New developments in palliative therapy.
Over the past 5 years, new developments in the palliative treatment of incurable cancer of the oesophagus and gastro-oesophageal junction have been introduced with the aim of palliating dysphagia and improving the survival of patients. Stent placement is currently the most widely used treatment for palliation of dysphagia from oesophageal cancer. A stent offers rapid relief of dysphagia; however, current recurrent dysphagia rates vary between 30 and 40%. Recently introduced new stent designs are likely to reduce recurrent dysphagia by decreasing stent migration and non-tumoral tissue overgrowth. Intraluminal radiotherapy (brachytherapy) has been demonstrated to compare favourably with stent placement in long-term effectiveness and safety. A disadvantage of brachytherapy, however, is that one-fifth of patients need an additional treatment because of persistent tumour growth in the oesophagus. A solution may be to administer brachytherapy not in a single fraction but in multiple fractions. Finally, efforts have been undertaken to improve survival of patients by using chemotherapy. In the future, a multimodal approach--for example by combining stent placement with chemotherapy or radiotherapy--may improve the prognosis of patients without jeopardizing their quality of life.
Siersema
Peter D
PD
Chief of Endoscopy, Head of the Gastrointestinal Oncology Program Department of Gastroenterology and Hepatology, Room Hs-512, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. p.siersema@erasmusmc.nl
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004937:Esophageal Fistula / Q000209:etiology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications / Q000628:therapy*; D004943:Esophagogastric Junction / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D004945:Esophagoscopy; D006801:Humans; D020360:Neoadjuvant Therapy; D010166:Palliative Care / Q000379:methods* / Q000639:trends; D011474:Prosthesis Design; D018714:Radiotherapy, Adjuvant; D015607:Stents
D000970:Antineoplastic Agents; D020099:Coated Materials, Biocompatible