Baseline, before subsequent chemotherapy cycles	NCI-CTC version 2
Taieb (2002) [37]	93 (93)	Chemo-therapy	Non-randomised phase II	HLFP	Mellow and Pinkas modified score	100%	Baseline, every month	NCI-CTC
Hayter (2000) [24]	22 (22)	Chemo-radiotherapy	Non-randomised phase II	3 Gy × 10 concomitant fluorouracil + mitomycin	Medical research council symptom index	100%	Daily diary cards during treatment	Not described

HLFP, hydroxyurea + leucovorin + fluorouracil + cisplatin; NCI-CTC, National Cancer Institute-Common Toxicity Criteria.

Table V. Outcome of patient-reported dysphagia studies of sufficient standard (n = 4).

First author (year of publication) [reference(s)]	Endpoints		Results			Authors conclusion
	Primary	Other	Clinical response	Patient reported response	Non-haematologic toxicity (>grade 2) and symptom ratings
Cho (2005) [16]		Toxicity, response rate, relief of dysphagia and survival	Tumour response 13/32 (41%), median survival 7 months	Dysphagia relief 11/29 (38%) no change 12/29 (41%) of which 5 had no dysphagia from start	Fatigue 23%, nausea and vomiting < 10%	Effective treatment with tumour response and dysphagia relief
Jatoi (2002) [28]	Tumour response	Progression free survival, overall survival, relief of dysphagia and toxicity	Tumour response 12/46 (26%), median survival 7.3 months	Dysphagia relief 7/29, no change 21/29, deterioration 1/29. 87% had no dysphagia or grade 1 before treatment	High-dose regimen induced high toxicity, 8% grade 4 diarrhoea, nausea and dyspnoea and 15% grade 3 fatigue, dose reduction reduced toxicity	Modest tumour response and high toxicity at high-dose levels. Dysphagia not a major symptom
Taieb (2002) [37]	Tumour response	Survival, relief of dysphagia, toxicity	Tumour response 24/42 (58%), median survival 12.7 months	Dysphagia relief 26/34 (76%)	Diarrhoea 7%, nausea/vomiting 10%, no weight gain 53%	HLFP is effective and well tolerated
Hayter (2000) [24]	Time to dysphagia relief	Toxicity, dysphagia free survival and overall survival	Median survival 20 weeks	Median time to dysphagia relief 5 weeks, dysphagia relief 15/22 (68%), and dysphagia free survival 11 weeks	Patients hospitalised for transient worsening of dysphagia (n = 1) or nausea and diarrhoea (n = 1)	Well tolerated complete relief of dysphagia in a substantial proportion of patients

HLFP, hydroxyurea + leucovorin + fluorouracil + cisplatin.

Findlay M, Cunningham D, Norman A, Mansi J, Nicolson M, Hickish T, et al. A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination with continuous infusion 5-fluorouracil (ECF). Ann Oncol 1994; 5:609–16.

 PubMed Web of Science ®Google Scholar

Homs MY, Essink-Bot ML, Borsboom GJ, Steyerberg EW, Siersema PD, Dutch SIREC Study Group. Quality of life after palliative treatment for oesophageal carcinoma – a prospective comparison between stent placement and single dose brachytherapy. Eur J Cancer 2004;40:1862–71.

 PubMed Web of Science ®Google Scholar

Ilson DH, Saltz L, Enzinger P, Huang Y, Kornblith A, Gollub M, et al. Phase II trial of weekly irinotecan plus cisplatin in advanced esophageal cancer. J Clin Oncol 1999;17: 3270–5.

 PubMed Web of Science ®Google Scholar

Shenfine J, McNamee P, Steen N, Bond J, Griffin SM. A randomized controlled clinical trial of palliative therapies for patients with inoperable esophageal cancer. Am J Gastroenterol 2009;104:1674–85.

 PubMed Web of Science ®Google Scholar

Spencer GM, Thorpe SM, Blackman GM, Solano J, Tobias JS, Lovat LB, et al. Laser augmented by brachytherapy versus laser alone in the palliation of adenocarcinoma of the oesophagus and cardia: A randomised study. Gut 2002;50:224–7.

 PubMed Web of Science ®Google Scholar

Tebbutt NC, Norman A, Cunningham D, Iveson T, Seymour M, Hickish T, et al. A multicentre, randomised phase III trial comparing protracted venous infusion (PVI) 5-fluorouracil (5-FU) with PVI 5-FU plus mitomycin C in patients with inoperable oesophago-gastric cancer. Ann Oncol 2002;13:1568–75.

 PubMed Web of Science ®Google Scholar

Cho SH, Chung IJ, Song SY, Yang DH, Byun JR, Kim YK, et al. Bi-weekly chemotherapy of paclitaxel and cisplatin in patients with metastatic or recurrent esophageal cancer. J Korean Med Sci 2005;20:618–23.

 PubMed Web of Science ®Google Scholar

Jatoi A, Tirona MT, Cha SS, Alberts SR, Rowland KM, Morton RF, et al. A phase II trial of docetaxel and CPT-11 in patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and gastric cardia. Int J Gastrointest Cancer 2002;32:115–23.

 PubMedGoogle Scholar

Rupinski M, Zagorowicz E, Regula J, Fijuth J, Kraszewska E, Polkowski M, et al. Randomized comparison of three palliative regimens including brachytherapy, photodynamic therapy, and APC in patients with malignant dysphagia (CONSORT 1a) (Revised II). Am J Gastroenterol 2011;106: 1612–20.

 PubMed Web of Science ®Google Scholar

Taeb J, Artru P, Baujat B, Mabro M, Carola E, Maindrault F, et al. Optimisation of 5-fluorouracil (5-FU)/cisplatin combination chemotherapy with a new schedule of hydroxyurea, leucovorin, 5-FU and cisplatin (HLFP regimen) for metastatic oesophageal cancer. Eur J Cancer 2002;38:661–6.

 PubMed Web of Science ®Google Scholar

Rao S, Starling N, Cunningham D, Sumpter K, Gilligan D, Ruhstaller T, et al. Matuzumab plus epirubicin, cisplatin and capecitabine (ECX) compared with epirubicin, cisplatin and capecitabine alone as first-line treatment in patients with advanced oesophago-gastric cancer: A randomised, multicentre open-label phase II study. Ann Oncol 2010;21: 2213–9.

 PubMed Web of Science ®Google Scholar

Curran D, Pozzo C, Zaluski J, Dank M, Barone C, Valvere V, et al. Quality of life of palliative chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction treated with irinotecan combined with 5-fluorouracil and folinic acid: Results of a randomised phase III trial. Qual Life Res 2009;18:853–61.

 PubMed Web of Science ®Google Scholar

Dank M, Zaluski J, Barone C, Valvere V, Yalcin S, Peschel C, et al. Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol 2008;19:1450–7.

 PubMed Web of Science ®Google Scholar

Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 2008;358:36–46.

 PubMed Web of Science ®Google Scholar

Sumpter K, Harper-Wynne C, Cunningham D, Rao S, Tebbutt N, Norman AR, et al. Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer 2005;92:1976–83.

 PubMed Web of Science ®Google Scholar

Ajani JA, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, et al. Quality of life with docetaxel plus cisplatin and fluorouracil compared with cisplatin and fluorouracil from a phase III trial for advanced gastric or gastroesophageal adenocarcinoma: The V-325 Study Group. J Clin Oncol 2007;25:3210–6.

 PubMed Web of Science ®Google Scholar

Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: A report of the V325 Study Group. J Clin Oncol 2006; 24:4991–7.

 PubMed Web of Science ®Google Scholar

Ross P, Nicolson M, Cunningham D, Valle J, Seymour M, Harper P, et al. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol 2002;20:1996–2004.

 PubMed Web of Science ®Google Scholar

Webb A, Cunningham D, Scarffe JH, Harper P, Norman A, Joffe JK, et al. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol 1997;15:261–7.

 PubMed Web of Science ®Google Scholar

van Meerten E, Eskens FA, van Gameren EC, Doorn L, van der GA. First-line treatment with oxaliplatin and capecitabine in patients with advanced or metastatic oesophageal cancer: A phase II study. Br J Cancer 2007;96:1348–52.

 PubMed Web of Science ®Google Scholar

Conroy T, Etienne PL, Adenis A, Ducreux M, Paillot B, Oliveira J, et al. Vinorelbine and cisplatin in metastatic squamous cell carcinoma of the oesophagus: Response, toxicity, quality of life and survival. Ann Oncol 2002;13:721–9.

 PubMed Web of Science ®Google Scholar

Bamias A, Hill ME, Cunningham D, Norman AR, Ahmed FY, Webb A, et al. Epirubicin, cisplatin, and protracted venous infusion of 5-fluorouracil for esophagogastric adenocarcinoma: Response, toxicity, quality of life, and survival. Cancer 1996;77:1978–85.

 PubMed Web of Science ®Google Scholar

Kassam Z, Wong RK, Ringash J, Ung Y, Kamra J, DeBoer G, et al. A phase I/II study to evaluate the toxicity and efficacy of accelerated fractionation radiotherapy for the palliation of dysphagia from carcinoma of the oesophagus. Clin Oncol (R Coll Radiol) 2008;20:53–60.

 PubMed Web of Science ®Google Scholar

Homs MY, Steyerberg EW, Eijkenboom WM, Tilanus HW, Stalpers LJ, Bartelsman JF, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: Multicentre randomised trial. Lancet 2004;364:1497–504.

 PubMed Web of Science ®Google Scholar

Bergquist H, Wenger U, Johnsson E, Nyman J, Ejnell H, Hammerlid E, et al. Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial. Dis Esophagus 2005; 18:131–9.

 PubMed Web of Science ®Google Scholar

Burmeister BH, Walpole ET, Burmeister EA, Thomas J, Thomson DB, Harvey JA, et al. Feasibility of chemoradiation therapy with protracted infusion of 5-fluorouracil for esophageal cancer patients not suitable for cisplatin. Int J Clin Oncol 2005;10:256–61.

 PubMedGoogle Scholar

O’Hanlon DM, Harkin M, Karat D, Sergeant T, Hayes N, Griffin SM. Quality-of-life assessment in patients undergoing treatment for oesophageal carcinoma. Br J Surg 1995;82: 1682–5.

 PubMed Web of Science ®Google Scholar

Hayter CR, Huff-Winters C, Paszat L, Youssef YM, Shelley WE, Schulze K. A prospective trial of short-course radiotherapy plus chemotherapy for palliation of dysphagia from advanced esophageal cancer. Radiother Oncol 2000;56: 329–33.

 PubMed Web of Science ®Google Scholar