ROCS study shows reduced bleeding in tumours treated with radiotherapy

The study has also shown that combining radiotherapy with stent placement in this vulnerable population doesn't improve swallowing further and the treatment is burdensome and as such it is best avoided for the majority of patients in this context.

Dr Dougal Adamson said, “Palliative radiotherapy did reduce the risk of bleeding and this is the first prospective study that we know of that has shown robust evidence of the impact of radiotherapy on tumour bleeding risk. This should however be reserved for the minority at highest risk of bleeding to minimize burden and optimize benefits.”

The ROCS study patient population were those with advanced oesophageal (gullet) cancer and average survival of 3-5 months, making them a vulnerable group. Significant difficulties with swallowing have an enormous impact on quality of life. In the UK a self-expanding stent placed in the gullet is the quickest way of improving swallowing. However, problems often arise after 10-12 weeks as the tumour grows into or around the stent and these patients end up in hospital and having further interventions just as they approach end of life.

The question for some time has been what else might be combined with stent and maintain swallowing functions for longer without significant additional burden to patients? Patients might be offered palliative chemotherapy which is often poorly tolerated and sometimes radiotherapy but the evidence for this is poor. The ROCS study therefore investigated if a combination of palliative (symptom controlling) radiotherapy with stent placement will improve swallowing as reported by patients, whilst looking carefully also at quality of life and the burden of treatment.

Dr Anthony Byrne said, “Our study shows how important it is to include patients in the palliative phase of their illness - with advanced disease - in clinical trials: they are rarely the focus of large scale studies despite the importance of such results to their care and quality of life. These patients and their families struggle with multiple psycho-social impacts of loss of eating and nutrition as well as the typical symptoms - which stent doesn't address; they have multiple hitherto unseen and therefore unmet needs that require earlier triggering of multi-disciplinary palliation.”

Involving 220 patients from 23 hospitals across the UK, the trial was sponsored by Velindre NHS University Trust and coordinated by the Centre for Trials Research at Cardiff University. It was jointly led by Dr Douglas Adamson from the Ninewells Hospital, Dundee and Dr Anthony Byrne, Consultant in Palliative Medicine at Cardiff and Vale University Health Board and Clinical Director Marie Curie Research Centre. The project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme.

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[1] Contributing Centres:

[2] Cancer Research UK. Oesophageal Cancer. Accessible: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/oesophageal-cancer