The Survival Rate for Esophageal Cancer Patients with Chemotherapy - Thesis Example

Sur Lecturer Literature Review The survival rate for esophageal cancer patients with chemotherapy This chapter seeks to present the literature review of the research study. In the discussion, the paper will attempt to discuss the overall survival rate for esophageal cancer patients improvement when chemotherapy is added as a concurrent treatment to intraluminal brachytherapy. The major objective of this research study is to ascertain the improvement of the dysphagia free-survival as well as overall survival with chemotherapy or not. On the other hand, the paper will also illustrate the ability to tolerate treatment, toxicity, patterns, and complications such as strictures, ulcerations, tracheoesophageal fistulae, of reoccurrence. Esophageal cancer is a very devastating disease (Gibson et al. 1564). This among others is factors that championed for the reason and purpose of this research study. Although esophageal cancer may be cured in some patients, esophageal cancer treatment is very protracted. It decreases the quality of the life of the victim and is often lethal in several cases. The idyllic treatment of esophageal cancer is actually debatable. In fact, some defendants of surgical treatment have argued that resection is the only modality treatment to provide curative intent; however, the defendant of non surgical approach have claimed that esophageal cancer is particularly incurable and that esophagectomy pose a prohibitive index of mortality. Adenocarcinoma of the esophagus which is specifically different from the squamous cell carcinoma has effects on the distal esophagus of the patients and is normally detected in its initial stages. These facts about esophageal cancer has altered the natural history of surgical treatment in the population of young patient, making its cure a reality. Historically, there has been a well description of esophageal carcinoma since the early 19th Century. The first resection that was successful was conducted by Frank Torek in 1913. This was followed by Ohsawa and Marshall who performed the first transthoracic esophagectomy in Japan and united States respectively with the reconstruction of the continent (Van Cutsem et al. 14991). According to recent studies, 90% of esophageal cancers are advanced locally at diagnosis, and its treatment brings about discouraging results. The rate of high dose brachytherapy (HDR-BT) allows an increment of the local doses with no particular significant toxic increment. Esophageal cancer has continued to pose a threat globally to the health of the public. The commonly witnessed practice is radiochemotherapy for unresectable tumors that have advanced locally and esophagectomy for the surgically resectable tumors. On the other hand, the control of the local regional tumor and the rate of survival of the patients of esophageal cancer have remain low and poor even after the use of the standard therapies. About 30% of esophageal cancer patients who are treated with just surgery only will develop reoccurrence locally, while 50% to 60% of the patients of esophageal cancer who are treated using radiochemotherapy are seen to only fail due to the local recurrence or persistent disease (Walsh et al. 17). It has also been noted that radiochemotherapy followed by esophagectomy or just preoperative radiochemotherapy has had an increase in a complete surgical rate of resection and a local regional control with no significant particular benefit of survival. In addition, preoperative radiochemotherapy after induction chemotherapy has also yielded some encouraging results. Some of the factors that are related to and associated with poor outcome include: the treatment of related factors, patient tumor, the number of the positive nodes of lymph after a preoperative radiochemotherapy, involvement of the nodes of the celiac axis, high activity of metabolism on the emission of the positron tomography scan after the radiochemotherapy, incomplete response of pathology, and incomplete surgical resection . Some studies have detailed additional facts that surgery after radiochemotherapy is associated with various significant adverse effects including postoperative pulmonary complications, treatment of related pneumonitis, pericarditis and esophagitis. The severity and incidence of the adverse effects are related to and associated with radiotherapy and chemotherapy dosimetric factors. Strategies of the innovative treatment including biologically and physically molecular targeted therapy is required to improve the outcome of the treatment of patients of esophageal cancer (Queisser et al. 190). Though esophageal cancer is uncommon relatively in the United States, it is a major global public health threat. The squamous cell carcinoma has remained a histology most common worldwide. However, adenocarcinoma of the esophagus has seen an increase in the proportions of epidemics in other Western countries and the United States. Both of the histologies have been documented to carry a poor prognosis. A 5-year mortality of the esophageal cancer has exceeded 85% to 90%. Other researchers have also asserted that esophageal cancer that have been advanced locally and treated with standard radiotherapy and surgery approaches is often associated with some sort of poor prognosis. This is due to the early dissemination of the disease and the high incidence of treatment failure locally and regionally. The undoubted need to deal with the early spread of the esophageal cancer through a systemic treatment is the foundation of this study that incorporates chemotherapy in the combined modality therapies that increase the survival rate. Today, concurrent radiotherapy and chemotherapy is the standard of care in the non surgical management esophageal cancer that is locally advanced. Based on recent clinical trials, combined preoperative chemoradiotherapy and preoperative chemotherapy have been noted as standards of esophageal cancer treatment too. Due to the increase in the use of chemotherapy in the operative management, a systemic chemotherapy is ultimately applied in treating most of the esophageal cancer patients. The failure of treatment of this highly virulent malignancy leads to the loss of many lives. About 50% of esophageal cancer patients presents with chemotherapy and overt metastatic disease. Due to the increase in the use of chemotherapy as an addition to the surgical management, as stated before, a continuous and systemic chemotherapy will be used in treating the majority of esophageal cancer patients (Jatoi et al. 120). Esophageal cancer often leads to death due to its severity. Although radical surgery has proved to be the most successful treatment of this sever disease, majority of the patients are not, at the time of diagnosis, operable. For such kind of patients, a choice for palliation or cure is provided by the external beam radiotherapy without or with concurrent chemotherapy. In addition, intraluminal brachytherapy has been suggested for patients with an advanced esophageal cancer as a method of increasing local control. Between 1989 and 2002, about 49 patients who had inoperable esophageal cancer received treatment with a combined intraluminal and external radiation therapy in the Central Hospital of the University of Turku. The external radiation therapy was performed with a 40 Gy median total dose given in 20 fractions. On a week average after this external radiation, there was an intraluminal radiation therapy of a 10 Gy median total dose given in 4 fractions. However, the intraluminal brachytherapy could be as well performed without any technical difficulties with no major complications seen. In most cases, 20 out of 49 patients (41% of the patients) the symptoms could be immediately relieved and the disease progression delayed. There is a chance of 30% and 18% of one and two year rate of survival respectively. The patients who remain alive after two years are termed as long term survivors. Therefore intraluminal brachytherapy is an efficient and safe treatment modality that provides a potential mechanism of cure to selected esophageal cancer patients (Pinto et al. 24). Although the general rate of survival for stage 1 esophageal cancer may seem excellent, there is a significant survival disparity that is often noted among institution for tumors in stage 2 to 4A that is treated by CRT. However, the high rate of intraluminal dose brachytherapy is one of the many effective palliation modalities of the advanced esophageal cancer. In an experimental study and a clinical test involving 30 patients with endoscopic proven and locally advanced squamous cell esophageal cancer, 29 of these patients were given high rate of intraluminal dose brachytherapy sessions of 8Gy in one week, and the remaining patient only got one session. After a month of following the patients, it was found out that the outcome involved symptoms control, quality of life: regurgitation, dysphagia, chest or back pain, odynophagia, and the general survival. There was a noted statistical improvement in quality of life after 4 months. Although pain, regurgitation and odynophagia were lower during this 4 month follow up, there was a generall median rate of survival from death of 165 days. We can therefore conclude that high rate of intraluminal dose brachytherapy of advanced esophageal cancer with a two out patient procedures has proven successful in accomplishing the principle objective of patients to improve the quality of life and reduce dysphagia as well as increase the survival rate (Ilson et al. 28). Although surgical excision is the principle treatment modality of esophageal cancer, it is not often applicable since majority of the patients, 80%, exhibit an advanced stage or unwillingness of the patient or even lack of expertise in surgical excision. The use of just radical external radiation is proven to result into just 6%, 5 year, rate of survival. This leaves 80% of the patients failing locally. Due to a 3 year rate of survival, there has been a significant consideration of concomitant chemoradiation as the standars approach for the unresectable esophageal cancer treatment. In spite of these improved results, the local and regional control of esophageal cancer is still very poor, in fact 48% of the patients fail locally only. Therefore, further improvement of esophageal cancer lies in the increment of biological response with the use of combined treatment modality optimally, that is intraluminal brachytherapy after a chemoradiation or just radiation only. Due to the rapid dose fall of and ability of intraluminal brachytherapy to deliver a high dose to esophageal cancer, intraluminal brachytherapy is used for local boost. Due to the limited time of treatment, ease of administration, better compliance by the patient, and high dose rate brachytherapy is preferred mostly. Because of the adverse events incidental with certain dose schedules, the dose per fraction and dose fraction in high dose rate brachytherapy of the esophageal cancer has remained an issue of great concern. Thus, this research study has been conducted to make certain that the overall survival rate for esophageal cancer patients improvies when chemotherapy is added as a concurrent treatment to intraluminal brachytherapy. Due to the study, it will also ascertain the improvement of the dysphagia free-survival as well as overall survival with chemotherapy or not. On the other hand, the paper will also illustrate the ability to tolerate treatment, toxicity, patterns, and complications such as strictures, ulcerations, tracheoesophageal fistulae, of reoccurrence (Heath EI et al. 97). Studies have ascertained that patients with locally advanced or recurrent esophageal cancer have indicated poor prognosis. Dysphagia relief is normally the goal of any further treatment. In order to alleviate dysphagia, several methods of treatment including prosthetic intubation, external beam irradiation, laser re-canalization, dilatation, and intraluminal brachytherapy can be used among diagnosed patients with esophageal cancer. In a study involving 11 patients, 3 newly diagnosed patients and 8 with recurrent tumor, were treated using a low dose intraluminal brachytherapy. Dysphagia relief was achieved in 9 patients. All these 9 patients were able to swallow a semi-solid food diet until the last follow up. Although there was a minimal toxicity, the rate of survival was poor, with a median of 3 months survival. This clearly indicates that intraluminal brachytherapy has various advantages compared to other methods of palliation, most especially in recurrent tumors in which there exists normal tissue tolerance making re-treatment very difficult. The intraluminal brachytherapy low dose rate take about 1 to 2 days to deliver, it is also very effective with very little morbidity. It achieves a relatively durable palliation. On the other hand, in unresectable esophageal cancer, the boost by brachytherapy after concurrent chemoradiation is feasible in patients with good and performance score of Karnofsky and are associated with acceptable toxicities. However, there is still a need for the standardization of schedules of the HDR brachytherapy with protocols of chemoradiation (Harpole et al. 564). Esophageal cancer has a tendency to present with some advanced diseases, and most of the patients are only suitable, at diagnosis, for palliative treatment. As stated earlier, dysphagia is the common symptom presented and undermines the quality of life significantly. However, high dose rate of intraluminal brachytherapy remains the option for dysphagia palliation for years and it has been used for quite some time now. Experience is normally presented in terms of dysphagia improvement and increase in the rate of survival. From the fact that esophageal cancer is among the most common cancers in the world, it has attracted much attention and endeavors to improve its treatment. This has however resulted into multiple clinical trials and experiments to ascertain the increase in rate of survival among the patieant. Today, the standard care of such patients experiencing early tumors is surgery and there may be no particular role of radiotherapy or chemotherapy. In addition, surgical treatment of patients in stage 2 with resectable tumors has been associated with very poor rate of survival due to the increased distant and regional lymph node metastases. Therefore, adjuvant chemotherapy should only be utilized in the clinical trials setting. The neoadjuvant chemo-radiotherapy role in resectable tumors patients is very controversial. Studies have also documented evidence that some of the patients with total response after application of chemo-radiotherapy do not have any benefit from further surgical treatment. Hence, the proper use of these varied interventions of therapy should be practiced at specialized centers only. Chemotherapy and radiation role has now been established in advanced inoperable disease locally. However, the best way to deliver these therapy modes is yet to be defined. In this case, prospective randomized trials are the only best way to define and decide on the best therapeutic strategies for varying patients with esophageal cancer. The responses to the combination of these treatments are likely to be improved by optimal protocols of radiotherapy, progress with new chemotherapy agents and innovations. These strategies may also minimize toxicity associated with the esophageal cancer. This paper hence suggest that future trials should assess indices of quality of life as the end points, which are of significant importance in the populations with approximately one year median survival. This is because patients with esophageal carcinoma in stage 4b have a less than six months life expectancy; hence strategies of palliative treatment should aim primarily on the improvement of symptoms related to tumor and maintenance of diet and nutrition (Govindan et al. 28). Although chemotherapy has been suggested as a palliative treatment for esophageal cancer, it is also associated with some side effects on the patients. Chemo drugs have an attack effect on the quickly dividing cells; this is why they act against cells of cancer. However, other body cells like those in the hair follicles, bone marrow, intestines and linings of the mouth also divide very fast. This cells therefore are likely to be impacted on by chemo, which may result into multiple side effects. These side effects however depend on specific used drugs, dose and length in time of the treatment. Some of the common effects of chemo may include: loss of appetite, nausea and vomiting, loss of hair, diarrhea, mouth sores, and low blood counts. Chemo normally impacts on the cells forming blood in the bone marrow. These results into low blood count, increased bleeding, increased chances of infection fatigue and breathe shortness. Some other chemo drugs such as docetaxel, cisplatin and paclitaxel cause nerve damage. This may result into problems with tingling, numbness, or even pain in the feet and hands. Cisplatin may also result into kidney damage and hearing loss. Epirubicin and doxorubicin can both lead to heart damage. However, once the treatment is stopped, majority of these side effects improve. It is hence important to note that, even though chemotherapy may be associated with increase in survival rates on average among esophageal cancer, treatment like radiation, chemo, and chemoradiation may lead to painful sores in the throat and mouth (Einzig et al. 1454). Brachytherapy has shown a pivotal role in esophageal cancer management with low complication rates. For the purposes of better individualization of the curative treatments, endoscopic ultrasound assisted treatment planning can be very significant. The esophageal cancer incidences in specific esophageal adenocarcinoma is largely increasing due to an increase in the adenocarcinoma risk factors.staging that is needed for the optimal patient selection to undergo esophageal resection when the esophageal cancer has been confirmed. However, neoadjuvant chemoradiation may be able to increase rate of survival after the surgery of the esophageal cancer. In addition, esophageal neoplasia is safe and effective, with good results being seen from an individualized approach using ablative therapy or mucosal endoscopic resection, or even both. Eventually, dysphagia from the esophageal cancer may be treated successfully with a single dose brachytherapy or stent placement (De Besi et al. 910). Nevertheless, future research need to establish whether the combinations of chemotherapy without or with radiotherapy contribute to survival rates, hence the motive of this research paper. Esophageal strictures are those problems encountererd commonly in the practice of gastroenterology and may be as a result of begnin or malignant lesions. Dysphagia is experienced by all patient however, regardless of wheter their strictures result from benign or malignant lesions. Brachytherapy and stent placement is the method that is commonly utilized for malignant esophageal stricture palliation, especially in patients with more than 3 months life expectancy and those who are expected to survive for 3 months or even less respectively. Brachytherapy has proved very beneficial among the esophageal cancer patients whose survival is expected to be more than 3 months regarding complications, improvement in dysphagia and quality of life. The treatment of the mainstay of benign esophageal strictures is dilation. Even though dilation often lead to symptomatic relief, there is still occurrence of recurrent strictures. To enable us predict the types of strictures which are likely to occur in most cases, it is vital to distinct between the simple esophageal strictures like straight, focal strictures with ability to allow the passage of endoscope through their diameter, and those complex esophageal strictures like the tortuous strictures which have narrow diameter. Thes esophageal strictures considered complex are refractory when they fail to dilate to a sufficient diameter. Incisional and temporary stent placement therapy are some of the novel modalities of treatment for those refractory strictures (Cunningham et al. 19). The other method that are used in efforts to cure or palliate esophageal neoplasms is the radiation therapy. However, the tolerance of radiation on the normal structures surrounding the oesophagus has restrictions in the dose of radiation that can easily be delivered. Experiences from various researches on overall survival rate for esophageal cancer patients improvement when chemotherapy is added as a concurrent treatment to intraluminal brachytherapy. Indicate that intraluminal brachytherapy is a safe and effective palliation method of dysphagia that results from the malignant esophageal stenosis. This has ascertained that there is improvement of the dysphagia free-survival as well as overall survival with chemotherapy or not. The same experience has also illustrated the ability to tolerate treatment, toxicity, patterns, and complications such as strictures, ulcerations, tracheoesophageal fistulae, of reoccurrence (Conroy et al. 164). Esophageal cancer is a fatal adenocarcinoma and malignancy of esophagus has an increase in incidence. Majority of patients present with advanced local metastatic or unresectable disease. The rate of survival (5 years) of esophageal cancer patients is less than 20%. Dysphagia is the common symptom presented by this disease and results into compromises in nutrition, deterioration of life quality, and pain. Palliation is a significant goal of the therapy of esophageal cancer. The severity of esophageal cancer is often measured by a dysphagia grade. This is because dysphagia is an fundamental component of the instrument of quality of life like the EORTC 24 and FACT-E. the investigation of dysphagia involves the study of radiography like Gastrografin or barium swallow, endoscopic ultrasonography, esophagogastroduodenoscopy, and other studies of staging for the esophageal cancer. Recent researches has detailed options of the current esophageal cancer management for the palliation of dysphagia. These include Nd:Yag laser therapy, esophageal dilation, photodynamic therapy, intraluminal stents, systemic chemotherapy, argon laser, brachytherapy, radiation therapy, external beam, and combined chemo-radiation therapy. The choice of the most appropriate and proper modality of treatment is dependent on the local expertise, the clinical situation, and cost effectiveness (Braybrooke et al. 295). These treatment modalities however possess various shortcomings and advantages. In the past five years, new innovations in palliative treatment of the incurable esophageal cancer have been introduced and developed with the goal of palliating dysphagia and increasing the rate of survival among patients. As the paper has discussed earlier, stent placement is the most widely applied treatment currently in the palliation of dysphagia from the cancer of oesophagus. Evidence has it that a stent provides relief rapidly in dysphagia. However, the rate of the present recurrent dysphagia varies between 30% and 40%. The recently acquired designs of stent are expected to minimize the recurrent dysphagia through reducing migration of stent and the overgrowth of the non tumoral tissue. Intraluminal brachytherapy has been illustrated to favorably compare with the stent placement in the long term safety and effectiveness. However, the disadvantage of brachytherapy is that 20% of patients often require additional treatment due to the unrelenting growth of tumor in the oesophagus. A solution to this may be to have brachytherapy administered not just in one fraction but in multiples of the same. Several attempts have been made to improve the rate of survival among patients through the use of chemotherapy. In the near future, there should be a multimodal approach of combining radiotherapy or chemotherapy with stent placement in order to improve the patient prognosis without compromising their life quality (Bhalla et al. 1726). A single dose brachytherapy is normally used modality of palliative treatment for esophageal cancer. However, a significant number of esophageal cancer patients require additional treatment for the recurrent or consistent dysphagia. Stenotic esophageal tumor patients who cannot be bypassed or those who were initially taken through chemotherapy are normally poor candidates for the use of chemotherapy of a single dose. For such kinds of patients, there should be a consideration of a fractionated or a higher dose of brachytherapy or other modalities of palliative treatment. Those patients who exhibit locally advanced disease, radiochemotherapy is known to show an improved pathologic and clinical tumor response and an improved rate of patient survival compared to radiotherapy alone or surgery. I addition, intraluminal brachytherapy with small size fraction enables an increased dose, without a high toxicity, to the tumor. Radiochemotherapy after esophagectomy could increase rates of survival compared to just a defined radiochemotherapy, however, it is vital to optimize the criteria of selection for surgery at the phase of re-evaluation. Evidence has shown that the major outcome parameters in the surgery of esophageal have been traditionally mortality and morbidity, however, the life quality has remained a significant consideration in the perspective of persistence and severity of the symptoms of postoperation. This research hence aims to discuss the overall survival rate for esophageal cancer patients improvement when chemotherapy is added as a concurrent treatment to intraluminal brachytherapy (Assersohn et al. 60). Progressive dysphagia though the most common symptom of the esophageal cancer, it may as well occur as an adverse effect of the esophageal cancer treatment. In order to evaluate dysphagia in patients, there should be a determination of its cause as well as assess its severity. There are various options of palliation for dysphagia. These have been mentioned earlier as the cost effectiveness, clinical circumstance, and the local expertise. These are then used in the determination of the proper treatment modality. The main aim of the palliative treatments majorly is to maintain an oral food intake, this is to stabilize and improve the life quality of the patients. Although stent placement provides relief for the dysphagia, the existing scientific evidence still suggests that anti-reflux stents be used for reasons of preventing gastro-esophageal reflux. In North America, photodynamic therapy is the commonly used treatment modality, however, because of the high treatment costs, the necessity of repeated treatment and the lasting adverse effects, photodynamic therapy is not an ideal palliative treatment of malignant dyspjagia. On the other hand, Nd:YAG laser has also been cited as a relatively safe and effective modality treatment. Even though laser treatment is as well expensive, difficult technically, it also requires repeated sessions of treatment at about an interval of 4 to 6 weeks. Palliative chemotherapy has provided a rate of response in recent clinical trials ranging between 35% and 50%. It has not been established yet whether palliative chemotherapy also leads to a survival benefit to the esophageal cancer patients. A measure of quality of life has hence remained a significant outcome measure for the clinical trials on the esophageal cancer palliation. Existing studies has it that specific cancer EORTC QLQ-C30 and specific esophageal cancer EORTC-OES-18 are the validated measurements of quality of life establishment. This research paper hence suggest that there should be an indication for a multimodality approach with brachytherapy or stent placement in combination with chemotherapy (Al-Batran et al. 24). Endoluminal palliation includes the utilization of the techniques of endoscopy or endoscopic devices for the relief of the symptoms of the obstruction of malignant gastrointestines. This is normally obtained through the use of self expendable metal stents. A high dose rate of brachytherapy for the advanced cancer of the oesophagus normally allows for the improvement, in majority of patients, of dysphagia. The partial or complete remission and the lower dysphagia grade that is observed in the initial month of the post-treatment makes the most vital factors of prognosis which allows for a lasting patient survival. A small tumor size, lower clinical stage and a higher performance of Karnofsky status are the significant prognostic prolonged survival factors. It has also been established that high dose rate brachytherapy allows for the treatment of superficial esophageal cancer patients with good tolerance. It is also evident that early tumors that are situated in the mucosa may be treated with a high dose rate brachytherapy alone or with a mixed treatment modality where a high dose rate brachytherapy may undertake a place like a boost. It is hence evident that this particular approach may be used to cure a localized recurrence. We can also assert from other studies that a combined brachytherapy and chemoradiotherapy boost obtained better control locally than just a mere radiotherapy. A recent study of the improvement of survival rate of patients with esophageal cancer under chemotherapy has detailed that the best modality for an advanced esophageal cancer palliation is a fractionated brachytherapy. This offers a good palliative treatment to the patients in comparison with the other treatment modalities being used currently. The recommended optimal brachytherapy dose in two fractions ranges between 16Gy and 18Gy in just 3 fractions administered a week apart (Ajani et al. 1087). The local control of the unresectable esophageal cancer has remained a pivotal problem despite the aggressive treatments. Chemotherapy, external beam radiation therapy, and a combined treatment modality have presented limited success with the treatment of esophageal cancer. The addition of the intracavitary brachytherapy to the external beam irradiation is tolerated well. It improves local control, and causes no significant toxicity. There are multiple variations in the treatment regimes, indications, and dosimetry for the brachytherapy in the esophageal cancer treatment. Researches has it that patients experiencing locally advanced or recurrent esophageal cancer have a poor prognosis. Any further treatment aims to improve relief of the dysphagia. Alleviation of dysphagia may be done through the use of intraluminal brachytherapy. Other methods may include dilation, laser re-canalization, external beam irradiation, and prosthetic intubation. In spite of the improvements in surgical and medical care, the patient prognosis has remained very pitiable. Most of the patients have hence remained the candidates for palliation rather than curative therapy. Most probably, surgery offers the most effective dysphagia palliation. However, surgery is normally associated with a high rate of morbidity. Many patients also remain unwilling to seek surgery due to the underlying medical problems associated with surgery. Because of the varying endoscopic palliation modalities, the therapy choice depends on the absence or presence of the fistula of the trachea-esophageal, the tumor location, and the prognosis projected for the esophageal cancer patients. For the inoperative esophageal cancer patients, expandable stents makes their treatment choice due to the relative safety and ease of their insertion. In addition, th other techniques of endoscopy are also useful as a compliment before the insertion of the expandable stent since they debulk the tumor (Airoldi et al. 20). In summary, attention should be given to the treatment modalities that increase the rate of patient survival. Therefore this research paper will be looking into chemotherapy as a necessary addition to increase the rate of survival among esophageal cancer patients. This is obviously needed in order to improve the quality of life of such patients. This paper has therefore detailed a literature review of the research paper. As stated earlier in the introduction part, this research paper has attempted to discuss the overall survival rate for esophageal cancer patients’ improvement when chemotherapy is added as a concurrent treatment to intraluminal brachytherapy. The major objective of this research study, to ascertain the improvement of the dysphagia free-survival as well as overall survival with chemotherapy or not, has also been addressed in this literature review. The paper has also illustrated the existing literature on the ability to tolerate treatment, toxicity, patterns, and complications such as strictures, ulcerations, tracheoesophageal fistulae, of reoccurrence (Webb et al. 260). 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