[Palliative treatment of esophageal cancer with dysphagia: more favourable outcome from single-dose internal brachytherapy than from the placement of a self-expanding stent; a multicenter randomised study].
OBJECTIVE
To compare the results of single-dose internal irradiation (brachytherapy) and self-expanding metal stent placement in the palliation of oesophageal obstruction due to cancer of the oesophagus.


METHODS
Randomised trial.


METHODS
In the period from December 1999-Jun 2002, 209 patients with dysphagia due to inoperable carcinoma of the oesophagus were randomised to placement of an Ultraflex stent (n = 108) or single-dose (12 Gy) brachytherapy (n = 101). Primary outcome was relief of dysphagia; secondary outcomes were complications, persistent or recurrent dysphagia, health-related quality of life, and costs. Patients were followed up by monthly home visits from a specialised nurse.


RESULTS
Dysphagia improved more rapidly after stent placement than after brachytherapy, but long-term relief of dysphagia was better after brachytherapy. Stent placement resulted in more complications than did brachytherapy (36/108 (33%) versus 21/101 (21%); p = 0.02), due mainly to an increased incidence of late haemorrhage in the stent group (14 versus 5; p = 0.05). The groups did not differ with regard to the incidence of persistent or recurrent dysphagia or median survival (p > 0.20). In the long term, quality-of-life scores were higher in the brachytherapy group. Total medical costs were also similar for both treatments: Euro 8,215 for stent placement and Euro 8,135 for brachytherapy.


CONCLUSIONS
Brachytherapy provided better long-term relief of dysphagia than did stent placement and also produced fewer complications. Brachytherapy is therefore recommended as the preferred treatment for the palliation of dysphagia due to oesophageal cancer.
Homs
M Y V
MY
Afd. Maag-, Darm- en Leverziekten, Erasmus MC, locatie Dijkzigt, Postbus 2040, 3000 CA Rotterdam.
Steyerberg
E W
EW
Eijkenboom
W M H
WM
Tilanus
H W
HW
Stalpers
L J A
LJ
Bartelsman
J F W M
JF
van Lanschot
J J B
JJ
Wijrdeman
H K
HK
Mulder
C J J
CJ
Reinders
J G
JG
Boot
H
H
Aleman
B M P
BM
Kuipers
E J
EJ
Siersema
P 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