title: Endoscopic stenting and concurrent chemoradiotherapy for advanced esophageal cancer: a case-control study.
abstract: OBJECTIVE
  To evaluate the role of endoscopic stenting with or without concurrent 3-dimensional conformal chemoradiotherapy (3D-CRT) in patients with inoperable esophageal cancer.
  
  
  METHODS
  Advanced esophageal cancer patients indicated for esophagectomy received esophageal stents. A part of patients completed 3D-CRT after stenting. Efficacy was assessed by endoscopy and computed tomographic scan before and 4 wk after completion of the treatment. The median survival, 3D-CRT toxicity and complications were compared between 3D-CRT and control groups.
  
  
  RESULTS
  From 1999 to 2008, 99 consecutive patients with T3/T4 disease and unsuitable for esophagectomy were placed with esophageal stents. Sixty-seven patients received 3D-CRT, while 36 patients treated with endoscopic stents alone were recruited as controls. After 3D-CRT treatment, the median tumor volume of 3D-CRT patients were reduced significantly from 43.7 ± 10.2 cm³ to 28.8 ± 8.5 cm³ (P < 0.05). The complete and partial response rate was 85.1%, and no response was 14.9%. After 3D-CRT, the incidence rate of T2 and T3 disease evident on CT scan increased to 78.4% while T4 decreased from 66.7% to 21.6% (P < 0.05). 3D-CRT Karnofsky Performance Status improved in 3D-CRT patients compared with the control group (P = 0.031). 3D-CRT patients had a longer survival than the control group (251.7 d vs 91.1 d, P < 0.05). And the median half-year survival rate in 3D-CRT group (91%) was higher than in the control group (50%, P < 0.05). The most common toxicity was leukocytopenia in the 3D-CRT group (46.7% vs 18.8%, P = 0.008). The control group had a higher rate of restenosis than the 3D-CRT group (81.3% vs 9.0%, P < 0.05). The rate of nephrotoxicity was increased in 3D-CRT as compared with the control group (31.3% vs 15.6%, P < 0.05).
  
  
  CONCLUSIONS
  3D-CRT can improve dysphagia in patients with inoperable esophageal carcinoma. 3D-CRT combined with stenting results in better survival as compared with endoscopic stents used alone.
authors.affiliation: Department of Gastroenterology, Qingdao Municipal Hospital affiliated to Qingdao University, Qingdao 266011, Shandong Province, China.
authors.forename: Xiang-Jun
authors.initials: XJ
authors.lastname: Jiang
authors.forename: Ming-Quan
authors.initials: MQ
authors.lastname: Song
authors.forename: Yong-Ning
authors.initials: YN
authors.lastname: Xin
authors.forename: Yu-Qiang
authors.initials: YQ
authors.lastname: Gao
authors.forename: Zi-Yu
authors.initials: ZY
authors.lastname: Niu
authors.forename: Zi-Bin
authors.initials: ZB
authors.lastname: Tian
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000379:methods*; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome