Esophageal Brachytherapy (ILRT) with Short course Hypofractionated accelerated EBRT versus EBRT alone in palliative treatment of esophageal cancers: a randomized phase III trial. (EBRISH trial)

Esophageal cancers often present late in their natural course of disease. In the advanced stages, many of the patients would not be suitable for treatment with a curative approach. Therefore, effective palliative treatment is necessary to decrease the burden of symptoms and improve quality of life. The ideal palliative regimen should have high rates of response with minimal toxicities. Also, patients should not be subjected to unnecessarily prolonged hospital visits. In a developing country like India, delivering effective palliative treatment with minimum hospital visits and out-of-pocket patient expenditure is crucial. One of the standard palliative external beam radiation regimens is 10 days of external beam radiotherapy (30 Grays in daily fractions over 2 weeks). However, this regimen requires at least 10 hospital visits. We wish to see if a 4 hospital visits radiation regimen combining shorter external beam radiotherapy (12 Grays in 4 fractions over 2 days, treated twice daily) with 2 sessions of intraluminal brachytherapy (12 Grays in 2 fractions) can produce potentially more relief of swallowing difficulty in esophageal patients. Decreasing treatment time would be beneficial for both the healthcare system and patients. This trial would compare the effectiveness, side effect profile, and improvement in quality of life of patients enrolled in both arms.