title: Self-expandable metallic stents for patients with recurrent esophageal carcinoma after failure of primary chemoradiotherapy.
abstract: BACKGROUND
  Recent advances in chemoradiotherapy for esophageal carcinoma have resulted in improved survival rates. However, there are few options for recurrent dysphagia due to refractory carcinoma after failure of primary chemoradiotherapy. The aim of this study was to evaluate the safety and efficacy of self-expandable metallic stent placement for patients with recurrent esophageal carcinoma where definitive chemoradiotherapy has failed.
  
  
  METHODS
  Thirteen consecutive patients with recurrent squamous cell carcinoma of the esophagus, in whom self-expandable metallic stents were placed after failure of primary chemoradiotherapy, were studied retrospectively. All patients had esophageal obstruction or malignant fistula.
  
  
  RESULTS
  The oral alimentation status of nine of 13 patients (69%) improved after successful placement of the stent. Following placement of the stent, fever (>38 degrees C) and severe chest pain occurred in 85% (11/13) of the patients. In all patients examined, C-reactive protein was elevated within 1 week of the operation. Esophageal perforation occurred in three patients. Stent-related mediastinitis and pneumonia developed in six (46%) and three (23%) patients, respectively. Seven of the 13 patients (54%) died of stent-related pulmonary complications.
  
  
  CONCLUSIONS
  Although the placement of a self-expandable metallic stent for patients with recurrent esophageal carcinoma after failure of chemoradiotherapy improved their oral alimentation status, we found that this treatment increases the risk of life-threatening pulmonary complications.
authors.affiliation: Department of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. mmuto@east.ncc.go.jp
authors.forename: M
authors.initials: M
authors.lastname: Muto
authors.forename: A
authors.initials: A
authors.lastname: Ohtsu
authors.forename: Y
authors.initials: Y
authors.lastname: Miyata
authors.forename: Y
authors.initials: Y
authors.lastname: Shioyama
authors.forename: N
authors.initials: N
authors.lastname: Boku
authors.forename: S
authors.initials: S
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D017211:Treatment Failure
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine