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

Abstract

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.

Fluoroscopically-guided palliative stenting for the management of malignant oesophageal obstruction: A five year experience

“…We did not employ an objective scoring system for assessment of dysphagia, which has been utilised in previous studies. 6,10,18,20 However, the hospital notes were clearly indicative of whether SEMS was successful or not in relieving dysphagia. Further studies should include quality of life assessment tools, which may give rise measures of patient-assessed outcomes.…”

“…Brachytherapy is another effective palliation and sustained dysphagia relief is comparable to SEMS. 18,20,21 However, availability of brachytherapy is very limited in the UK and USA. 22 In future, combination treatments with stents and brachytherapy may become the mainstay of palliation and promising trials are underway.…”

“…22 In future, combination treatments with stents and brachytherapy may become the mainstay of palliation and promising trials are underway. 20,23,24 Oesophageal cancer is a debilitating illness with reports as high as 80% of patients presenting with weight loss. 25,26 This relates to actual dysphagia-related anorexia and cancer cachexia.…”

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

“…the editor Current Oncology June 20, 2012 hanna et al 1 investigated the improvement in dysphagia score (ds) in inoperable esophageal cancer treated with endoluminal stenting or radiation therapy. They defined ds ≤ 1 at the 10-week follow-up mark as acceptable resolution of dysphagia, and they claimed a statistically significant improvement in the whole sample and in both treatment groups.…”

Palliative Stenting With or Without Radiotherapy for Inoperable Esophageal Carcinoma

“…Of those approaches, endoluminal stenting and radiation therapy are the ones most commonly used. 4 In the past there have been attempts to combine radiotherapy with stent placement in patients with esophageal cancer. These efforts are based on the premise that radiotherapy and stenting complement each other.…”