Self-expandable esophageal stent loaded with 125I seeds: initial experience in patients with advanced esophageal cancer.
OBJECTIVE
To prospectively compare the response to treatment with a self-expandable esophageal stent loaded with iodine 125 ((125)I) seeds for intraluminal brachytherapy versus the response to treatment with a conventional self-expandable covered stent in patients with advanced esophageal cancer.


METHODS
The study protocol was approved by the institutional ethics committee, and informed consent was obtained from each patient. Patients from one institution who had dysphagia caused by inoperable esophageal cancer were randomly assigned to receive treatment with a stent loaded with (125)I seeds (irradiation stent group) or a conventional covered stent (control group). After stent implantation, the outcomes were measured in terms of relief of dysphagia, survival time, and complications related to the procedure. Dysphagia was assigned a grade. A P value of less than .05 was considered to indicate a significant difference.


RESULTS
The stent was successfully placed in the diseased esophagus in all 53 patients (27 patients in the irradiation stent group and 26 patients in the control group). The dysphagia grades significantly improved in both groups within the 1st month after stent placement but were better in the irradiation stent group than in the control group after 2 months (P < .05). The median and mean survival times were better in the irradiation stent group than in the control group, and the differences were significant (P < .001). Hemorrhage occurred in 16 (30%) patients in both groups combined during follow-up.


CONCLUSIONS
In patients with advanced esophageal cancer, treatment with an esophageal stent loaded with (125)I seeds, compared with that with a conventional covered stent, has potential benefit in that it allows a slightly longer relief of dysphagia and extended survival.
Guo
Jin-He
JH
Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
Teng
Gao-Jun
GJ
Zhu
Guang-Yu
GY
He
Shi-Cheng
SC
Fang
Wen
W
Deng
Gang
G
Li
Guo-Zhao
GZ
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D003287:Contrast Media; D003680:Deglutition Disorders; D004938:Esophageal Neoplasms / Q000532:radiotherapy*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D015641:Radiography, Interventional; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome
D003287:Contrast Media; D007457:Iodine Radioisotopes; D007472:Iohexol