Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial.
BACKGROUND
Both single-dose brachytherapy and self-expanding metal stent placement are commonly used for palliation of oesophageal obstruction due to inoperable cancer, but their relative merits are unknown. We undertook a randomised trial to compare the outcomes of brachytherapy and stent placement in patients with oesophageal cancer.


METHODS
Nine hospitals in the Netherlands participated in our study. Between December, 1999, and June, 2002, 209 patients with dysphagia from inoperable carcinoma of the oesophagus or oesophagogastric junction were randomly assigned to stent placement (n=108) or single-dose (12 Gy) brachytherapy (n=101), and were followed up after treatment. Primary outcome was relief of dysphagia during follow-up, and secondary outcomes were complications, treatment for persistent or recurrent dysphagia, health-related quality of life, and costs. Analysis was by intention to treat.


RESULTS
Nine patients (six [brachytherapy] vs three [stent placement]) did not receive their allocated treatments. None was lost to follow-up. Dysphagia improved more rapidly after stent placement than after brachytherapy, but long-term relief of dysphagia was better after brachytherapy. Stent placement had more complications than brachytherapy (36 [33%] of 108 vs 21 [21%] of 101; p=0.02), which was mainly due to an increased incidence of late haemorrhage (14 [13%] of 108 vs five [5%] of 101; p=0.05). Groups did not differ for persistent or recurrent dysphagia (p=0.81), or for median survival (p=0.23). Quality-of-life scores were in favour of brachytherapy compared with stent placement. Total medical costs were also much the same for stent placement (8215) and brachytherapy (8135).


CONCLUSIONS
Despite slow improvement, single-dose brachytherapy gave better long-term relief of dysphagia than metal stent placement. Since brachytherapy was also associated with fewer complications than stent placement, we recommend it as the primary treatment for palliation of dysphagia from oesophageal cancer.
Homs
Marjolein Y V
MY
Department of Gastroenterology and Hepatology, Erasmus MC/University Medical Centre Rotterdam, Rotterdam, Netherlands.
Steyerberg
Ewout W
EW
Eijkenboom
Wilhelmina M H
WM
Tilanus
Hugo W
HW
Stalpers
Lukas J A
LJ
Bartelsman
Joep F W M
JF
van Lanschot
Jan J B
JJ
Wijrdeman
Harm K
HK
Mulder
Chris J J
CJ
Reinders
Janny G
JG
Boot
Henk
H
Aleman
Berthe M P
BM
Kuipers
Ernst J
EJ
Siersema
Peter D
PD
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D010166:Palliative Care; D011788:Quality of Life; D012008:Recurrence; D015607:Stents / Q000009:adverse effects
D008670:Metals