A randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma

doi:10.1067/mge.2001.118947

Gastrointestinal Endoscopy

Volume 54, Issue 5, November 2001, Pages 549-557

https://doi.org/10.1067/mge.2001.118947 Get rights and content

Abstract

Background: Expandable metal stent insertion and thermal tumor ablation (TTA) both improve dysphagia in patients with advanced esophageal cancer, but no direct comparison study of their efficacy on health-related quality of life has been published. The aim of this study was to compare survival, relief of dysphagia, quality of life, and cost in patients treated by thermal ablation or stent insertion. Methods: Sixty-five patients with histologically proven, inoperable esophageal and esophagogastric cancer were initially assessed by endoscopy, barium contrast radiography, and CT of the thorax and abdomen. Dysphagia and quality of life were serially assessed at monthly intervals. Patients were randomized to either repeated TTA or insertion of an expandable metal stent. Results: Median survival was significantly longer for patients who underwent TTA; 125 days (17-546) versus 68 days (8-602) for those in whom a stent was inserted (p < 0.05), although relief of dysphagia was disappointing in both groups. Several patients in both groups had serious treatment-related complications and required further therapy. Median length of hospital stay and cost were greater for patients treated by TTA. Health-related quality of life was globally impaired in both groups at randomization and deteriorated significantly in the stent group. Pain was reported more commonly by patients with stents. Conclusions: The palliation of patients with advanced esophageal and esophagogastric cancer remains unsatisfactory. Health-related quality of life deteriorated in the stent group but not in the TTA group. Patients treated by TTA live longer than patients treated by stent insertion, but the cost of TTA is higher. (Gastrointest Endosc 2001;54:549-57.)

Section snippets

Patients and methods

Sixty-five patients referred for palliative treatment of dysphagia caused by esophageal or esophagogastric cancer were recruited. All had been assessed by a gastroenterologist and upper GI surgeon who agreed that resectional surgery was inappropriate because of locally advanced disease (5 TTA and 6 stent patients), metastases (21 TTA and 17 stent patients), or severe comorbidity (8 patients in each group). Exclusion criteria were as follows: extremely short predicted life expectancy based on

Results

Thirty-four patients were randomized to TTA and 31 to stent insertion. The median age of the 2 groups, median dysphagia score, and tumor characteristics of the 2 groups were similar at the time of initial therapy (Table 1).

. Characteristics of patients undergoing stent or ablative therapy

Characteristics	TTA (n = 34)	Stent (n = 31)
Male	18	15
Median age, y (range)	75 (49-90)	77 (54-90)
Median pretreatment dysphagia score (range)	2 (0-3)	2 (1-4)
Site of stricture
Distal	26	23
Mid	8	7
Proximal	0	1
Histology
Squamous cell

Discussion

The aims of palliation in patients with advanced esophageal cancer are to overcome dysphagia and optimize quality of life by using interventions that have minimal complications. Our series, like all others, has demonstrated that this is difficult to achieve. Relief of dysphagia was disappointing and similar in patients treated by TTA or stent insertion. Most patients reported no change in overall quality of swallowing 1 month after intervention and those who survived for several months also

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^☆: Reprint requests: Helen J. Dallal, MD, GI Unit, Western General Hospital, Crewe Rd., Edinburgh, EH4 2XU United Kingdom.

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Original ArticlesA randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma☆

Abstract

Section snippets

Patients and methods

Results

Discussion

Gastrointest Endosc

Am J Surg

Gastroenterology

Eur J Cancer

Gastrointest Endosc

Soc Sci Med

A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer

N Engl J Med

Metal stents improve dysphagia, nutrition and survival in malignant esophageal stenosis: a randomised controlled trial comparing modified Gianturco Z-stents with plastic Atkinson tubes

Eur J Gastroenterol Hepatol

Palliation of esophageal carcinoma using the argon beam coagulator

Br J Surg

Laser recanulization versus endoscopic intubation in the palliation of malignant dysphagia: a randomized prospective study

Br J Surg

Palliation of inoperable esophageal cancer: a prospective randomized trial of laser therapy and stent placement

Radiology

Original Articles
A randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma☆