Implantation of self-expanding metallic stent for patients with malignant stricture after failure of definitive chemoradiotherapy for T3 or T4 esophageal squamous cell carcinomas.
OBJECTIVE
Definitive chemoradiotherapy can have curative potential in unresectable patients with malignant stricture due to locally advanced esophageal carcinoma, however, dysphagia is the principal problem in patients who had recurrence or who did not respond to chemoradiotherapy. In this prospective study, we investigated the efficacy and feasibility of metallic stent implantation for patients with dysphagia after chemoradiotherapy failed.


METHODS
Concurrent chemoradiotherapy was performed in 40 patients with severe dysphagia due to esophageal squamous cell carcinomas accompanied by T3 or T4 disease containing M1 lymph node (LYM) disease. A self-expanding metallic stent was inserted for patients with malignant stricture of the thoracic esophagus after failure of chemoradiotherapy using identical protocols.


RESULTS
Of 40 patients, 13 (33%) achieved a complete response. However, 12 patients complained of severe dysphagia again after chemoradiotherapy despite a good performance status. Esophageal stricture of these 12 patients was caused by stable disease (n = 4), local progression (n = 5), and compression of metastatic lymph node (n = 3). Metallic stents were successfully inserted for all 12 patients, and dysphagia improved in 10 (83%) of these 12 patients. Life-threatening complication (17%) of sepsis in two patients was found in an early phase after stent insertion, although approximately 200 days had passed in a dysphagia-free state after chemoradiotherapy.


CONCLUSIONS
Implantation of self-expanding metallic stent for patients with malignant stricture after failure of chemoradiotherapy is effective, however, serious complication can occur in the early phase.
Kaneko
Kazuhiro
K
Second Department of Internal Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. gikaneko@med.showa-u.ac.jp
Ito
Hiroaki
H
Konishi
Kazuo
K
Kurahashi
Toshinori
T
Katagiri
Atsushi
A
Katayose
Kohzo
K
Kitahara
Tadashi
T
Ohtsu
Atsushi
A
Mitamura
Keiji
K
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D003251:Constriction, Pathologic; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D017211:Treatment Failure
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil