Esophageal Metal Stents with Concurrent Chemoradiation Therapy for Locally Advanced Esophageal Cancer: Safe or Not?

Lu, Yueh‐Feng; Chung, Chen‐Shuan; Liu, Chao‐Yu; Shueng, Pei‐Wei; Wu, Lianghong; Hsu, Chen‐Xiong; Kuo, Deng‐Yu; Hou, Pei‐Yu; Chou, Hsiu‐Ling; Leong, Ka-I; How, Cheng‐Hung; Chou, San‐Fang; Wang, Li Ying; Hsieh, Chen‐Hsi

doi:10.1634/theoncologist.2017-0646

Cited by 17 publications

(15 citation statements)

References 39 publications

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“…In an observational study of 38 patients who received a stent and who were propensity-score matched to 152 patients who did not receive a stent, the stent group had worse oncologic outcomes including positive margins on resection (39% vs. 15%, P=0.04), shorter median time to recurrence (6.5 vs. 9 months, P=0.04), and worse 3-year survival (25% vs. 44%, P=0.02) (10). Esophageal stents have been associated with early life-threatening morbidity and higher mortality rates during concurrent neoadjuvant chemoradiation compared to no stent placement (11). In addition, radiation planning is affected by placement of self-expanding metallic stents (12), which cause radiation dose perturbations ranging from 0 to 30%.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following interventions to sustain body weight in esophageal cancer patients starting preoperative therapy: a retrospective cohort study

Velotta¹,

Dusendang²,

Kwak³

et al. 2021

J Thorac Dis

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Background: To improve nutritional status and dysphagia, esophageal cancer patients starting neoadjuvant therapy in advance of curative-intent surgery may receive a jejunostomy tube (J-tube) or esophageal stent, or they may be managed without a feeding modality. We examined percent total weight loss (%TWL), reinterventions, and progression to surgery in relation to these options. Methods: The retrospective cohort study included stage II-III esophageal cancer patients diagnosed during 2010-2017 who received J-tube, stent, or nutritional counseling only, without a procedure, when starting chemotherapy or combined modality chemoradiation. Data were obtained from the electronic medical record and chart review. We compared median %TWL between intervention groups and reinterventions using Chi-square and Kruskal-Wallis tests. Results: Among the 366 patients, median %TWL reached a nadir at 120 days, when it was 7% for patients with no procedure (N=307), 4% for J-tube (N=39), and 16% for stent (N=20) (P=0.01). Individual case analysis revealed 72-80% of the patients in the three groups started chemotherapy or chemoradiation as neoadjuvant curative-intent therapy (P difference=0.79). In J-tube patients, the reasons for intervention was anticipation of weight loss in 49% and mitigation of actual weight loss in 15%, whereas 95% of stent patients received the stent for dysphagia (P<0.001). A complication of the procedure was recorded in 85% of stent patients and 74% of J-tube patients (P<0.001). Among those who received no procedure initially, 25% received one later, compared with 15% of J-tube patients and 70% of stent patients who received a second procedure (P<0.001). Progression to surgery was observed in 65% of patients with no procedure, 51% of patients with J-tube, and 40% of stent patients, P=0.28). Conclusions: For stage II-III esophageal cancer patients starting chemotherapy, this study gives evidence that stents were associated with significant %TWL and risk of reintervention. Although J-tube patients returned to baseline weight sooner than those with no procedure, they experienced complications from their J-tubes. For esophageal cancer patients undergoing curative-intent treatment and with acceptable levels of weight loss, no procedure at all may be superior to placing a J-tube in terms of complications, weight loss, and progression to curative-intent surgery.

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Section: Discussionmentioning

confidence: 99%

Outcomes following interventions to sustain body weight in esophageal cancer patients starting preoperative therapy: a retrospective cohort study

Velotta¹,

Dusendang²,

Kwak³

et al. 2021

J Thorac Dis

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“…However, off-target RT may produce unexpected or unwanted biological effects (Shueng et al, 2009;Darby et al, 2013). For example, the increased scattering of low-dose irradiation by esophageal stent during treatment increases the risk of aortic pseudoaneurysm formation and the risk of perforating the esophagus (Hou et al, 2015;Lu et al, 2018). An additional 1 Gy of radiation increases the incidence of major coronary events by 7.4% in breast cancer patients receiving RT FIGURE 4 | (A) Mean bile concentration-time curves of 5-FDHU (•) in rat bile after 5-FU administration (100 mg/kg, iv) alone, 5-FU (100 mg/kg, i.v.)…”

Section: Discussionmentioning

confidence: 99%

Local Irradiation Modulates the Pharmacokinetics of Metabolites in 5-Fluorouracil—Radiotherapy–Pharmacokinetics Phenomenon

Liu

Tsai²,

Chen

et al. 2020

Front. Pharmacol.

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Background: The effects of radiotherapy (RT) on the pharmacokinetics (PK) of 5-FU and 5-fluoro-5,6-dihydro-uracil (5-FDHU) were investigated by animal experiments. Methods: Whole-pelvis RT with 0.5 and 2 Gy was delivered to Sprague-Dawley rats. 5-FU at 100 mg/kg was intravenously infused 24 h after radiation. The pharmacokinetics of 5-FU and 5-FDHU in the plasma and bile system were calculated. Results: The areas under the concentration versus time curve (AUC) of 5-FU in the plasma were reduced by local irradiation by 23.7% at 0.

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“…In cases of severe malnutrition from esophageal tumor obstruction, esophageal stent placement is increasingly used in the palliative setting and can lead to an immediate improvement of obstructive symptoms. While this may prevent the need for enteral nutrition, risks including esophageal fistula formation have been reported when stents were placed prior to chemoradiotherapy [ 27 ]. While these strategies hold promise, further prospective evaluation is necessary before standard use in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy

et al. 2020

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Background: Patients with esophageal cancer (EC) have high rates of malnutrition due to tumor location and treatment-related toxicity. Various strategies are used to improve nutritional status in patients with EC including oral and enteral support. Methods: We conducted a retrospective analysis to determine the impact of malnutrition and prophylactic feeding jejunostomy tube (FJT) placement on toxicity and outcomes in patients with localized EC who were treated with neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy. Results: We identified 125 patients who were treated with nCRT between 2002 and 2014. Weight loss and hypoalbuminemia occurred frequently during nCRT and were associated with multiple adverse toxicity outcomes including hematologic toxicity, nonhematologic toxicity, grade ≥3 toxicity, and hospitalizations. After adjusting for relevant covariates including the specific nCRT chemotherapy regimen received and the onset of toxicity, there were no significant associations between hypoalbuminemia, weight loss, or FJT placement and relapse-free survival (RFS) or overall survival (OS). FJT placement was associated with less weight loss during nCRT (p = 0.003) but was not associated with reduced toxicity or improved survival. Conclusions: Weight and albumin loss during nCRT for EC are important factors relating to treatment toxicity but not RFS or OS. While pretreatment FJT placement may reduce weight loss, it may not impact treatment tolerance or survival.

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Esophageal Metal Stents with Concurrent Chemoradiation Therapy for Locally Advanced Esophageal Cancer: Safe or Not?

Cited by 17 publications

References 39 publications

Outcomes following interventions to sustain body weight in esophageal cancer patients starting preoperative therapy: a retrospective cohort study

Outcomes following interventions to sustain body weight in esophageal cancer patients starting preoperative therapy: a retrospective cohort study

Local Irradiation Modulates the Pharmacokinetics of Metabolites in 5-Fluorouracil—Radiotherapy–Pharmacokinetics Phenomenon

Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy

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