Brachytherapy Superior to Stents for Dysphagia in Esophageal Cancer
by CD Buckner M.D.
According to a recent article published in The Lancet, brachytherapy provides superior long-term relief over placement of a stent in terms of difficulty in swallowing for patients with advanced esophageal cancer.
The esophagus is a hollow tube that connects the back of the mouth to the stomach. All food and drink normally ingested in humans passes through the esophagus. Esophageal cancer has a low rate of long-term survival in the United States, mainly due to the fact that it is not routinely screened for, and thus is not often diagnosed until it has spread from its site of origin to other places in the body. Treatment for advanced esophageal cancer typically consists of chemotherapy, radiation therapy and/or biologic therapy in an attempt to improve quality of life and/or duration of survival.
One common symptom of advanced esophageal cancer is inability or difficulty in swallowing, referred to as dysphagia. Patients may be treated with radiation therapy and/or laser therapy to reduce the size of the cancer and allow for less painful or obstructed swallowing. One type of radiation that may be used for dysphagia is brachytherapy, in which small “seeds” of radioactive material are surgically implanted into and near the cancer. Patients may also undergo the surgical placement of a stent, which is a physical device that is in the shape of an “O”, to help relieve dysphagia. The stent is implanted into the esophagus to keep the esophagus open and allow food and drink to pass through. However, the relative merits of brachytherapy or stent placement for treatment of dysphagia in patients with esophageal cancer have not been well compared until now.
Researchers from Denmark recently conducted a clinical trial to compare brachytherapy and stent placement for the treatment of dysphagia in patients with advanced esophageal cancer. This trial included 209 patients with inoperable esophageal cancer who were suffering from dysphagia and were treated with either a one-time placement of brachytherapy or a metal stent. Immediately following treatment, improvement in dysphagia scores were more immediate in patients treated with stent placement. However, at 30 days following treatment, improvement in dysphagia scores were similar between the groups of patients treated with either modality, and after 30 days, patients treated with brachytherapy reported improved dysphagia scores over those treated with stent placement. Overall survival was similar between the two groups of patients (155 days for those treated with brachytherapy vs. 145 days for those treated with stent placement); however, patients treated with brachytherapy had more survival days without dysphagia (115 days) than those treated with stent placement (82 days). Total complications directly attributed to treatment occurred in 21% of patients treated with brachytherapy, compared to 33% of patients treated with stent placement.
The researchers concluded that patients with inoperable esophageal cancer who are suffering from dysphagia have improved long-term relief with brachytherapy compared to the placement of a metal stent. Patients with advanced esophageal cancer who are experiencing dysphagia may wish to speak with their physician about their individual risks and benefits of different treatment options.
Reference: Homs MYV, Steyerberg EW, Eijkenboom MH, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. The Lancet. 2004;364:1497-1504.