Interventions for dysphagia in oesophageal cancer

Sreedharan, Aravamuthan; Harris, Keith M.; Crellin, A.; Forman, David; Everett, Simon

doi:10.1002/14651858.cd005048.pub2

Cited by 69 publications

(36 citation statements)

References 92 publications

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“…18,19 However, a recently published Cochrane review on interventions for dysphagia concluded that there were no evidence of external radiotherapy providing better palliation of dysphagia than endoluminal interventions such as stent insertion or brachytherapy. 14 The lack of association between symptom relief and radiotherapy dose in our data is also in accordance with more recent studies demonstrating that relief of dysphagia might be independent of radiotherapy doses. [20][21][22] The only way to properly compare the treatment modalities is by performing adequately powered prospective randomized trials.…”

Section: Discussionsupporting

confidence: 93%

“…The literature supports that brachytherapy or stents alone would be sufficient to ensure palliation for the remaining lifetime for patients with expected survival Յ3 months. [11][12][13][14] The optimal treatment for patients in a palliative situation with longer life expectancy is under discussion. Stent insertion or laser evaporization alone is considered to be insufficient, 12,14 and only 5% (5/91) of our patients with 'long' survival received such treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] The optimal treatment for patients in a palliative situation with longer life expectancy is under discussion. Stent insertion or laser evaporization alone is considered to be insufficient, 12,14 and only 5% (5/91) of our patients with 'long' survival received such treatment. Even though there is a general agreement that the focus of palliative treatment of esophageal cancer patients is symptom relief, this subgroup of patients may benefit from more aggressive treatment.…”

Section: Discussionmentioning

confidence: 99%

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Palliative interventions and prognosis in patients with advanced esophageal cancer

Amdal

Jacobsen

Tausjø

et al. 2011

Diseases of the Esophagus

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In a retrospective review, in order to describe the palliative care and prognosis of patients with advanced cancer of the esophagus, the clinical characteristics and the treatment modalities applied were explored in relation to survival and symptom relief for 261 patients treated without curative potential. The data were obtained from a study of all patients with cancer of the esophagus treated at the Norwegian Radium Hospital in the 10-year period from 1990 to 1999. Medical data of the patients were reviewed and missing clinical information was retrieved from local hospitals and general practitioners. The patients were divided into three groups based upon the overall survival from start of treatment to death. Survival ≤3 months is in this paper, defined as 'short,' while survival > 6 months is defined as 'long.' Median survival for the total group of patients was 4 months. The 1-, 2-, and 3-year survival was 8%, 3%, and 1%, respectively. Patients with short survival (n= 107) had more advanced disease, lower performance status, and more dysphagia, weight loss, and pain and used more analgesics than patients with long survival (n= 91). Tumor characteristics such as localization, tumor length, and histology were not significantly associated with survival. This result was confirmed in a logistic regression analysis (with backward stepwise elimination) including sex, age, clinical stage, tumor length, tumor localization, histology, performance status, dysphagia, weight loss, and pain, where clinical stage, performance status, weight loss, and pain were included in the final model. A large variety of first-line palliative treatments were applied within the studied time period; external radiotherapy ± brachytherapy (n= 149), brachytherapy alone (n= 44), endoluminal stent (n= 28), laser evaporization (n= 8), chemotherapy (n= 5), and best supportive care only (n= 27). There were no clear differences in the effect on dysphagia between the modalities. Fourteen percent of the patients had treatment related complications. In conclusion, symptoms, performance status, and use of analgesics seemed to better prognosticate survival than tumor characteristics other than stage of disease. Our study reveals that knowledge about prognostic factors is crucial for the choice of palliative treatment. Even though all of the different treatment modalities seemed to provide relief of dysphagia, several other factors should be considered when deciding which treatment modality to offer. The time to onset of relief, duration of response, level of complications, and time spent in hospital should be a part of the decision-making process when selecting the appropriate treatment.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Palliative interventions and prognosis in patients with advanced esophageal cancer

Amdal

Jacobsen

Tausjø

et al. 2011

Diseases of the Esophagus

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“…Palliative treatment with self-expanding metal stents (SEMS) is regarded as a safe and highly effective procedure for relief of symptoms caused by malignant obstructions of the gastrointestinal (GI) tract [1–8]. Most studies concerning treatment with SEMS, whether randomized, comparative, or merely descriptive, focus on technical success (e.g., correct deployment of the stent), clinical success (restored passage), procedure-related complications, and cost-effectiveness.…”

mentioning

confidence: 99%

Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

et al. 2011

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BackgroundThe clinical effect of stent treatment has been evaluated by mainly physicians; only a limited number of prospective studies have used patient-reported outcomes for this purpose. The aim of this work was to study the clinical effect of self-expanding metal stents in treatment of malignant gastrointestinal obstructions, as evaluated by patient-reported outcomes, and compare the rating of the treatment effect by patients and physicians.MethodsBetween November 2006 and April 2008, 273 patients treated with SEMS for malignant GI and biliary obstructions were recruited from nine Norwegian hospitals. Patients and physicians assessed symptoms independently at the time of treatment and after 2 weeks using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire supplemented with specific questions related to obstruction.ResultsA total of 162 patients (99 males; median age = 72 years) completed both assessments and were included in the study. A significant improvement in the mean global health score was observed after 2 weeks (from 9 to 18 on a 0–100 scale, P < 0.03) for all stent locations. Both patients and physicians reported a significant reduction in all obstruction-related symptoms (>20 on the 0–100 scale, P < 0.006) after SEMS treatment. The physicians reported a larger mean improvement in symptoms than did the patients, mainly because they reported more severe symptoms before treatment.ConclusionSEMS treatment is effective in relieving symptoms of malignant GI and biliary obstruction, as reported by patients and physicians. The physicians, however, reported a larger reduction in obstructive symptoms than did the patients. A prospective assessment of patient-reported outcomes is important in evaluating SEMS treatment.

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“…Despite these potential limitations, the current consensus among many thoracic oncologic surgeons is that stents are a superior approach for achieving relief of dysphagia when compared to other palliative modalities [13]. …”

Section: Discussionmentioning

confidence: 99%

Gastric Outlet Obstruction Palliation: A Novel Stent-Based Solution

Rueth

Andrade

Groth

et al. 2010

Case Rep Gastroenterol

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Gastric outlet obstruction (GOO) after esophagectomy is a morbid outcome and significantly hinders quality of life for end-stage esophageal cancer patients. In the pre-stent era, palliation consisted of chemotherapy, radiation, tumor ablation, or stricture dilation. In the current era, palliative stenting has emerged as an additional tool; however, migration and tumor ingrowth are ongoing challenges. To mitigate these challenges, we developed a novel, hybrid, stent-based approach for the palliative management of GOO. We present a patient with esophageal cancer diagnosed with recurrent, metastatic disease 1 year after esophagectomy. She developed dehydration and intractable emesis, which significantly interfered with her quality of life. For palliation, we dilated the stenosis and proceeded with our stent-based solution. Using a combined endoscopic and fluoroscopic approach, we placed a 12-mm silicone salivary bypass tube across the pylorus, where it kinked slightly because of local tumor biology. To bridge this defect and ensure luminal patency, we placed a nitinol tracheobronchial stent through the silicone stent. Clinically, the patient had immediate relief from her pre-operative symptoms and was discharged home on a liquid diet. In conclusion, GOO and malignant dysphagia after esophagectomy are significant challenges for patients with end-stage disease. Palliative stenting is a viable option, but migration and tumor ingrowth are common complications. The hybrid approach presented here provides a unique solution to these potential pitfalls. The flared silicone tube minimized the chance of migration and impaired tumor ingrowth. The nitinol stent aided with patency and overcame the challenges of the soft tube. This novel strategy achieved palliation, describing another endoscopic option in the treatment of malignant GOO.

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Interventions for dysphagia in oesophageal cancer

Cited by 69 publications

References 92 publications

Palliative interventions and prognosis in patients with advanced esophageal cancer

Palliative interventions and prognosis in patients with advanced esophageal cancer

Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

Gastric Outlet Obstruction Palliation: A Novel Stent-Based Solution

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