Radioactive self-expanding stents for palliative management of unresectable esophageal cancer: a systematic review and meta-analysis

Abstract

Stent insertion is a feasible and safe palliative management for advanced unresectable esophageal cancer. The aim of this study is to assess the efficacy of radioactive stent for unresectable esophageal cancer compared with conventional stent. Systematic searches of the PubMed and Web of science are dated from their beginning to January 25, 2016. Studies that compared radioactive stent with conventional stent for unresectable esophageal cancer were included. The outcomes were postimplantation survival, relief of dysphagia, and complications related to stent implant. Six studies with 539 patients were included. All of them used stent equipped with radioactive iodine beads as a radioactive stent. The pooled weighted mean difference for median survival was 2.734 months (95% CI 1.710-3.775; Z = 5.21, P = 0.000) between two groups. The 1,3,6 month survival rates were higher in radioactive stents than conventional stent, with the pooled ORs 3.216 (95% CI 1.293-7.999; Z = 2.51, P = 0.012), 3.095 (95% CI 1.908-5.020; Z = 4.58, P = 0.000), and 7.503 (95% CI 2.206- 25.516; Z = 3.23, P = 0.001, respectively). The pooled hazard ratio was 0.464 (95% CI 0.328-0.655; Z = 4.35, P = 0.000) between two groups. For relief of dysphagia, two stents all have good relief of the dysphagia effect, but radioactive stent showed a better effect at 3, 6 months follow-up after implantation. For complications related to stent implant, no significant differences were found between two stents in terms of severe chest pain (30.0% vs. 35.7%, OR 0.765, 95% CI 0.490-1.196), gastroesophageal reflux (18.6% vs. 16.1%, OR 1.188, 95% CI 0.453-3.115), fever (12.1% vs. 12.1%, OR 1.014, 95% CI 0.332-3.097), bleeding (16.7% vs. 14.2%, OR 1.201, 95% CI 0.645-2.236), perforation or fistula (6.1% vs. 9.0%, OR 0.658, 95% CI 0.291-1.486), pneumonia (10.7% vs. 14.1%, OR 0.724, 95% CI 0.343-1.526), stent migration (7.0% vs. 10.2%, OR 0.651, 95% CI 0.220-1.924), and restenosis (24.2% vs. 20.6%, OR 1.228, 95% CI 0.674-2.239). Radioactive stent insertion had potential benefits for palliative management for patients with unresectable esophageal cancer. This method prolonged survival and dysphagia relief period without more complications. However, this conclusion should be confirmed by more trials.

Iodine‑125 seed radiation induces ROS‑mediated apoptosis, autophagy and paraptosis in human esophageal squamous cell carcinoma cells

“…Compared with external beam radiotherapy (EBRT) using single/fractionated high-dose-rate irradiation, 125 I seed brachytherapy has the advantages of easy preparation, direct contact with tumor tissue, less radiation to adjacent normal tissues and a higher relative biological effect (RBE) on tumor cells (8,9). A series of studies have reported that combination therapy of 125 I seed brachytherapy and stent placement shows good tumor control and survival benefits in patients with advanced esophageal cancer (10)(11)(12). However, to the best of our knowledge, there are no studies examining the mechanisms underlying the anti-cancer effects of 125 I seed radiation in ESCC.…”

Surface Modification of Esophageal Stent Materials by a Drug-Eluting Layer for Better Anti-Restenosis Function

“…Although the stent implantation may treat the stenosis and maintain the patency of the esophagus within a short time, the cancer microenvironment still exists and will induce esophageal lumen restenosis [32,33]. Thus, loading anti-cancer drug on the stents and endowing the stents strong anti-cancer properties via drug release after implantation became a preferable strategy for esophageal carcinoma treatment.…”

A viewpoint on material and design considerations for oesophageal stents with extended lifetime

“…For example, within the UK's National Health Service (NHS) SEMS are estimated to cost from £600-£800 ($820-$1090 USD) [26]. Whereas within China, the conventional self-expanding stents used are reported to cost just ¥2000 ($310 USD), with newer irradiated devices costing ¥4000 ($620 USD) [27]. Stenting therapy remains more affordable than alternative palliative therapies for dysphasia caused by oesophageal cancer, including LASER ablation, argon beam, and photodynamic therapy [28].…”