Palliative therapy

Abstract

There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.

First-line treatment with oxaliplatin and capecitabine in patients with advanced or metastatic oesophageal cancer: a phase II study

“…Many patients with oesophageal cancer require palliative therapy to treat symptoms, such as dysphagia. Placement of a self-expanding metal stent, external beam radiotherapy, intraluminal radiotherapy (brachytherapy), and laser therapy are commonly used palliative modalities to treat dysphagia (Homs et al, 2005).…”

Influence of Negative Poisson′s Ratio on Stent Applications

“…Current stent technology guided delivery device to pass a compressed and constrained mesh stent across the area to be treated. Metal stents have become popular for the palliation of patients with malignant esophageal obstruction, especially patients with a poor prognosis [8][9][10][11]. At present more than 100 types of stent are available on the market [12], ified in accordance with their clinical use (vascular or nonvascular, coronary or peripheral).…”

Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer

“…In terms of nutritional support, the most important factor is maintenance of oral food intake, which should stabilize or even improve quality of life. Dysphagia improves more rapidly after stent placement [12,13] and long-term relief of dysphagia is better after brachytherapy [24,25] . Therefore, stent placement may be reserved for esophageal cancer patients with severe dysphagia in combination with a short life expectancy who need more rapid relief of dysphagia and for patients with persistent or recurrent tumor growth after The transilluminated area on the abdominal wall was pushed with a finger; B, C: The stomach was punctured using a double-lumen gastropexy device; D: A needle with an outer plastic sheath (18-French) was introduced into the stomach under endoscopic control; E: The needle was removed and the guidewire was replaced; F, G: The skin incision was dilated by passing a dilator percutaneously into the stomach over the guidewire under endoscopic visualization; H: After the dilator was removed, a 24-French percutaneous endoscopic gastrostomy tube using an obturator was inserted over the guidewire; I: The tube was fixed to the abdominal wall.…”

“…Direct method brachytherapy [12,13] . When these modalities are technically not possible, nutritional support with a nasoenteric feeding tube or PEG tube should be considered to maintain adequate calorie intake.…”

“…These patients require palliative treatment, including brachytherapy, chemotherapy and endoscopic palliation techniques, such as esophageal dilatation, intraluminal stents and laser therapy, to relieve progressive dysphagia [12,13] . The two most commonly used strategies for improving swallowing are stent insertion and radiation, including intraluminal brachytherapy.…”