title: Chemotherapy versus self-expanding metal stent as primary treatment of severe dysphagia from unresectable oesophageal or gastro-oesophageal junction cancer.
abstract: OBJECTIVE
  To compare chemotherapy first (group 1) versus self-expanding metal stent first (group 2) for the management of malignant dysphagia in unresectable oesophageal or gastro-oesophageal junction cancer.
  
  
  METHODS
  Patients from two university hospitals with severe malignant dysphagia (dysphagia score ≥ 2) uneligible for surgery or radiochemotherapy were evaluated retrospectively.
  
  
  RESULTS
  Forty-two patients were included in group 1, and 29 in group 2. After 4 weeks, dysphagia scores improved by at least 1 point in 67% of patients in group 1 versus 93% in group 2 (p=0.01); 48% of patients in group 1 were able to eat solid food versus 68% in group 2 (p=0.054). In group 1, a self-expanding metal stent was secondarily placed in 18 patients (42.9%), whereas in group 2 dysphagia required a second self-expanding metal stent placement in 33.3% of patients.
  
  
  CONCLUSIONS
  Chemotherapy as the first treatment may be a valid option, avoiding self-expanding metal stent insertion in half of the patients.
authors.affiliation: Institut des Maladies de l'Appareil Digestif, Gastrointestinal Oncology Unit, University Hospital, Nantes Cedex 1, France. Electronic address: yann.touchefeu@chu-nantes.fr.
authors.forename: Yann
authors.initials: Y
authors.lastname: Touchefeu
authors.affiliation: Institut des Maladies de l'Appareil Digestif, Gastrointestinal Oncology Unit, University Hospital, Nantes Cedex 1, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Archambeaud
authors.affiliation: Department of Gastroenterology, Hôpital européen Georges Pompidou, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Landi
authors.affiliation: Medical Oncology Department, René Huguenin Hospital, Institut Curie, Saint-Cloud, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: Lièvre
authors.affiliation: Department of Gastroenterology, Hôpital européen Georges Pompidou, Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Lepère
authors.affiliation: Department of Gastroenterology, Hôpital européen Georges Pompidou, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rougier
authors.affiliation: Medical Oncology Department, René Huguenin Hospital, Institut Curie, Saint-Cloud, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mitry
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D004943:Esophagogastric Junction; D004945:Esophagoscopy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005773:Gastroscopy; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008670:Metals; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010166:Palliative Care; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents
chemical_list: D008670:Metals; D009944:Organoplatinum Compounds; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil
keywords: Chemotherapy; Dysphagia; Oesophageal neoplasms; Stents