A Controlled Trial of an Expansile Metal Stent for Palliation of Esophageal Obstruction Due to Inoperable Cancer

Knyrim, K.; Wagner, Hans‐Joachim; Bethge, N; Keymling, Michael; Vakil, Nimish

doi:10.1056/nejm199310283291803

Cited by 678 publications

(359 citation statements)

References 26 publications

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“…Most of our patients had a good PS before and after treatment. The change in the grade of dysphagia in our study was not different from those reported by other investigators (Knyrim et al, 1993;May et al, 1995;Wengrower et al, 1998). However, implantation of the metallic stent is unlikely to be curative in patients with severe dysphagia.…”

Section: Discussioncontrasting

confidence: 74%

“…In these results (Knyrim et al, 1993;May et al, 1995;Wengrower et al, 1998), the stent was placed successfully and dysphagia improved in approximately 90% of the patients. Furthermore, there seemed to be few fatal complications in the early postinsertion period, although late complications occurred in 22 -30% of the patients (Knyrim et al, 1993;May et al, 1995;Wengrower et al, 1998). The mean survival time was 4 -5 months after stent insertion.…”

Section: Discussionmentioning

confidence: 84%

“…However, the indication for metallic stent insertion in patients with malignant stricture caused by oesophageal carcinoma remains controversial. In one study, 21 patients with malignant oesophageal stricture received a self-expanding metallic stent, and all stents were placed successfully with no immediate severe complications (Knyrim et al, 1993). Dysphagia improved in 92% of their patients and the dysphagia score decreased from 3 to 1, while the mean survival time was 168 days.…”

Section: Discussionmentioning

confidence: 99%

“…The grade of dysphagia was determined by the dysphagia score as described previously (Mellow et al, 1985;Knyrim et al, 1993). A score of 0 denoted the ability to eat a normal diet, 1 denoted the ability to eat some solid food, 2 denoted the ability to eat semisolids only, 3 denoted the ability to swallow liquids only, and 4 denoted complete dysphagia, even to saliva.…”

Section: Evaluation Of Response and Toxicity Of Chemoradiotherapymentioning

confidence: 99%

“…Chemotherapy, radiotherapy, laser therapy, and stent insertion have been reported to relieve symptoms. Recently, metallic stents have become popular in the palliative treatment of patients with dysphagia caused by oesophageal carcinoma (Song et al, 1991;Bethge et al, 1992;Fleischer et al, 1992;Kozarek et al, 1992;Schaer et al, 1992;Knyrim et al, 1993;May et al, 1995;Wengrower et al, 1998). These stents can be inserted on an outpatient basis and provide rapid relief of symptoms of dysphagia.…”

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confidence: 99%

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Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus

et al. 2003

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We retrospectively investigated the efficacy and feasibility of concurrent chemoradiotherapy for patients with severe dysphagia caused by oesophageal squamous cell carcinoma. Concurrent chemoradiotherapy was performed in 57 patients with T3 or T4 disease containing M1 lymph node (LYM) disease. Chemotherapy consisted of protracted infusion of 5-fluorouracil (5-FU) 400 mg m À2 24 h À1 on days 1 -5 and 8 -12, combined with 2-h infusion of cisplatin (CDDP) 40 mg m À2 on days 1 and 8. Radiation treatment at a dose of 30 Gy in 15 fractions of the mediastinum was administered concomitantly with chemotherapy. A course schedule with 3-week treatment and a 1 to 2-week break was applied twice, with a total radiation dose of 60 Gy, followed by two or more courses of 5-FU and CDDP. In all, 24 patients (42%) achieved a complete response, and the 3-year survival rate was 19%. Major toxicities were leukocytopenia and oesophagitis, and there were two (4%) treatment-related deaths. In contrast, 22 patients with T3 disease survived longer than 35 patients with T4 disease (P ¼ 0.001); however, the survival rate in 15 patients with M1 LYM disease did not differ significantly from that in 42 patients without M1 LYM disease (P ¼ 0.3545). Our results indicate that definitive chemoradiotherapy is potentially curative for locally advanced oesophageal carcinoma with malignant stricture. The efficacy and survival of patients treated with this regimen are related to the T factor.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Evaluation Of Response and Toxicity Of Chemoradiotherapymentioning

confidence: 99%

mentioning

confidence: 99%

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Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus

et al. 2003

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Pretreatment staging by endoscopic ultrasonography does not predict complete response to neoadjuvant chemoradiation in patients with esophageal carcinoma

Mallery

DeCamp

Bueno

et al. 1999

Cancer

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BACKGROUND Endoscopic ultrasonography (EUS) provides highly accurate preoperative T and N classifications in patients with esophageal carcinoma. Although previous data have suggested that patients with tumors classified as T4 by EUS do not benefit from surgical resection, these data were acquired prior to the widespread use of preoperative chemoradiation. The current study investigated whether pretreatment EUS can predict a complete response to neoadjuvant therapy. METHODS Patients with esophageal carcinoma (adenocarcinoma or squamous cell carcinoma) underwent EUS classification prior to therapy. Patients classified as T2, T3, or T4 and M0 were treated with 5‐fluorouracil, cisplatin, and radiation under protocol. Patients with T1 lesions underwent resection without prior chemoradiation. Chemoradiation was followed in all cases by attempted surgical resection. The initial EUS classification was compared with the final pathologic results. RESULTS Fifty‐five patients (47 males and 8 females) with a mean age of 60.5 years (range, 31–78 years) were evaluated. There were 41 adenocarcinomas and 14 squamous cell carcinomas. Among the total population, a complete response was achieved in 3 of 5 patients (60%) with tumors classified as T2 by EUS, 14 of 42 patients (33%) with tumors classified as T3 by EUS, and 5 of 8 patients (63%) with tumors classified as T4 by EUS (P = 0.19). A complete response was achieved in 9 of 24 patients (38%) found to have N0 disease by EUS versus 13 of 30 patients (43%) determined to have N1 disease (P = 0.66). The results for patients with adenocarcinoma and squamous cell carcinoma were similar. CONCLUSIONS The results of the current study demonstrate that pretreatment EUS does not predict reliably which patients with esophageal carcinoma will achieve a complete pathologic response to preoperative neoadjuvant chemoradiation. Cancer 1999;86:764–9. © 1999 American Cancer Society.

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Concurrent chemoradiotherapy for esophageal carcinoma patients with malignant fistulae

Muto

Ohtsu

Miyamoto

et al. 1999

Cancer

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A Controlled Trial of an Expansile Metal Stent for Palliation of Esophageal Obstruction Due to Inoperable Cancer

Abstract: Expansile metal stents are a safe and cost-effective alternative to conventional plastic endoprostheses in the treatment of esophageal obstruction due to inoperable cancer.

Cited by 678 publications

References 26 publications

Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus

Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus

Pretreatment staging by endoscopic ultrasonography does not predict complete response to neoadjuvant chemoradiation in patients with esophageal carcinoma

Concurrent chemoradiotherapy for esophageal carcinoma patients with malignant fistulae

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