Suresh C. Sharma

Aim: To investigate the quality of life (QOL) of patients with advanced carcinoma esophagus treated with different palliative radiation schedules.\n Methods: Sixty-two consecutive patients with inoperable, non-metastatic carcinoma of the esophagus were randomly allocated to Arm-A (external radiotherapy 30 Gy/10 fractions + brachytherapy 12 Gy/two sessions), Arm-B (external radiotherapy 30 Gy /10 fractions) and Arm-C (external radiotherapy 20Gy /five fractions). The QOL was assessed using the European Organization for Research and Treatment of Cancer questionnaire at presentation, after treatment and at 3 months follow-up.\n Results: The mean QOL score improved, in arm-A from 38 to 52 after treatment and 56 at 3 months, in arm-B from 30 to 44 after treatment and 55 at 3 months and in arm-C from 24 to 40 after treatment but decreased to 37 at 3 months. Improvement in dysphagia scores at the first follow-up was 46.1% in arm-A, 25.0% in arm-B and 22.6% in arm-C. The difference was maintained at 3 months, with maximum improvement in arm-A (57.6%). No significant differences were found between the three arms with regard to complications and additional procedures needed for relief of dysphagia.\n Conclusion: In comparison with external radiotherapy alone, external radiotherapy with intraluminal brachytherapy has shown a trend toward better QOL and consistent dysphagia relief without significant difference in adverse effects.

Management of anal cancer is a challenge. The goal of treatment is to eradicate tumor without sacrificing the anal sphincters. The idea of organ preservation emerged following the discovery of a high complete response rate from preoperative combined chemoradiation (CRT) prior to abdominoperineal resection.CRT is widely accepted as the standard therapy for treating anal squamous cell cancer. The combination of external beam radiotherapy with interstitial brachytherapy increases the dose to the tumor volume and decreases dose to normal tissues. The current goal is to avoid colostomy, and surgery has become a salvage or secondary therapy. In this article, we review the non-surgical management of anal cancer with special emphasis on CRT, role of intensity modulated radiation therapy and brachytherapy.