title: Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer.
abstract: Obstructing esophageal cancer produces severe dysphagia with ensuing death within 90 days. Palliation is possible with modalities like stent placement, laser, and photodynamic therapy. However, these treatments have a high rate of complications, and the overall mortality is not altered. A new alternative treatment evaluated in this study is endoscopic intratumoral injection with cisplatin/epinephrine (CDDP/epi) gel. CDDP/epi gel injections were administered weekly for 3 to 8 weeks in nine patients, median age, 72 years; mean tumor volume (+/-SEM), 41.44 (+/-22.4) cm3. Eight patients had stage IV, and one had stage III esophageal carcinoma. The mean dysphagia score (+/-SEM) was 3.5 (+/-0.17). All patients were followed up until death. Dysphagia resolved in eight patients with reduction in mean dysphagia score (+/-SEM) from 3.5 (+/-0.17) to 0.75 (+/-0.28; p = 0.005). Tumor volume was reduced by 75% in one patient and by 50% in two patients. The median survival was 4 months. The longest follow-up has been 15 months (458 days). In this pilot study, intratumoral injection of CDDP/epi gel restored swallowing in eight of nine patients and was an effective and safe outpatient treatment in patients with obstructive esophageal cancer.
authors.affiliation: Department of Gastroenterology/Development and Molecular Biology, Department of Veterans Affairs Medical Center, Washington, DC 20422, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Monga
authors.forename: R
authors.initials: R
authors.lastname: Wadleigh
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.forename: H
authors.initials: H
authors.lastname: Adib
authors.forename: D
authors.initials: D
authors.lastname: Strader
authors.forename: G
authors.initials: G
authors.lastname: Singh
authors.forename: J W
authors.initials: JW
authors.lastname: Harmon
authors.forename: M
authors.initials: M
authors.lastname: Berlin
authors.forename: D K
authors.initials: DK
authors.lastname: Monga
authors.forename: L
authors.initials: L
authors.lastname: Mishra
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy*; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage*; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D016503:Drug Delivery Systems; D004837:Epinephrine / Q000008:administration & dosage*; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy; D005500:Follow-Up Studies; D005782:Gels; D006801:Humans; D015552:Injections, Intralesional; D017567:Karnofsky Performance Status; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D010865:Pilot Projects; D015996:Survival Rate; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D000970:Antineoplastic Agents; D005782:Gels; D014662:Vasoconstrictor Agents; D002945:Cisplatin; D004837:Epinephrine