Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial

Bergquist, Henrik; Wenger, Urs; Johnsson, Erik L.; Nyman, Jan; Ejnell, Hasse; Hammerlid, Eva; Lundell, Lars; Ruth, Magnus

doi:10.1111/j.1442-2050.2005.00467.x

Cited by 156 publications

(98 citation statements)

References 34 publications

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“…However, patients who were treated with endoluminal stents had a clear advantage in terms of rapidity of symptom resolution. In a Swedish trial, Bergquist et al 13 showed that dysphagia scores (dss) and quality-of-life scores were better in the stent group than in the brachytherapy group at 1 month of follow-up. However, patients who survived more than 6 weeks showed far better outcomes with brachytherapy, especially in terms of recurrence of dysphagia, which was greater in the stent group because of migration and tumor ingrowth.…”

Section: Resultsmentioning

confidence: 99%

“…Although two randomized controlled trials comparing endoluminal stenting with brachytherapy have shown a certain advantage for brachytherapy in terms of long-term relief from dysphagia, those trials failed to address many important issues, including the lag time between diagnosis and treatment, the time spent in treatment, and the efficacy of combined-modality treatments with both stenting and radiotherapy 12,13 . We undertook the present study to shed light on some of those issues and to attempt to identify an ideal approach to this difficult clinical scenario.…”

Section: Discussionmentioning

confidence: 99%

“…The ds was measured using a previously validated 4-point Likert scale: 0, no dysphagia; 1, dysphagia to solids; 2, dysphagia to semi-solids; 3, dysphagia to liquids; 4, dysphagia to own saliva 13 . The ds was documented for every patient before onset of treatment and at 2-week intervals until the 10th week after initiation of treatment.…”

Section: Methodsmentioning

confidence: 99%

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What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

et al. 2012

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Background: The palliation of dysphagia in metastatic esophageal cancer remains a challenge, and the optimal approach for this difficult clinical scenario is not clear. We therefore sought to define and determine the efficacy of various treatment options used at our institution for this condition. Methods: We reviewed a prospective database for all patients managed in an esophageal cancer referral centre over a 5-year period. All patients receiving palliation of malignant dysphagia were reviewed for demographics, palliative treatment modalities, complications, and dysphagia scores (0 = none to 4 = complete). The Wilcoxon signed rank test was used to determine significance (p < 0.05). Results: During 2004–2009, 63 patients with inoperable esophageal cancer were treated for palliation of dysphagia. The primary treatment was radiotherapy in 79% (brachytherapy in 18 of 50; external-beam in 10 of 50; both types in 22 of 50), and stenting in 21%. Mean wait time from diagnosis to treatment was 22 days in the stent group and 54 days in the radiotherapy group (p = 0.003). Mean duration of treatment was 1 day in the stent group and 40 days in the radiotherapy group (p = 0.001). In patients treated initially by stenting, dysphagia improved within 2 weeks of treatment in 85% of patients (dysphagia score of 0 or 1). However, 20% of patients presented with recurrence of dysphagia at 10 weeks of treatment. In the radiotherapy group, the onset of palliation was slower, with only 50% of patients palliated at 2 weeks (dysphagia score of 0 or 1). However, long-term palliation was more satisfactory, with 90% of patients remaining palliated after 10 weeks of treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

et al. 2012

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“…This technique may be used alone or in combination with external beam radiotherapy with or without chemotherapy. The indication of brachytherapy is the treatment of superficial esophageal cancer for curative intent in Japan (local control rate: 79-85 %) [28][29][30][31][32][33][34]; on the other hand, it is used to relieve symptom such as dysphagia for palliative intent in the treatment of advanced esophageal cancer in Western countries [35,36]. Brachytherapy involves intraluminal placement of a radioactive source into the esophagus with an intraorally or intranasally inserted applicator.…”

Section: Brachytherapymentioning

confidence: 99%

Radiation Therapy

Ito¹

2014

Esophageal Squamous Cell Carcinoma

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Radiotherapy is indicated for the treatment of esophageal cancer both with curative intent and with palliative intent. Concurrent chemoradiotherapy is the standard treatment for patients in good condition who can receive chemotherapy, based on the result of randomized trial that compared chemoradiotherapy with radiotherapy alone. For locally advanced unresectable esophageal cancer, definitive chemoradiotherapy is the standard therapy with potentially curative intent. And for resectable esophageal cancer, definitive chemoradiotherapy is a treatment option in an attempt to preserve the esophagus from favorable results of clinical trials. These results are supported by salvage treatment in cases of residual or recurrent disease after chemoradiotherapy. However high mortality rate of salvage surgery and high incidence of late toxicities after chemoradiotherapy with higher radiation dose are important problems to be solved. Neoadjuvant chemoradiotherapy is standard treatment for locally advanced esophageal cancer in Western countries; however it is investigational in Japan. Combination chemotherapy of new agents and new radiotherapy technique such as intensity-modulated radiation therapy, protonbeam therapy, and heavy-particle radiotherapy have been evaluated in clinical trials to improve the treatment results including efficacy and toxicity.

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“…Although brachytherapy was found to be preferable, there are studies (such as Refs. [27,28]) suggesting the stent placement may play an important role for the palliation of disease. In that case, the prognostic models were used as evidence-based tools in decision making.…”

Section: Brachytherapy Of Esophageal Cancermentioning

confidence: 99%

Radiation Therapy for Esophageal Cancer

Buzurović¹,

Daróczi²,

O’Farrell³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer develops in the mucosa of the esophagus and spreads toward the muscle layer. The nonsurgical treatment for localized, deeply invasive esophageal cancer has been external beam radiation therapy (EBRT) and concurrent chemotherapy. Recently, intraluminal brachytherapy showed a strong potential for the improvement of the therapeutic ratio. It was found that the fractionated high dose rate (HDR) brachytherapy ofered beneicial palliation for a longer period of time with more durable symptom control. A similar was concluded for advanced unresectable esophageal cancer in previously irradiated patients. HDR brachytherapy may be a useful salvage treatment option for inoperable patients diagnosed with local esophageal cancer. Although beter local control can be achieved with higher brachytherapy dose, this increases the risk of acute morbidity and late morbidity, especially in the seting of recurrence cancer. It was found that the moderate dose of EBRT and HDR brachytherapy could give a beter local response than EBRT alone.

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Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial

Cited by 156 publications

References 34 publications

What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

Radiation Therapy

Radiation Therapy for Esophageal Cancer

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