A Combination of Self‑Expansile Metallic Stent and External Beam Radiotherapy in Management of Advanced Esophageal Carcinoma with Grade III Dysphagia and Beyond

ABSTRACT

Background and Objectives: Most of the patients of Esophageal Malignancy present in advanced stage. These patients receive palliative treatment. We wanted to evaluate whether combination of SEMS and RT improves the grade of dysphagia. Methods: 165 patients diagnosed with Advanced Esophageal Malignancy in middle third of Esophagus with grade III dysphagia were enrolled for the study. Demographic data, grade of dysphagia, improvement in the grade of dysphagia, complications and survival were studied. Follow up was done for a period of 1 year. Results: All patients grade of dysphagia improved from grade III- IV to grade I-II. One patient had stent migration. Thirty patients died in one year Followup. Conclusion: SEMS along with RT may provide survival benefit in advanced Esophageal Malignancy.

Keywords

Dysphagia - esophageal carcinoma - external beam radiotherapy - palliation - self‑expansile metallic stent

• References

• 1 Enzinger PC, Mayer RJ. Medical progress: Esophageal cancer. N Engl J Med 2003; 349: 2241-52
• 2 Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74-108
• 3 Kubba AK, Krasner N. An update in the palliative management of dysphagia. Eur J Surg Oncol 2000; 26: 116-29
• 4 Mason R. Palliation of oesophageal cancer. Surg Oncol 2001; 10: 123-6
• 5 Sugahara S, Ohara K, Yoshioka H. Improvement of swallowing function in patients with esophageal cancer treated by radiology. J Jpn Soc Cancer Ther 1996; 31: 1124-30
• 6 Weigel TL, Frumiento C, Gaumintz E. Endoluminal palliation for dysphagia secondary to esophageal carcinoma. Surg Clin North Am 2002; 82: 747-61
• 7 Allum W, Griffin S, Watson A, Colin-Jones D. Guidelines for the management of oesophageal and gastric cancer. Gut 2002; 50: v1-23
• 8 Bown SG. Palliation of malignant dysphagia: Surgery, radiotherapy, laser, intubation alone or in combination?. Gut 1991; 32: 841-4
• 9 O'Donnell CA, Fullarton GM, Watt E, Lennon K, Murray GD, Moss JG. et al. Randomized clinical trial comparing self-expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancer. Br J Surg 2002; 89: 985-92
• 10 Eldeeb H, El-Hadaad HA. Radiotherapy versus stenting in treating malignant dysphagia. J Gastrointest Oncol 2012; 3: 322-5
• 11 Watt E, Whyte F. The experience of dysphagia and its effect on the quality of life of patients with oesophageal cancer. Eur J Cancer Care (Engl) 2003; 12: 183-93
• 12 Ogilvie AL, Dronfield MW, Ferguson R, Atkinson M. Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy. Gut 1982; 23: 1060-7
• 13 Zhong J, Wu Y, Xu Z, Liu X, Xu B, Zhai Z. et al. Treatment of medium and late stage esophageal carcinoma with combined endoscopic metal stenting and radiotherapy. Chin Med J (Engl) 2003; 116: 24-8
• 14 Han YT, Peng L, Fang Q, Li Q. Value of radiotherapy and chemotherapy after SEMS implantation operation in patients with malignant esophageal stricture. Ai Zheng 2004; 23: 682-4
• 15 Slabber CF, Nel JS, Schoeman L, Burger W, Falkson G, Falkson CI. et al. A randomized study of radiotherapy alone versus radiotherapy plus 5-fluorouracil and platinum in patients with inoperable, locally advanced squamous cancer of the esophagus. Am J Clin Oncol 1998; 21: 462-5
• 16 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
• 17 Conio M, Repici A, Battaglia G, De Pretis G, Ghezzo L, Bittinger M. et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol 2007; 102: 2667-77
• 18 Song HY, Lee DH, Seo TS, Kim SB, Jung HY, Kim JH. et al. Retrievable covered nitinol stents: Experiences in 108 patients with malignant esophageal strictures. J Vasc Interv Radiol 2002; 13: 285-93
• 19 Yu YT, Yang G, Liu Y, Shen BZ. Clinical evaluation of radiotherapy for advanced esophageal cancer after metallic stent placement. World J Gastroenterol 2004; 10: 2145-6
• 20 Rueth NM, Shaw D, D'Cunha J, Cho C, Maddaus MA, Andrade RS. et al. Esophageal stenting and radiotherapy: A multimodal approach for the palliation of symptomatic malignant dysphagia. Ann Surg Oncol 2012; 19: 4223-8
• 21 Ramakrishnaiah VP, Malage S, Sreenath GS, Kotlapati S, Cyriac S. Palliation of dysphagia in carcinoma esophagus. Clin Med Insights Gastroenterol 2016; 9: 11-23