title: Radioactive self-expanding stents for palliative management of unresectable esophageal cancer: a systematic review and meta-analysis.
abstract: Stent insertion is a feasible and safe palliative management for advanced unresectable esophageal cancer. The aim of this study is to assess the efficacy of radioactive stent for unresectable esophageal cancer compared with conventional stent. Systematic searches of the PubMed and Web of science are dated from their beginning to January 25, 2016. Studies that compared radioactive stent with conventional stent for unresectable esophageal cancer were included. The outcomes were postimplantation survival, relief of dysphagia, and complications related to stent implant. Six studies with 539 patients were included. All of them used stent equipped with radioactive iodine beads as a radioactive stent. The pooled weighted mean difference for median survival was 2.734 months (95% CI 1.710-3.775; Z = 5.21, P = 0.000) between two groups. The 1,3,6 month survival rates were higher in radioactive stents than conventional stent, with the pooled ORs 3.216 (95% CI 1.293-7.999; Z = 2.51, P = 0.012), 3.095 (95% CI 1.908-5.020; Z = 4.58, P = 0.000), and 7.503 (95% CI 2.206- 25.516; Z = 3.23, P = 0.001, respectively). The pooled hazard ratio was 0.464 (95% CI 0.328-0.655; Z = 4.35, P = 0.000) between two groups. For relief of dysphagia, two stents all have good relief of the dysphagia effect, but radioactive stent showed a better effect at 3, 6 months follow-up after implantation. For complications related to stent implant, no significant differences were found between two stents in terms of severe chest pain (30.0% vs. 35.7%, OR 0.765, 95% CI 0.490-1.196), gastroesophageal reflux (18.6% vs. 16.1%, OR 1.188, 95% CI 0.453-3.115), fever (12.1% vs. 12.1%, OR 1.014, 95% CI 0.332-3.097), bleeding (16.7% vs. 14.2%, OR 1.201, 95% CI 0.645-2.236), perforation or fistula (6.1% vs. 9.0%, OR 0.658, 95% CI 0.291-1.486), pneumonia (10.7% vs. 14.1%, OR 0.724, 95% CI 0.343-1.526), stent migration (7.0% vs. 10.2%, OR 0.651, 95% CI 0.220-1.924), and restenosis (24.2% vs. 20.6%, OR 1.228, 95% CI 0.674-2.239). Radioactive stent insertion had potential benefits for palliative management for patients with unresectable esophageal cancer. This method prolonged survival and dysphagia relief period without more complications. However, this conclusion should be confirmed by more trials.
authors.affiliation: School of Nursing, Nantong University, Nantong, Jiangsu, China.
authors.forename: Hong-Lin
authors.initials: HL
authors.lastname: Chen
authors.affiliation: School of Nursing, Nantong University, Nantong, Jiangsu, China.
authors.forename: Wang-Qin
authors.initials: WQ
authors.lastname: Shen
authors.affiliation: Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D002637:Chest Pain / Q000209:etiology / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome
keywords: conventional stent; palliative management; radioactive stent; systematic review; unresectable esophageal cancer