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Published in: World Journal of Surgical Oncology 1/2016

Open Access 01-12-2015 | Research

Comparative study of self-expanding metal stent and intraluminal radioactive stent for inoperable esophageal squamous cell carcinoma

Authors: Dong Tian, Hongying Wen, Maoyong Fu

Published in: World Journal of Surgical Oncology | Issue 1/2016

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Abstract

Background

We compared the effectiveness of self-expanding metal stent alone vs. radioactive stent embedded with 125I seeds implantation insertion in patients of inoperable esophageal squamous cell cancer combined with malignant esophageal stenosis.

Methods

We studied two groups of patients with stenosis attribute to inoperable esophageal squamous cell carcinoma. Group A had placed self-expanding metal stent alone insertion; group B encountered radioactive stent embedded with 125I seeds. Patients were followed up by monthly home visits or telephone interview. Survival time was analyzed with Kaplan-Meier analysis. Log rank test was used to analyze factors of survival time for all significant differences.

Results

There was no significant difference between the two groups of all baseline characteristics. There was no statistical difference in complications including massive hematemesis, pain more than 1 month, stent migration, and restenosis. Survival time and causes of death such as tumor metastasis, massive hemorrhage, non-tumor-related factors, and restenosis were comparable between the two groups (P > 0.05). The medical costs were significantly less in group A than those in group B (P < 0.01).

Conclusions

Radioactive stent embedded with 125I seeds was not significant in improving survival rate, but showed to increase hospitalization costs compared to self-expandable metal stent alone in treating inoperable esophageal squamous cell carcinoma stricture.
Literature
2.
go back to reference Park JG, Jung GS, Oh KS, Park SJ. Double-layered PTFE-covered nitinol stents: experience in 32 patients with malignant esophageal strictures. Cardiovasc Intervent Radiol. 2010;33(4):772–9. doi:10.1007/s00270-009-9718-0. Epub 2009 Sep 29.CrossRefPubMed Park JG, Jung GS, Oh KS, Park SJ. Double-layered PTFE-covered nitinol stents: experience in 32 patients with malignant esophageal strictures. Cardiovasc Intervent Radiol. 2010;33(4):772–9. doi:10.​1007/​s00270-009-9718-0. Epub 2009 Sep 29.CrossRefPubMed
3.
go back to reference Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer. 2001;37 Suppl 8:S4–66.CrossRefPubMed Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer. 2001;37 Suppl 8:S4–66.CrossRefPubMed
4.
go back to reference Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med. 1993;329(18):1302–7.CrossRefPubMed Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med. 1993;329(18):1302–7.CrossRefPubMed
5.
go back to reference Song HY, Do YS, Han YM, Sung KB, Choi EK, Sohn KH, et al. Covered, expandable esophageal metallic stent tubes: experiences in 119 patients. Radiology. 1994;193(3):689–95.CrossRefPubMed Song HY, Do YS, Han YM, Sung KB, Choi EK, Sohn KH, et al. Covered, expandable esophageal metallic stent tubes: experiences in 119 patients. Radiology. 1994;193(3):689–95.CrossRefPubMed
6.
go back to reference Christie NA, Buenaventura PO, Fernando HC, Nguyen NT, Weigel TL, Ferson PF, et al. Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann Thorac Surg. 2001;71(6):1797–801. discussion 1801-2.CrossRefPubMed Christie NA, Buenaventura PO, Fernando HC, Nguyen NT, Weigel TL, Ferson PF, et al. Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann Thorac Surg. 2001;71(6):1797–801. discussion 1801-2.CrossRefPubMed
7.
go back to reference Sabharwal T, Hamady MS, Chui S, Atkinson S, Mason R, Adam A. A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut. 2003;52(7):922–6.PubMedCentralCrossRefPubMed Sabharwal T, Hamady MS, Chui S, Atkinson S, Mason R, Adam A. A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut. 2003;52(7):922–6.PubMedCentralCrossRefPubMed
8.
go back to reference Frimberger E. Endoscopic treatment of benign esophageal stricture. Endoscopy. 1983;15 Suppl 1:199–202.CrossRefPubMed Frimberger E. Endoscopic treatment of benign esophageal stricture. Endoscopy. 1983;15 Suppl 1:199–202.CrossRefPubMed
9.
go back to reference Song HY, Park SI, Do YS, Yoon HK, Sung KB, Sohn KH, et al. Expandable metallic stent placement in patients with benign esophageal strictures: results of long-term follow-up. Radiology. 1997;203(1):131–6.CrossRefPubMed Song HY, Park SI, Do YS, Yoon HK, Sung KB, Sohn KH, et al. Expandable metallic stent placement in patients with benign esophageal strictures: results of long-term follow-up. Radiology. 1997;203(1):131–6.CrossRefPubMed
10.
11.
go back to reference Guo JH, Teng GJ, Zhu GY, He SC, Fang W, Deng G, et al. Self-expandable esophageal stent loaded with 125I seeds: initial experience in patients with advanced esophageal cancer. Radiology. 2008;247(2):574–81. doi:10.1148/radiol.2472070999. Epub 2008 Mar 18. Guo JH, Teng GJ, Zhu GY, He SC, Fang W, Deng G, et al. Self-expandable esophageal stent loaded with 125I seeds: initial experience in patients with advanced esophageal cancer. Radiology. 2008;247(2):574–81. doi:10.​1148/​radiol.​2472070999. Epub 2008 Mar 18.
12.
go back to reference Zhongmin W, Xunbo H, Jun C, Gang H, Kemin C, Yu L, et al. Intraluminal radioactive stent compared with covered stent alone for the treatment of malignant esophageal stricture. Cardiovasc Intervent Radiol. 2012;35(2):351–8. doi:10.1007/s00270-011-0146-6. Epub 2011 Mar 24.CrossRefPubMed Zhongmin W, Xunbo H, Jun C, Gang H, Kemin C, Yu L, et al. Intraluminal radioactive stent compared with covered stent alone for the treatment of malignant esophageal stricture. Cardiovasc Intervent Radiol. 2012;35(2):351–8. doi:10.​1007/​s00270-011-0146-6. Epub 2011 Mar 24.CrossRefPubMed
13.
go back to reference Bartelsman JF, Bruno MJ, Jensema AJ, Haringsma J, Reeders JW, Tytgat GN. Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experiences in 153 patients. Gastrointest Endosc. 2000;51(2):134–8.CrossRefPubMed Bartelsman JF, Bruno MJ, Jensema AJ, Haringsma J, Reeders JW, Tytgat GN. Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experiences in 153 patients. Gastrointest Endosc. 2000;51(2):134–8.CrossRefPubMed
14.
go back to reference Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344(22):1681–7.CrossRefPubMed Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344(22):1681–7.CrossRefPubMed
15.
go back to reference Jager J, Langendijk H, Pannebakker M, Rijken J, de Jong J. A single session of intraluminal brachytherapy in palliation of oesophageal cancer. Radiother Oncol. 1995;37(3):237–40.CrossRefPubMed Jager J, Langendijk H, Pannebakker M, Rijken J, de Jong J. A single session of intraluminal brachytherapy in palliation of oesophageal cancer. Radiother Oncol. 1995;37(3):237–40.CrossRefPubMed
16.
go back to reference Sur RK, Levin CV, Donde B, Sharma V, Miszczyk L, Nag S. Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma—an International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys. 2002;53(1):127–33.CrossRefPubMed Sur RK, Levin CV, Donde B, Sharma V, Miszczyk L, Nag S. Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma—an International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys. 2002;53(1):127–33.CrossRefPubMed
17.
go back to reference Raijman I, Siddique I, Ajani J, Lynch P. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc. 1998;48(2):172–9.CrossRefPubMed Raijman I, Siddique I, Ajani J, Lynch P. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc. 1998;48(2):172–9.CrossRefPubMed
18.
go back to reference Homs MY, Steyerberg EW, Eijkenboom WM, Tilanus HW, Stalpers LJ, Bartelsman JF, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004;364(9444):1497–504.CrossRefPubMed Homs MY, Steyerberg EW, Eijkenboom WM, Tilanus HW, Stalpers LJ, Bartelsman JF, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004;364(9444):1497–504.CrossRefPubMed
19.
go back to reference Polinder S, Homs MY, Siersema PD, Steyerberg EW, Dutch SIREC Study Group. Cost study of metal stent placement vs single-dose brachytherapy in the palliative treatment of oesophageal cancer. Br J Cancer. 2004;90(11):2067–72.PubMedCentralPubMed Polinder S, Homs MY, Siersema PD, Steyerberg EW, Dutch SIREC Study Group. Cost study of metal stent placement vs single-dose brachytherapy in the palliative treatment of oesophageal cancer. Br J Cancer. 2004;90(11):2067–72.PubMedCentralPubMed
20.
go back to reference Nishimura Y, Nagata K, Katano S, Hirota S, Nakamura K, Higuchi F, et al. Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents: a questionnaire survey of the Japanese Society for Esophageal Diseases. Int J Radiat Oncol Biol Phys. 2003;56(5):1327–32.CrossRefPubMed Nishimura Y, Nagata K, Katano S, Hirota S, Nakamura K, Higuchi F, et al. Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents: a questionnaire survey of the Japanese Society for Esophageal Diseases. Int J Radiat Oncol Biol Phys. 2003;56(5):1327–32.CrossRefPubMed
21.
go back to reference Yakami M, Mitsumori M, Sai H, Nagata Y, Hiraoka M, Nishimura Y. Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancer. Int J Clin Oncol. 2003;8(6):395–8.CrossRefPubMed Yakami M, Mitsumori M, Sai H, Nagata Y, Hiraoka M, Nishimura Y. Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancer. Int J Clin Oncol. 2003;8(6):395–8.CrossRefPubMed
22.
go back to reference Shin JH, Song HY, Kim JH, Kim SB, Lee GH, Park SI, et al. Comparison of temporary and permanent stent placement with concurrent radiation therapy in patients with esophageal carcinoma. J Vasc Interv Radiol. 2005;16(1):67–74.CrossRefPubMed Shin JH, Song HY, Kim JH, Kim SB, Lee GH, Park SI, et al. Comparison of temporary and permanent stent placement with concurrent radiation therapy in patients with esophageal carcinoma. J Vasc Interv Radiol. 2005;16(1):67–74.CrossRefPubMed
23.
go back to reference Sundelöf M, Ye W, Dickman PW, Lagergren J. Improved survival in both histologic types of oesophageal cancer in Sweden. Int J Cancer. 2002;99(5):751–4.CrossRefPubMed Sundelöf M, Ye W, Dickman PW, Lagergren J. Improved survival in both histologic types of oesophageal cancer in Sweden. Int J Cancer. 2002;99(5):751–4.CrossRefPubMed
24.
go back to reference Dai Z, Zhou D, Hu J, Zhang L, Lin Y, Zhang J, et al. Clinical application of iodine-eluting stent in patients with advanced esophageal cancer. Oncol Lett. 2013;6(3):713–8. Epub 2013 Jul 15.PubMedCentralPubMed Dai Z, Zhou D, Hu J, Zhang L, Lin Y, Zhang J, et al. Clinical application of iodine-eluting stent in patients with advanced esophageal cancer. Oncol Lett. 2013;6(3):713–8. Epub 2013 Jul 15.PubMedCentralPubMed
25.
go back to reference Ogilvie AL, Dronfield MW, Ferguson R, Atkinson M. Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy. Gut. 1982;23(12):1060–7.PubMedCentralCrossRefPubMed Ogilvie AL, Dronfield MW, Ferguson R, Atkinson M. Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy. Gut. 1982;23(12):1060–7.PubMedCentralCrossRefPubMed
26.
go back to reference Orringer MB. Substernal gastric bypass of the excluded esophagus—results of an ill-advised operation. Surgery. 1984;96(3):467–70.PubMed Orringer MB. Substernal gastric bypass of the excluded esophagus—results of an ill-advised operation. Surgery. 1984;96(3):467–70.PubMed
27.
go back to reference Mannell A, Becker PJ, Nissenbaum M. Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases. Br J Surg. 1988;75(3):283–6.CrossRefPubMed Mannell A, Becker PJ, Nissenbaum M. Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases. Br J Surg. 1988;75(3):283–6.CrossRefPubMed
28.
go back to reference Gupta NM, Saxena R, Nagi B. Esophageal exclusion and gastric bypass for unresectable carcinoma of the thoracic esophagus. Indian J Gastroenterol. 1989;8(2):77–9.PubMed Gupta NM, Saxena R, Nagi B. Esophageal exclusion and gastric bypass for unresectable carcinoma of the thoracic esophagus. Indian J Gastroenterol. 1989;8(2):77–9.PubMed
29.
go back to reference McGrath JP, Browne M, Riordan C, Ravi N, Reynolds JV. Expandable metal stents in the palliation of malignant dysphagia and oesophageal-respiratory fistulae. Ir Med J. 2001;94(9):270–2.PubMed McGrath JP, Browne M, Riordan C, Ravi N, Reynolds JV. Expandable metal stents in the palliation of malignant dysphagia and oesophageal-respiratory fistulae. Ir Med J. 2001;94(9):270–2.PubMed
30.
go back to reference Sarper A, Oz N, Cihangir C, Demircan A, Isin E. The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg. 2003;23(5):794–8.CrossRefPubMed Sarper A, Oz N, Cihangir C, Demircan A, Isin E. The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg. 2003;23(5):794–8.CrossRefPubMed
31.
go back to reference Grundy A. The Strecker Esophageal stent in the management of oesophageal strictures: technique of insertion and early clinical experience. Clin Radiol. 1994;49(6):421–4.CrossRefPubMed Grundy A. The Strecker Esophageal stent in the management of oesophageal strictures: technique of insertion and early clinical experience. Clin Radiol. 1994;49(6):421–4.CrossRefPubMed
32.
go back to reference Wagner HJ, Stinner B, Schwerk WB, Hoppe M, Klose KJ. Nitinol prostheses for the treatment of inoperable malignant esophageal obstruction. J Vasc Interv Radiol. 1994;5(6):899–904.CrossRefPubMed Wagner HJ, Stinner B, Schwerk WB, Hoppe M, Klose KJ. Nitinol prostheses for the treatment of inoperable malignant esophageal obstruction. J Vasc Interv Radiol. 1994;5(6):899–904.CrossRefPubMed
33.
go back to reference Raijman I, Walden D, Kortan P, Haber GB, Fuchs E, Siemens M, et al. Expandable esophageal stents: initial experience with a new nitinol stent. Gastrointest Endosc. 1994;40(5):614–21.CrossRefPubMed Raijman I, Walden D, Kortan P, Haber GB, Fuchs E, Siemens M, et al. Expandable esophageal stents: initial experience with a new nitinol stent. Gastrointest Endosc. 1994;40(5):614–21.CrossRefPubMed
34.
go back to reference Aoki T, Osaka Y, Takagi Y, Okada R, Shinohara M, Tsuchida A, et al. Comparative study of self-expandable metallic stent and bypass surgery for inoperable esophageal cancer. Dis Esophagus. 2001;14(3-4):208–11.CrossRefPubMed Aoki T, Osaka Y, Takagi Y, Okada R, Shinohara M, Tsuchida A, et al. Comparative study of self-expandable metallic stent and bypass surgery for inoperable esophageal cancer. Dis Esophagus. 2001;14(3-4):208–11.CrossRefPubMed
35.
go back to reference Sgourakis G, Gockel I, Karaliotas C, Moehler M, Schimanski CC, Schmidberger H, et al. Survival after chemotherapy and/or radiotherapy versus self-expanding metal stent insertion in the setting of inoperable esophageal cancer: a case-control study. BMC Cancer. 2012;12:70. doi:10.1186/1471-2407-12-70.PubMedCentralCrossRefPubMed Sgourakis G, Gockel I, Karaliotas C, Moehler M, Schimanski CC, Schmidberger H, et al. Survival after chemotherapy and/or radiotherapy versus self-expanding metal stent insertion in the setting of inoperable esophageal cancer: a case-control study. BMC Cancer. 2012;12:70. doi:10.​1186/​1471-2407-12-70.PubMedCentralCrossRefPubMed
Metadata
Title
Comparative study of self-expanding metal stent and intraluminal radioactive stent for inoperable esophageal squamous cell carcinoma
Authors
Dong Tian
Hongying Wen
Maoyong Fu
Publication date
01-12-2015
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2016
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-016-0768-x

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