Expandable metal stents versus laser combined with radiotherapy for palliation of unresectable esophageal cancer: a prospective randomized trial.
OBJECTIVE
Because of the short life expectancy of patients with esophageal cancer, relief of dysphagia associated with low morbidity and mortality must be the aim of any therapeutic strategy.


METHODS
A total of 39 patients with unresectable esophageal cancer were randomly allocated to either receive combined laser-percutaneous radiotherapy (group 1, n = 21) or to have a self-expanding metal stent placed (group 2, n = 18). Some patients in group 2 required initial laser therapy (group 2a, n = 8). Treatment efficacy was evaluated on the basis of improved dysphagia, restenosis, hospital stay, survival time and costs.


RESULTS
Both treatments were able to significantly improve dysphagia. Restenosis occurred in 43% of group 1 and 22% of group 2 patients. In group 1, 2 patients had severe bleeding episodes and 2 patients developed esophago-tracheal fistulas. One group 1 patient died due to uncontrollable bleeding and 1 patient to recurrent aspiration. No treatment-related death was observed in group 2. Hospital stay was 30.0 (mean: 5.4) days in group 1, 18.9 (mean: 4.2) days in group 2a and 7.1 (mean: 3.1) days in group 2b. There was no statistical difference between the 3 groups with regard to survival. Costs were highest in group 1 and lowest in group 2b.


CONCLUSIONS
The treatment of unresectable esophageal cancer with self-expanding metal stents appears to be simple, safe, as good as laser combined with radiotherapy and cost efficient.
Königsrainer
A
A
Dept. of Surgery and Radiooncology, University Hospital, Innsbruck, Austria.
Riedmann
B
B
De Vries
A
A
Ofner
D
D
Spechtenhauser
B
B
Aigner
F
F
Fritsch
E
E
Margreiter
R
R
D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D053685:Laser Therapy; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D015607:Stents