Combination of biodegradable stent placement and single-dose brachytherapy is associated with an unacceptably high complication rate in the treatment of dysphagia from esophageal cancer.
BACKGROUND
For the palliative treatment of dysphagia, esophageal stent placement provides immediate improvement, whereas brachytherapy offers better long-term relief.


OBJECTIVE
To evaluate safety and efficacy of concurrent brachytherapy and biodegradable stent placement.


METHODS
Prospective, single-arm study.


METHODS
Two tertiary-care referral centers.


METHODS
Nineteen consecutive patients with significant dysphagia resulting from unresectable esophageal cancer, with a life expectancy of more than 3 months.


METHODS
Single-dose brachytherapy (12 Gy) on day 1 followed by biodegradable stent placement on day 2.


METHODS
Intervention-related major complications (determined by an expert panel) and dysphagia.


RESULTS
Nineteen patients (13 men, median age 66 years [interquartile range (IQR) 59-71] years) were included; 7 patients (37%) also received palliative chemotherapy. After inclusion of 19 patients, the study was ended prematurely because the safety threshold was exceeded. In total, 28 major complications occurred in 17 patients (89%). In 9 patients (47%), major complications were determined intervention-related (severe retrosternal pain with or without vomiting [n = 6], hematemesis [n = 1], recurrent dysphagia [n = 2]. Dysphagia scores decreased significantly from a median of 3 (IQR 3-4) to a median of 1 (IQR 0-3) after 1 month (P < .001). Despite adequate luminal patency in 17 patients (89%), normal diet could not be tolerated in 7 patients (37%) because of retrosternal pain and vomiting.


CONCLUSIONS
Lack of routine endoscopy or contrast esophagram to evaluate recurrent dysphagia during follow-up.


CONCLUSIONS
Despite restoration of luminal patency, a combined treatment of brachytherapy and biodegradable stent placement cannot be recommended for the palliative treatment of esophageal cancer because of an unacceptably high intervention-related major complication rate.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands. M.M.C.Hirdes@umcutrecht.nl
Meike M C
MM
Hirdes
Jeanin E
JE
van Hooft
Harm K
HK
Wijrdeman
Maarten C C M
MC
Hulshof
Paul
P
Fockens
Onne
O
Reerink
Martijn G H
MG
van Oijen
Ingeborg
I
van der Tweel
Frank P
FP
Vleggaar
Peter D
PD
Siersema
D020341:Absorbable Implants / Q000009:adverse effects*; D059787:Acute Pain / Q000453:epidemiology / Q000209:etiology; D000230:Adenocarcinoma / Q000150:complications; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000150:complications; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology / Q000532:radiotherapy / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications*; D004945:Esophagoscopy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology