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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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Norton BC, Papaefthymiou A, Aslam N, Telese A, Murray C, Murino A, Johnson G, Haidry R. The endoscopic management of oesophageal strictures. Best Pract Res Clin Gastroenterol 2024; 69:101899. [PMID: 38749578 DOI: 10.1016/j.bpg.2024.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 05/26/2024]
Abstract
An oesophageal stricture refers to a narrowing of the oesophageal lumen, which may be benign or malignant. The cardinal feature is dysphagia, and this may result from intrinsic oesophageal disease or extrinsic compression. Oesophageal strictures can be further classified as simple or complex depending on stricture length, location, diameter, and underlying aetiology. Many endoscopic options are now available for treating oesophageal strictures including dilatation, injectional therapy, stenting, stricturotomy, and ablation. Self-expanding metal stents have revolutionised the palliation of malignant dysphagia, but oesophageal dilatation with balloon or bougienage remains first-line therapy for most benign strictures. The increase in endoscopic and surgical interventions on the oesophagus has seen more benign refractory oesophageal strictures that are difficult to treat, and often require advanced endoscopic techniques. In this review, we provide a practical overview on the evidence-based management of both benign and malignant oesophageal strictures, including a practical algorithm for managing benign refractory strictures.
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Affiliation(s)
- Benjamin Charles Norton
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK; Centre for Obesity Research, Department of Medicine, University College London, Rayne Institute, 5 University St, London, WC1E 6JF, UK.
| | - Apostolis Papaefthymiou
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
| | - Nasar Aslam
- Department of Gastroenterology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Andrea Telese
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK; Division of Surgery and Interventional Science, University College London, Royal Free Hospital, 10 Pond Street, London, NW3 2PS, UK
| | - Charles Murray
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
| | - Alberto Murino
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
| | - Gavin Johnson
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
| | - Rehan Haidry
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
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Gopakumar H, Khan H, Sharma N, Puli SR. Endoscopic spray cryotherapy for dysphagia palliation in esophageal cancer: Systematic review and meta-analysis. Endosc Int Open 2024; 12:E211-E217. [PMID: 38348331 PMCID: PMC10861318 DOI: 10.1055/a-2231-7328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024] Open
Abstract
Background and study aims Endoscopically delivered liquid nitrogen spray cryotherapy is reported to be a safe and possibly more effective strategy for dysphagia palliation in patients with advanced esophageal cancer. This systematic review and meta-analysis aimed to pool all available data to evaluate the impact of this treatment modality. Methods Electronic databases (PubMed, Embase, and Cochrane Library) from January 2005 through June 2023 were searched for studies evaluating endoscopically delivered liquid nitrogen spray cryotherapy for dysphagia palliation in patients with advanced esophageal cancer. Pooled proportions were calculated using random-effects (DerSimonian-Laird) model. Results From an initial 895 studies, data were extracted and analyzed from five studies comprising a total of 230 patients that met inclusion criteria. In this pooled analysis, dysphagia improved or did not deteriorate in 81.40% of patients (95% confidence interval [CI] 73.75-87.99). Significant improvement in dysphagia was reported by 55.19% of patients (95% CI 29.62-79.37). An alternate method of dysphagia palliation despite spray cryotherapy was required in 18.78% of patients (95% CI 8.09-32.63) with 10.56% (95% CI 2.53-23.18) requiring esophageal stents. The weighted mean number of spray cryotherapy sessions per patient was 3.37 (95% CI 2.55-4.18). The pooled major adverse event rate was 3.26% (95% CI 0.15-10.14). Conclusions Endoscopic liquid nitrogen spray cryotherapy can effectively and safely treat dysphagia in esophageal cancer. It can be considered an option for dysphagia palliation in centers with expertise and equipment.
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Affiliation(s)
- Harishankar Gopakumar
- Division of Gastroenterology and Hepatology, University of Illinois Chicago College of Medicine at Peoria, Peoria, United States
| | - Hamza Khan
- Mund-Lagowski Department of Chemistry and Biochemistry, Bradley University, Peoria, United States
| | - Neil Sharma
- Gastroenterology, Parkview Health, Fort Wayne, United States
| | - Srinivas Reddy Puli
- Division of Gastroenterology and Hepatology, University of Illinois Chicago College of Medicine at Peoria, Peoria, United States
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Soliman YY, Kundranda M, Kachaamy T. Endoscopic Palliative Therapies for Esophageal Cancer. Gastrointest Endosc Clin N Am 2024; 34:91-109. [PMID: 37973233 DOI: 10.1016/j.giec.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Endoscopic palliation of dysphagia for patients with inoperable esophageal cancer is complex, highly dependent on local expertise, and best done in a multidisciplinary fashion. Systemic therapy is the standard of care because it has been shown to improve survival. Esophageal stenting has traditionally been the most used endoscopic modality. Some modalities such as laser and photodynamic therapy are rarely used. There has been an increasing amount of data on cryotherapy, especially for patients with mild-to-moderate dysphagia on systemic chemotherapy. This article will discuss the latest evidence guiding the palliation of esophageal cancer.
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Affiliation(s)
- Youssef Y Soliman
- Gastroenterology, City of Hope Phoenix, 14200 W Celebrate Life Way, Goodyear, AZ 85338, USA
| | - Madappa Kundranda
- Gastrointestinal Oncology, Banner MD Anderson Cancer Center, Banner Gateway Medical Center, 2946 East Banner Gateway Drive, Gilbert, AZ 85324, USA
| | - Toufic Kachaamy
- Gastroenterology, City of Hope Phoenix, 14200 W Celebrate Life Way, Goodyear, AZ 85338, USA.
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S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Jiménez-Gutiérrez JM, Alonso-Lárraga JO, Hernández-Guerrero AI, Lino-Silva LS, Olivas-Martinez A. Efficacy and safety of self-expanding metal stents in patients with inoperable esophageal cancer: a real-life study. Ther Adv Gastrointest Endosc 2023; 16:26317745231200975. [PMID: 37771789 PMCID: PMC10524049 DOI: 10.1177/26317745231200975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Dysphagia is the most frequent symptom in patients diagnosed with esophageal cancer. Self-expanding metal stents (SEMS) are the current palliative treatment of choice for dysphagia in patients with non-curable esophageal cancer. This study aimed to evaluate the efficacy and adverse events (AEs) of different types of SEMS for palliation of dysphagia. Methods We performed a retrospective cohort study of patients with advanced esophageal cancer and SEMS placement for dysphagia palliation in a tertiary care center. The primary outcome was the clinical success defined as an improvement in dysphagia (reduction of at least 2 points in the Mellow-Pinkas scoring system for dysphagia) after SEMS placement. Results Between January 1999 and May 2020, 295 patients with esophageal cancer were identified. Among them, 75 had a SEMS placement for dysphagia palliation. The mean age of the patients was 61.3 years (standard deviation: 13.4), 69 patients (92%) were men, and the mean Mellow-Pinkas scoring for dysphagia pre- and post-SEMS placement were 3.1 and 1.4 (change from baseline -1.7), respectively. Technical success and clinical success were achieved in 98.6% and 58.9%, respectively. AEs were identified in 35/75 patients (46.7%), and SEMS migration was the most frequent AE in 22/75 patients (29.3%). There were no significant differences in improvement in dysphagia (p = 0.054), weight changes (p = 0.78), and AE (p = 0.73) among fully covered SEMS (fc-SEMS) and partially covered SEMS (pc-SEMS). The median follow-up was 89 days (interquartile range: 29-221). Conclusion SEMS placement was associated with a rapid improvement in dysphagia, high technical success, and a modest improvement in dysphagia with no major AE among fc-SEMS and pc-SEMS.
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Affiliation(s)
- José Miguel Jiménez-Gutiérrez
- Department of Endoscopy, Instituto Nacional de Cancerología, San Fernando 22, Tlalpan, Ciudad de México 14080, México
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Mohapatra S, Santharaman A, Gomez K, Pannala R, Kachaamy T. Optimal Management of Dysphagia in Patients with Inoperable Esophageal Cancer: Current Perspectives. Cancer Manag Res 2022; 14:3281-3291. [PMID: 36448034 PMCID: PMC9701451 DOI: 10.2147/cmar.s362666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/08/2022] [Indexed: 08/30/2023] Open
Abstract
The majority of patients with esophageal cancer are diagnosed at an advanced, incurable stage. Palliation of symptoms, specifically dysphagia, is a crucial component to improve quality of life and optimize nutritional status. Despite multiple available treatment modalities, there is not one accepted or recommended to be the preferred treatment option. Palliative management is often decided by a multidisciplinary team considering factors including local availability, preference, patient life expectancy, and symptom severity. Systemic therapies such as chemotherapy are the most commonly used palliative modalities. Oncologists are most familiar with radiation for dysphagia palliation, especially for advanced metastatic cancer patients with good performance status. One common approach used by endoscopist is self-expandable metal stents. This is preferred for patients with short-term survival and poor functional status as it provides rapid relief of dysphagia. Cryotherapy is a relatively new endoscopic ablative modality and appears to be a promising option for dysphagia palliation, but more data is needed for wider adoption. This review summarizes the current literature on endoscopic and non-endoscopic treatment options for malignant dysphagia.
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Affiliation(s)
- Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Aadhithyaraman Santharaman
- Department of Internal Medicine, Saint Peter’s University Hospital, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, 08901, USA
| | - Krista Gomez
- Department of Gastroenterology and Hepatology, Cancer Treatment Centers of America, Phoenix, AZ, 85338, USA
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Toufic Kachaamy
- Department of Gastroenterology and Hepatology, Cancer Treatment Centers of America, Phoenix, AZ, 85338, USA
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Dobashi A, Li DK, Mavrogenis G, Visrodia KH, Bazerbachi F. Endoscopic Management of Esophageal Cancer. Thorac Surg Clin 2022; 32:479-495. [DOI: 10.1016/j.thorsurg.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paiji C, Sedarat A. Endoscopic Management of Esophageal Cancer. Cancers (Basel) 2022; 14:cancers14153583. [PMID: 35892840 PMCID: PMC9329770 DOI: 10.3390/cancers14153583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Advances in technology and improved understanding of the pathobiology of esophageal cancer have allowed endoscopy to serve a growing role in the management of this disease. Precursor lesions can be detected using enhanced diagnostic modalities and eradicated with ablation therapy. Furthermore, evolution in endoscopic resection has provided larger specimens for improved diagnostic accuracy and offer potential for cure of early esophageal cancer. In patients with advanced esophageal cancer, endoluminal therapy can improve symptom burden and provide therapeutic options for complications such as leaks, perforations, and fistulas. The purpose of this review article is to highlight the role of endoscopy in the diagnosis, treatment, and palliation of esophageal cancer.
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Zhu F, Wang BR, Zhu ZF, Wang SQ, Chai CX, Shang D, Li M. Photodynamic therapy: A next alternative treatment strategy for hepatocellular carcinoma? World J Gastrointest Surg 2021; 13:1523-1535. [PMID: 35070061 PMCID: PMC8727193 DOI: 10.4240/wjgs.v13.i12.1523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/20/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Liver cancer is one of the most common cancers in the world. Of all types of liver cancer, hepatocellular carcinoma (HCC) is known to be the most frequent primary liver malignancy and has seriously compromised the health status of the general population. Locoregional thermal ablation techniques such as radiofrequency and microwave ablation, have attracted attention in clinical practice as an alternative strategy for HCC treatment. However, their aggressive thermal effect may cause undesirable complications such as hepatic decompensation, hemorrhage, bile duct injury, extrahepatic organ injuries, and skin burn. In recent years, photodynamic therapy (PDT), a gentle locoregional treatment, has attracted attention in ablation therapy for patients with superficial or luminal tumors as an alternative treatment strategy. However, some inherent defects and extrinsic factors of PDT have limited its use in clinical practice for deep-seated HCC. In this contribution, the aim is to summarize the current status and challenges of PDT in HCC treatment and provide potential strategies to overcome these deficiencies in further clinical translational practice.
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Affiliation(s)
- Feng Zhu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Bi-Rong Wang
- Department of Breast and Thyroid Surgery, Wuhan Fourth Hospital (Puai Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Zheng-Feng Zhu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Si-Qin Wang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Chu-Xing Chai
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Min Li
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Das KK, Hasak S, Elhanafi S, Visrodia KH, Ginsberg GG, Ahmad NA, Hollander T, Lang G, Kushnir VM, Mullady DK, Abu Dayyeh BK, Buttar NS, Wong Kee Song LM, Kochman ML, Chandrasekhara V. Performance and Predictors of Migration of Partially and Fully Covered Esophageal Self-Expanding Metal Stents for Malignant Dysphagia. Clin Gastroenterol Hepatol 2021; 19:2656-2663.e2. [PMID: 32898705 DOI: 10.1016/j.cgh.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Self-expanding metal stents (SEMS) are routinely used to palliate malignant dysphagia. However esophageal SEMS can migrate or obstruct due to epithelial hyperplasia. The aim of this study was to evaluate the rates and factors predicting migration and obstruction, and the nutritional outcomes in partially covered (pc) vs. fully covered (fc) SEMS vs. fcSEMS with antimigration fins (AF) placed for malignant dysphagia. METHODS A retrospective review of consecutive patients undergoing SEMS placement for malignant dysphagia at three academic medical centers. RESULTS Among 357 patients, there were 55 (15.4%) stent migrations, 45 (12.6%) obstructions from epithelial hyperplasia, and 20 (5.6%) food impactions. Median overall survival was 79 days (IQR 41,199). The percent weight change/change in albumin at 30 and 60 days after SEMS placement were -2.24%/-0.544 g/dL and -2.98%/-0.55 g/dL, respectively. Stent migration occurred significantly more often with fcSEMS than pcSEMS (25.3% vs 10.9%; P < .003), but there was no difference when either group was compared to fcSEMS-AF (19.3%). The overall rate of epithelial hyperplasia resulting in stent obstruction was low (12.6%) and not different between stent types. Factors associated with increased risk of SEMS migration on multivariable logistic regression included stricture traversability with a diagnostic endoscope (OR, 2.37; 95% CI, 1.29-4.35) and use of fcSEMS (OR, 2.56; 1.31-5.00) or fcSEMS-AF (OR, 2.30, 1.03-5.14). CONCLUSIONS Traversability of a malignant esophageal stenosis predicts SEMS migration. In these patients with a limited overall survival, pcSEMS are associated with lower rates of stent migration and similar rates of obstruction compared to fcSEMS.
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Affiliation(s)
- Koushik K Das
- Division of Gastroenterology, Washington University, St. Louis, Missouri.
| | - Stephen Hasak
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Sherif Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Kavel H Visrodia
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory G Ginsberg
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nuzhat A Ahmad
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Thomas Hollander
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Gabriel Lang
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Daniel K Mullady
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Navtej S Buttar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael L Kochman
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Reducing dysphagia with palliative 2D high-dose-rate brachytherapy improves survival in esophageal cancer. J Contemp Brachytherapy 2020; 11:534-540. [PMID: 31969911 PMCID: PMC6964340 DOI: 10.5114/jcb.2019.91223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/19/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose The goal of this study was to assess the effectiveness of dysphagia relief and overall survival in patients with advanced esophageal cancer treated with palliative high-dose-rate (HDR) brachytherapy (BT) without computed tomography-based planning. Material and methods Palliative 2D HDR-BT was used to treat 93 patients with advanced or incurable esophageal cancer in a regional cancer center from October 2010 to December 2016. Before the treatment patients presented the following grades of dysphagia: 0 - 0%, I - 57%, II - 33.3%, III - 6.5%, IV - 3.2%. The planned dose was 22.5 Gy in 3 fractions. The median age of patients was 65 years (45-88). Squamous cell carcinoma was diagnosed in 59.4%, adenocarcinoma in 22.6%, and other histological types of tumors in 6.7% of cases. The histopathological report was unknown in 11.3% of patients. Results The mean follow-up was 5.0 months (range 1-43). The median tumor length was 72.5 mm. Due to BT dysphagia was significantly decreased: grade 0 - 38.7%, I - 31.2%, II - 20.4%, IV - 1.1% (p < 0.001). Dysphagia relief was achieved in 55% of patients and lasted for a mean time of 4.6 months; stabilization occurred in 31% and deterioration in 14%. The patients with partial or complete dysphagia relief lived longer (5.8 vs. 4.1 months, p = 0.02). The patients with a length of the tumor less than 72.5 mm, histopathologically confirmed adenocarcinoma or after dilatation with a metal stent subsequently to BT had improved overall survival as well (7.1 vs. 3.6; 8.0 vs. 4.1; 6.5 vs. 4.0 months, respectively; p < 0.05). The primary localization and primary grade of dysphagia were not factors that influenced the survival of patients. The logistic regression model did not reveal any predictors for treatment response. Conclusions 2D HDR-BT reduces dysphagia and prolongs survival in patients who respond to the treatment. It meets the assumption of palliative treatment for advanced esophageal cancer because of its simplicity and effectiveness.
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Lancellotta V, Cellini F, Fionda B, De Sanctis V, Vidali C, Fusco V, Barbera F, Gambacorta MA, Corvò R, Magrini SM, Tagliaferri L. The role of palliative interventional radiotherapy (brachytherapy) in esophageal cancer: An AIRO (Italian Association of Radiotherapy and Clinical Oncology) systematic review focused on dysphagia-free survival. Brachytherapy 2019; 19:104-110. [PMID: 31636025 DOI: 10.1016/j.brachy.2019.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/16/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this review was to examine efficacy of palliative interventional radiotherapy (IRT) in esophageal cancer compared with other treatment in terms of dysphagia-free survival (DyFS) and safety. METHODS AND MATERIAL A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles evaluating the efficacy of IRT as palliation in patients with esophageal cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. We analyzed only clinical study as full text of patients with symptomatic esophageal cancer treated with IRT alone or in combination with other treatment. Conference paper, survey, letter, editorial, book chapter, and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered. The primary outcome was the duration of dysphagia relief (DyFS) after brachytherapy vs. other treatment (external-beam radiotherapy, photodynamic therapy, argon plasma coagulation, stent, and laser) during followup. Secondary outcomes included overall survival and adverse event rates. RESULTS The literature search resulted in 554 articles. Sixty-six articles were assessed via full text for eligibility. Of these, 59 articles were excluded for various reasons, leaving seven randomized studies. The number of evaluated patients was 905 patients, and median age was 70.5 years. In the IRT group, the median DyFS was 99 days, the most relevant G3-G4 toxicity were fistula development and stenosis reported, respectively, in 8.3% and 12.2%; the overall median survival was 175.5 days. CONCLUSION In conclusion, we provided evidence-based support that IRT is an effective and safe treatment option; therefore, its underuse is no longer justified.
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Affiliation(s)
- Valentina Lancellotta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Bruno Fionda
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.
| | - Vitaliana De Sanctis
- Faculty of Medicina e Psicologia, Sant'Andrea Hospital, Department of Radiation Oncology, University of Rome "La Sapienza", Rome, Italy
| | - Cristiana Vidali
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Vincenzo Fusco
- Department of Radiation Oncology, Centro di Riferimento Oncologico Regionale, Rionero in Vulture, Potenza, Italy
| | - Fernando Barbera
- Brachytherapy Section, Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - Renzo Corvò
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Department of Health Science, University of Genoa, Genoa, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
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Liu H, Liu Y, Wang L, Ruan X, Wang F, Xu D, Zhang J, Jia X, Liu D. Evaluation on Short-Term Therapeutic Effect of 2 Porphyrin Photosensitizer-Mediated Photodynamic Therapy for Esophageal Cancer. Technol Cancer Res Treat 2019; 18:1533033819831989. [PMID: 30885065 PMCID: PMC6425523 DOI: 10.1177/1533033819831989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: To analyze and study the short-term therapeutic effects and main adverse effects of 2 Porphyrin photosensitizer-mediated photodynamic therapy for esophageal cancer. Methods: We apply the hematoporphyrin derivative and hematoporphyrin injection produced by different manufacturers at different periods as photosensitizers in therapy of 79 esophageal cancer cases, with the administration dosage of 5 mg/kg and intravenous drip 24 hours before irradiation. We apply the gold vapor laser and semiconductor laser, respectively, as treatment light source, with the power density of 100 to 300 mW/cm2 and energy density of 100 to 300 J/cm2. After treatment for 1 to 4 sessions, we evaluate the short-term therapeutic effects as complete response, partial response, minor response, or no change, and then make comparative study on therapeutic effects and adverse effects. Results: There were 47 patients in hematoporphyrin derivative group, including 3 (6.4%) patients with complete response, 31 (66.0%) patients with partial response, 10 (21.3%) patients with minor response, and 3 (6.4%) patients with no change. The dysphagia score was reduced from 2.53 (1.16) before treatment to 1.32 (1.20; P < .01) after treatment. There were 32 patients in the hematoporphyrin injection group, including 3 (9.4%) patients with complete response, 19 (59.4%) patients with partial response, 6 (18.8%) patients with minor response, and 4 (12.5%) patients with no change. The dysphagia score was reduced from 2.41 (1.13) before treatment to 1.18 (0.99; P < .01) after treatment. The dysphagia scores of 2 groups after treatment were significantly reduced compared to those before treatment. Both groups did not display serious adverse effect. Conclusions: Two porphyrin photosensitizers in treatment of esophageal cancer at different clinical stages all had good effect with similar therapeutic effect, mild adverse effect, and good tolerance, which implies it is a preferable palliative therapy means.
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Affiliation(s)
- Huilong Liu
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
| | - Yanfang Liu
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
| | - Li Wang
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
| | - Xinjian Ruan
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
| | - Fei Wang
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
| | - Dandan Xu
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
| | - Jing Zhang
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
| | - Xiaoyan Jia
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
| | - Duanqi Liu
- 1 Department of Oncology, The PLA Army General Hospital, Beijing, China
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15
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Blanco D, Altman D, Moher D, Boutron I, Kirkham JJ, Cobo E. Scoping review on interventions to improve adherence to reporting guidelines in health research. BMJ Open 2019; 9:e026589. [PMID: 31076472 PMCID: PMC6527996 DOI: 10.1136/bmjopen-2018-026589] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The goal of this study is to identify, analyse and classify interventions to improve adherence to reporting guidelines in order to obtain a wide picture of how the problem of enhancing the completeness of reporting of biomedical literature has been tackled so far. DESIGN Scoping review. SEARCH STRATEGY We searched the MEDLINE, EMBASE and Cochrane Library databases and conducted a grey literature search for (1) studies evaluating interventions to improve adherence to reporting guidelines in health research and (2) other types of references describing interventions that have been performed or suggested but never evaluated. The characteristics and effect of the evaluated interventions were analysed. Moreover, we explored the rationale of the interventions identified and determined the existing gaps in research on the evaluation of interventions to improve adherence to reporting guidelines. RESULTS 109 references containing 31 interventions (11 evaluated) were included. These were grouped into five categories: (1) training on the use of reporting guidelines, (2) improving understanding, (3) encouraging adherence, (4) checking adherence and providing feedback, and (5) involvement of experts. Additionally, we identified lack of evaluated interventions (1) on training on the use of reporting guidelines and improving their understanding, (2) at early stages of research and (3) after the final acceptance of the manuscript. CONCLUSIONS This scoping review identified a wide range of strategies to improve adherence to reporting guidelines that can be taken by different stakeholders. Additional research is needed to assess the effectiveness of many of these interventions.
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Affiliation(s)
- David Blanco
- Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Doug Altman
- Nuffield Department ofOrthopaedics, Rheumatologyand Musculoskeletal Sciences,Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - David Moher
- Centre for Journalology, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Isabelle Boutron
- Centre d\'épidémiologie Clinique, Université Paris Descartes, Paris, France
| | - Jamie J Kirkham
- Biostatistics, University of Liverpool, Liverpool, Merseyside, UK
| | - Erik Cobo
- Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
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16
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Kachaamy T, Prakash R, Kundranda M, Batish R, Weber J, Hendrickson S, Yoder L, Do H, Magat T, Nayar R, Gupta D, DaSilva T, Sangal A, Kothari S, Kaul V, Vashi P. Liquid nitrogen spray cryotherapy for dysphagia palliation in patients with inoperable esophageal cancer. Gastrointest Endosc 2018; 88:447-455. [PMID: 29750984 DOI: 10.1016/j.gie.2018.04.2362] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Dysphagia is a debilitating symptom in patients with inoperable esophageal cancer that contributes to poor quality of life and worsening nutritional status. The 2 most commonly used palliative modalities for dysphagia are radiation therapy and esophageal stent placement. However, radiation therapy is limited by adverse events (AEs) and total dose, and stent placement has a high rate of AEs, including reflux, migration, and chest pain. A relatively new modality of liquid nitrogen endoscopic spray cryotherapy has been described as salvage when other options have been exhausted and when patients are no longer receiving systemic therapy. We evaluated the safety and efficacy of cryotherapy as the primary modality for relieving dysphagia in inoperable esophageal cancer including patients receiving systemic cancer therapy. METHODS This is a retrospective, multicenter, consecutive case series of 49 inoperable esophageal cancer patients undergoing palliative endoscopic cryotherapy at 4 specialized cancer centers from May 2014 to May 2016. The primary outcomes were change in dysphagia scores between pre- and postcryotherapy and AEs. Dysphagia was measured using a 5-point Likert scale: 0, no dysphagia; 1, dysphagia to solids; 2, dysphagia to semisolids; 3, dysphagia to liquids; 4, dysphagia to saliva. RESULTS Thirty-nine men and 10 women with a mean age of 58 years underwent a total of 120 cryotherapy treatments. The mean dysphagia score improved significantly from 2.4 precryotherapy to 1.7 postcryotherapy (improvement of .7 points; P < .001). Minor AEs were seen in 6 of 120 (5.0%) cryotherapy treatments (1 intraprocedural and 5 postprocedural). In addition, 1 patient developed a severe intraprocedural AE of dilation-related perforation, whereas another patient developed a benign stricture requiring dilation. CONCLUSIONS This preliminary retrospective study suggests that liquid nitrogen spray cryotherapy may be safe and effective for dysphagia palliation in inoperable esophageal cancer. Large prospective studies are needed to confirm these findings and identify patient and procedure characteristics associated with the greatest benefit.
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Affiliation(s)
- Toufic Kachaamy
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Ravi Prakash
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | | | - Raman Batish
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Jeffrey Weber
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | | | - Leon Yoder
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Hannah Do
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Theresa Magat
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Rajeev Nayar
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Digant Gupta
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Trisha DaSilva
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Ashish Sangal
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
| | - Shivangi Kothari
- University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York, USA
| | - Vivek Kaul
- University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York, USA
| | - Pankaj Vashi
- Cancer Treatment Centers of America, Boca Raton, Florida, USA
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Hennequin C, Guillerm S, Wong S, Quéro L. Endoluminal brachytherapy: Bronchus and oesophagus. Cancer Radiother 2018; 22:367-371. [PMID: 29858135 DOI: 10.1016/j.canrad.2017.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022]
Abstract
Endobronchial brachytherapy could be proposed in case of endoluminal tumours either as a palliative or a curative treatment. As a curative treatment, endobronchial brachytherapy could obtain a high local control rate in case of limited disease. In palliative setting, endobronchial brachytherapy improved thoracic symptoms in more than 80% of cases, but it is less efficient than external beam radiation therapy for palliation. It could be also proposed to maintain the airway open after laser therapy. Oesophageal brachytherapy is a valuable option as a palliative treatment, underused at this time. It causes less side effects and a better quality of life compared to self-expanded metallic stents. For a curative aim, there is today no demonstration that a combination of external beam radiotherapy and oesophageal brachytherapy give better results than external beam radiotherapy alone in locally advanced tumours. For superficial diseases, the combination of external beam radiotherapy and oesophageal brachytherapy seems, on the contrary, promising.
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Affiliation(s)
- C Hennequin
- Department of Radiation Oncology, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris, France; Université Paris Diderot, 1, avenue Claude-Vellefaux, 75475 Paris, France.
| | - S Guillerm
- Department of Radiation Oncology, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris, France; Université Paris Diderot, 1, avenue Claude-Vellefaux, 75475 Paris, France
| | - S Wong
- Radiation Oncology Department, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - L Quéro
- Department of Radiation Oncology, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris, France
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18
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van Rossum PSN, Mohammad NH, Vleggaar FP, van Hillegersberg R. Treatment for unresectable or metastatic oesophageal cancer: current evidence and trends. Nat Rev Gastroenterol Hepatol 2018; 15:235-249. [PMID: 29235549 DOI: 10.1038/nrgastro.2017.162] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Approximately half of the patients diagnosed with oesophageal cancer present with unresectable or metastatic disease. Treatment for these patients aims to control dysphagia and other cancer-related symptoms, improve quality of life and prolong survival. In the past 25 years, modestly improved outcomes have been achieved in the treatment of patients with inoperable non-metastatic cancer who are medically not fit for surgery or have unresectable, locally advanced disease. Concurrent chemoradiotherapy offers the best outcomes in these patients. In distant metastatic oesophageal cancer, several double-agent or triple-agent chemotherapy regimens have been established as first-line treatment options. In addition, long-term results of multiple large randomized phase III trials using additional targeted therapies have been published in the past few years, affecting contemporary clinical practice and future research directions. For the local treatment of malignant dysphagia, various treatment options have emerged, and self-expandable metal stent (SEMS) placement is currently the most widely applied method. Besides the continuous search for improved SEMS designs to minimize the risk of associated complications, efforts have been made to develop and evaluate the efficacy of antireflux stents and irradiation stents. This Review outlines the current evidence and ongoing trends in the different modern-day, multidisciplinary interventions for patients with unresectable or metastatic oesophageal cancer with an emphasis on key randomized trials.
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Affiliation(s)
- Peter S N van Rossum
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
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19
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Sigounas DE, Krystallis C, Couper G, Paterson-Brown S, Tatsioni A, Plevris JN. Argon plasma coagulation compared with stent placement in the palliative treatment of inoperable oesophageal cancer. United European Gastroenterol J 2017; 5:21-31. [PMID: 28405318 PMCID: PMC5384556 DOI: 10.1177/2050640616650786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 04/27/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Self-expandable metal stents (SEMSs) are the main palliative modality used in inoperable oesophageal cancer. Other palliative modalities, including argon plasma coagulation (APC), have also been used. OBJECTIVE The purpose of this study was to assess the relative efficacy of SEMS and APC regarding the survival of patients with inoperable oesophageal cancer, not receiving chemo/radiotherapy. METHODS Single centre, retrospective analysis of all patients (n = 228) with inoperable oesophageal cancer between January 2000 and July 2014, not receiving chemo-radiotherapy, treated with SEMS (n = 160) or APC (n = 68) as primary palliation modalities. Cox regression analysis was performed to identify individual factors affecting survival and Kaplan-Meier curves were created for patients treated with APC and SEMS for stage III and IV disease. Survival intervals were compared by the log-rank test. RESULTS Type of treatment was the only statistically significant factor affecting survival, after disease stage stratification (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.13-1.65 of SEMS over APC, p: 0.002). Median survival for patients treated with APC and SEMS was 257 (interquartile range (IQR): 414, 124) and 151 (IQR: 241, 61) days respectively in stage III disease. It was 135 (IQR: 238, 43) and 70 (IQR: 148, 32) days respectively in stage IV disease. Both differences were statistically significant (p = 0.02 and 0.05 respectively). CONCLUSIONS APC is a promising palliation modality in inoperable oesophageal cancer, when patients are not candidates for chemo-radiotherapy. A randomized controlled trial will be needed to confirm those results.
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Affiliation(s)
- Dimitrios E Sigounas
- Centre for Liver and Digestive Disorders, University of Edinburgh, Edinburgh, UK
| | | | - Graeme Couper
- University Department of Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Simon Paterson-Brown
- University Department of Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - John N Plevris
- Centre for Liver and Digestive Disorders, University of Edinburgh, Edinburgh, UK
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20
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Ramakrishnaiah VPN, Malage S, Sreenath GS, Kotlapati S, Cyriac S. Palliation of Dysphagia in Carcinoma Esophagus. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2016; 9:11-23. [PMID: 27279758 PMCID: PMC4896534 DOI: 10.4137/cgast.s30303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 01/10/2023]
Abstract
Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of dysphagia needs to be chosen for the patient. This study aims to discuss the recent trends in palliation of dysphagia with promising results and the most suitable therapy for palliation of dysphagia in a given patient. A total of 64 articles that were published between years 2005 and 2015 on various modes of palliation of dysphagia in carcinoma esophagus were studied, which were mainly randomized and prospective studies. Through this study, we conclude that stents are the first choice of therapy for palliation, which is safe and cost-effective, and they can be combined with either radiotherapy or chemotherapy for long-term palliation of dysphagia with good quality of life. Radiotherapy can be used as a second-line treatment modality.
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Affiliation(s)
| | - Somanath Malage
- Senior Resident, Department of Surgery, Jawaharlal Institute of Postgraduation Medical Education & Research (JIPMER), Puducherry, India
| | - G S Sreenath
- Associate Professor, Department of Surgery, Jawaharlal Institute of Postgraduation Medical Education & Research (JIPMER), Puducherry, India
| | - Sudhakar Kotlapati
- Senior Resident, Department of Radiotherapy, Jawaharlal Institute of Postgraduation Medical Education & Research (JIPMER), Puducherry, India
| | - Sunu Cyriac
- Assistant Professor, Department of Medical Oncology, Jawaharlal Institute of Postgraduation Medical Education & Research (JIPMER), Puducherry, India
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21
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High dose-rate endoluminal brachytherapy for primary and recurrent esophageal cancer. Strahlenther Onkol 2016; 192:458-66. [DOI: 10.1007/s00066-016-0979-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/08/2016] [Indexed: 12/19/2022]
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22
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Kozarek RA. Photodynamic therapy in esophageal cancer. GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.18528/gii1400008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
Background This is a review of endoscopic therapy in the setting of palliative management of patients suffering from esophageal cancer (EC). Unfortunately, many cases of EC present in a stage of disease in which curative therapy is not possible. The maintenance of quality of life includes the ability to swallow and of oral feeding, pain control, and the prevention of bleeding. Methods A review of the current literature was performed. Results Many endoscopic methods are available for the management of dysphagia, of which dilation, endoluminal tumor destruction, stenting, and brachytherapy are the most common. Conclusion Surgical palliation should be avoided as much as possible since the alternatives show at least the same efficacy and have fewer complications.
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Affiliation(s)
- Thomas Rabenstein
- Department of Gastroenterology, Diakonissen Speyer-Mannheim, Diakonissen Krankenhaus Speyer, Speyer, Germany
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24
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Fokas E, Rödel C. Definitive, Preoperative, and Palliative Radiation Therapy of Esophageal Cancer. VISZERALMEDIZIN 2015; 31:347-53. [PMID: 26989391 PMCID: PMC4789905 DOI: 10.1159/000440638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term survival in patients with esophageal cancer remains dismal despite the recent improvements in surgery, the advances in radiotherapy (RT) technology, and the refinement of systemic treatments, including the advent of targeted therapies. Although surgery constitutes the treatment of choice for early-stage disease (stage I), a multimodal approach, including preoperative or definitive chemoradiotherapy (CRT) and perioperative chemotherapy, is commonly pursued in patients with locally advanced disease. METHODS A review of the literature was performed to assess the role of RT, alone or in combination with chemotherapy, in the management of esophageal cancer. RESULTS Evidence from large, randomized phase III trials and meta-analyses supports the application of perioperative chemotherapy alone or preoperative concurrent CRT in patients with lower esophageal and esophagogastric junction adenocarcinomas. Preoperative CRT but not preoperative chemotherapy alone is now routinely used in patients with locally advanced squamous cell carcinoma (SCC). Additionally, definitive CRT without surgery has also emerged as a valuable approach in the management of resectable esophageal SCC to avoid surgery-related morbidity and mortality, whereas salvage surgery is reserved for those with persistent disease. Furthermore, brachytherapy offers a valuable option in the palliative treatment of patients with locally advanced, unresponsive disease. Fluorodeoxyglucose-positron emission tomography (FDG-PET) can facilitate a more accurate treatment response assessment and patient selection. Finally, the development of modern RT techniques, such as intensity-modulated and image-guided RT as well as FDG-PET-based RT planning, could further increase the therapeutic ratio of CRT. CONCLUSION Altogether, CRT constitutes an important tool in the treatment armamentarium for esophageal cancer. Further optimization of CRT using modern technology and imaging, targeted therapies, and newer chemotherapeutic agents is a major challenge and should be the goal of future research and clinical trials.
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Affiliation(s)
- Emmanouil Fokas
- Department of Radiation Therapy and Oncology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Toulba A, Bakkali H, Boutayeb S, Kebdani T, Ahid S, Benjaafar N. [Curietherapy in the palliative treatment of esophageal cancer]. Pan Afr Med J 2015; 20:59. [PMID: 26090017 PMCID: PMC4449984 DOI: 10.11604/pamj.2015.20.59.5881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022] Open
Abstract
Les patients atteints du cancer de l’œsophage ont souvent une maladie localement avancée, la dysphagie est le symptôme majeur chez la plupart de ces patients, plusieurs modalités thérapeutiques ont été utilisées pour améliorer cette dysphagie. Le but de ce travail est d’étudier l'efficacité et la tolérance de la curiethérapie haut débit de dose (HDR) endo-luminale dans le traitement palliatif des cancers de l’œsophage inopérable. Sur une période de 15 ans, l’étude a inclus les patients atteints de cancer de l’œsophage inopérable et/ou métastatique avec une dysphagie, sans extension à l'hypopharynx ou a la trachée et qui ont bénéficié d'une curiethérapie HDR avec ou sans radiothérapie externe à visée palliative. Au total 46 patients ont été inclus dans l’étude, 58,7% étaient des hommes, 42,2% avaient une dysphagie grade 2 et 37,8% étaient aphagiques, 78,6% des patients étaient performance satus PS 2, l'amaigrissement à été trouvé chez 81,4%, la localisation de la tumeur était surtout au niveau du tiers moyen et inférieur dans 97,8%, la hauteur médiane de la tumeur était de 7 cm (5,5-9), le carcinome épidermoïde était le type histologique le plus fréquent chez 31 patients (70,5%). Après un médiane de suivi de 5 mois, l'amélioration de la dysphagie a été retrouvée chez 76% des malades (p1]. L′incidence la plus élevée est observée dans certains pays notamment en Asie et en Afrique, et l′incidence dans les pays développés occidentaux est en augmentation [2]. Selon le registre du cancer de Rabat 2006-2008, le cancer de l’œsophage est rare et constitue 1,5% de tous les cancers chez l'homme [3]. Le taux de survie globale à 5 ans est de 8%, avec 80% des décès liés à l’évolution locale de la maladie [4]. Pour la minorité des patients avec une maladie localisée, le traitement par radiochimiothérapie concomitante avec ou sans chirurgie permet une amélioration de la survie [5]. Plus de 50% des patients atteints de cancer de l′œsophage ont une maladie inopérable au moment du diagnostic due à une tumeur localement avancée, des métastases ou un mauvais état général avec une médiane de survie globale de 2,5 à 9,9 mois [6]. La majorité de ces patients ont besoin de soins palliatifs pour soulager la dysphagie qui est présente chez plus de 70% des patients et qui est responsable d'une dégradation importante de la qualité de vie [7]. À l′heure actuelle, plusieurs modalités de prise en charge sont disponibles pour le traitement palliatif de cette dysphagie. Les options de traitement les plus couramment utilisées comprennent le placement de stent métallique [8–10], le traitement au laser [11], et la curiethérapie avec ou sans radiothérapie externe et ou éventuellement une chimiothérapie [12–15]. Une méta-analyse a conclu qu'il n'y a pas de supériorité claire de l'une des méthodes utilisées dans la palliation du cancer de l’œsophage, le choix de l'une de ces méthodes dépend de l'expérience du centre et de l’état du patient. Cette méta-analyse a aussi démontré que la pose d'une prothèse métallique expansible et la curiethérapie étaient les deux méthodes de référence, la première étant la plus rapide pour améliorer la dysphagie, mais la seconde constitue une réelle alternative pouvant améliorer la survie et la qualité de vie [16]. Un inconvénient du traitement au laser est la nécessité de répéter les séances afin d'obtenir et de maintenir le bénéfice [17, 18]. Dans notre centre la curiethérapie est souvent utilisée pour pallier à la dysphagie. Le but de notre travail est de déterminer l'efficacité et la tolérance de la curiethérapie dans le traitement palliatif du cancer de l’œsophage.
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Affiliation(s)
- Ahmedou Toulba
- Service de Radiothérapie, Institut Nation d'Oncologie, Faculté de médecine et Pharmacie de Rabat, Université Mohammed V Souissi, Rabat, Maroc
| | - Hanae Bakkali
- Service de Radiothérapie, Institut Nation d'Oncologie, Faculté de médecine et Pharmacie de Rabat, Université Mohammed V Souissi, Rabat, Maroc
| | - Salwa Boutayeb
- Physique Médicale, Institut Nation d'Oncologie, Rabat, Maroc
| | - Tayeb Kebdani
- Service de Radiothérapie, Institut Nation d'Oncologie, Faculté de médecine et Pharmacie de Rabat, Université Mohammed V Souissi, Rabat, Maroc
| | - Samir Ahid
- Equipe de Recherche Pharmaco-épidémiologie et Pharmaco-économie, Faculté de médecine et pharmacie de Rabat, Université Mohammed V Souissi, Rabat, Maroc ; Laboratoire de Biostatistique, de Recherche Clinque et d'Epidémiologie, Faculté de Médecine et Pharmacie de Rabat, Université Mohammed V Souissi, Rabat, Maroc
| | - Noureddine Benjaafar
- Service de Radiothérapie, Institut Nation d'Oncologie, Faculté de médecine et Pharmacie de Rabat, Université Mohammed V Souissi, Rabat, Maroc
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Altman DG. Making research articles fit for purpose: structured reporting of key methods and findings. Trials 2015; 16:53. [PMID: 25888056 PMCID: PMC4334591 DOI: 10.1186/s13063-015-0575-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 01/10/2023] Open
Affiliation(s)
- Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.
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Dai Y, Li C, Xie Y, Liu X, Zhang J, Zhou J, Pan X, Yang S. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev 2014; 2014:CD005048. [PMID: 25354795 PMCID: PMC8106614 DOI: 10.1002/14651858.cd005048.pub4] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most patients with oesophageal and gastro-oesophageal carcinoma are diagnosed at an advanced stage and require palliative intervention. Although there are many kinds of interventions, the optimal one for the palliation of dysphagia remains unclear. This review updates the previous version published in 2009. OBJECTIVES The aim of this review was to systematically analyse and summarise the efficacy of different interventions used in the palliation of dysphagia in primary oesophageal and gastro-oesophageal carcinoma. SEARCH METHODS To find new studies for this updated review, in January 2014 we searched, according to the Cochrane Upper Gastrointestinal and Pancreatic Diseases model, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and CINAHL; and major conference proceedings (up to January 2014). SELECTION CRITERIA Only randomised controlled trials (RCTs) were included in which patients with inoperable or unresectable primary oesophageal cancer underwent palliative treatment. Different interventions like rigid plastic intubation, self-expanding metallic stent (SEMS) insertion, brachytherapy, external beam radiotherapy, chemotherapy, oesophageal bypass surgery, chemical and thermal ablation therapy, either head-to-head or in combination, were included. The primary outcome was dysphagia improvement. Secondary outcomes included recurrent dysphagia, technical success, procedure related mortality, 30-day mortality, adverse effects and quality of life. DATA COLLECTION AND ANALYSIS Data collection and analysis were performed in accordance with the methods of the Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group. MAIN RESULTS We included 3684 patients from 53 studies. SEMS insertion was safer and more effective than plastic tube insertion. Thermal and chemical ablative therapy provided comparable dysphagia palliation but had an increased requirement for re-interventions and for adverse effects. Anti-reflux stents provided comparable dysphagia palliation to conventional metal stents. Some anti-reflux stents might have reduced gastro-oesophageal reflux and complications. Newly-designed double-layered nitinol (Niti-S) stents were preferable due to longer survival time and fewer complications compared to simple Niti-S stents. Brachytherapy might be a suitable alternative to SEMS in providing a survival advantage and possibly a better quality of life, and might provide better results when combined with argon plasma coagulation or external beam radiation therapy. AUTHORS' CONCLUSIONS Self-expanding metal stent insertion is safe, effective and quicker in palliating dysphagia compared to other modalities. However, high-dose intraluminal brachytherapy is a suitable alternative and might provide additional survival benefit with a better quality of life. Some anti-reflux stents and newly-designed stents lead to longer survival and fewer complications compared to conventional stents. Combinations of brachytherapy with self-expanding metal stent insertion or radiotherapy are preferable due to the reduced requirement for re-interventions. Rigid plastic tube insertion, dilatation alone or in combination with other modalities, and chemotherapy alone are not recommended for palliation of dysphagia due to a high incidence of delayed complications and recurrent dysphagia.
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Affiliation(s)
- Yingxue Dai
- Department of Child, Adolescent and Maternal Health, Hua Xi School of Public Health, Sichuan University, 17 Ren min nan lu san duan, Chengdu, Sichuan, China, 610041
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Kozarek RA. WITHDRAWN: Photodynamic therapy in esophageal cancer. GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Intraluminal brachytherapy in oesophageal cancer: defining its role and introducing the technique. J Contemp Brachytherapy 2014; 6:236-41. [PMID: 25097567 PMCID: PMC4105652 DOI: 10.5114/jcb.2014.43780] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/10/2014] [Accepted: 06/26/2014] [Indexed: 01/10/2023] Open
Abstract
Intraluminal brachytherapy plays an important role in the treatment of oesophageal tumours. This article aims to define this role in the curative as well as in the palliative treatment settings drawing on data from the literature, and also emphasizing its potential for harm when used inexpertly. It also provides a short introduction to practical aspects of the treatment procedure and treatment planning.
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Hirdes MM, Siersema P. Endoprosthetics for malignant esophageal disease. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
Reports of randomized controlled trials (RCTs) inform the care of future patients and are especially important to clinicians and systematic reviewers. Readers should satisfy themselves that the study methods were sound. Clinicians should consider the relevance to their own patients, both benefits and harms, and absolute as well as relative effects. Trial reports should provide a clear, transparent, and complete report of what was done and what was found. Unfortunately, bad reporting of RCTs is common, which has serious consequences for clinical practice, research, policy making, and ultimately for patients. RCT reports should adhere to the CONSORT Statement, a minimum set of items that should be addressed. Authors, peer reviewers, and editors should all work to ensure that research reports maximize the value derived from the cost and effort of conducting a trial.
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Affiliation(s)
- Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
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Amdal CD, Jacobsen AB, Guren MG, Bjordal K. Patient-reported outcomes evaluating palliative radiotherapy and chemotherapy in patients with oesophageal cancer: a systematic review. Acta Oncol 2013. [PMID: 23190360 DOI: 10.3109/0284186x.2012.731521] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) and assessments of treatment-related toxicity provide important information on the effect of palliative chemotherapy and/or radiotherapy. The aim of this study was to review the effect of palliative radiotherapy and/or chemotherapy on symptoms and quality of life assessed by PROs and measurement of toxicity for patients with oesophageal cancer. METHODS The Central, Medline and Embase databases (1990 to November 2011) were systematically searched for prospective studies of palliative chemotherapy and/or radiotherapy in patients with advanced oesophageal cancer with PRO- and/or toxicity outcomes. The risks of bias were assessed. RESULTS Of 2677 records identified, only 32 included PROs, of which eight were randomised controlled trials. In studies with sufficient standard of PRO (n = 18), either Health Related Quality of Life (HRQL) (n = 14) or patient-reported dysphagia (n = 4), were assessed. Docetaxel added to cisplatin + fluorouracil (CF) improved HRQL compared to CF only, even though toxicity increased. Epirubicin added to CF resulted in longer preserved HRQL than its comparator in two trials, and non-inferiority in one. All phase II chemotherapy studies reported maintained HRQL or improved dysphagia combined with low level of toxicity. Brachytherapy resulted in better HRQL compared to stent placement in two trials, and external radiotherapy relieved dysphagia. The quality of the HRQL methodology and the interpretation and presentation of the PRO results varied, and clinical significance was seldom discussed. CONCLUSION PRO endpoints are seldom used and further studies of homogenous patient groups with valid measures and methodology of PROs should be encouraged in the evaluation of palliative treatment. Brachytherapy, external radiotherapy and combination chemotherapy improved HRQL and dysphagia in the few identified studies with sufficient PRO methodology.
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Affiliation(s)
- Cecilie Delphin Amdal
- Department of oncology, Division of Cancer medicine, Surgery and Transplantation, Oslo University Hospital, Oslo, Norway.
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Wong S, Hennequin C, Quero L. [Brachytherapy for oesophageal cancer]. Cancer Radiother 2013; 17:159-61. [PMID: 23603254 DOI: 10.1016/j.canrad.2013.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/07/2013] [Indexed: 01/10/2023]
Abstract
The main indication of oesophageal brachytherapy is palliative: it can improve dysphagia in patients with a tumor not suitable for surgery or chemoradiotherapy. A randomized clinical trial showed that survival without dysphagia and quality of life was improved by endoluminal brachytherapy in comparison to self-expansible metallic stents. It also increases the duration of palliation after laser deobstruction. Its role as a curative treatment of locally advanced tumors is still discussed: in combination with external beam radiotherapy, it seems that brachytherapy increased the rate of severe toxicity (haemorrhages, fistula, stenosis). In superficial lesions, brachytherapy with or without external beam radiotherapy seems logical but large prospective studies are missing in this setting.
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Affiliation(s)
- S Wong
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris, France
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Evans JA, Early DS, Chandraskhara V, Chathadi KV, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jue TL, Pasha SF, Sharaf R, Shergill AK, Dominitz JA, Cash BD. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 2013; 77:328-34. [PMID: 23410694 DOI: 10.1016/j.gie.2012.10.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 02/08/2023]
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Abstract
This article reviews the current management of esophageal cancer, including staging and treatment options, as well as providing support for using multidisciplinary teams to better manage esophageal cancer patients.
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Enestvedt BK, Ginsberg GG. Advances in endoluminal therapy for esophageal cancer. Gastrointest Endosc Clin N Am 2013; 23:17-39. [PMID: 23168117 DOI: 10.1016/j.giec.2012.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Advances in endoscopic therapy have resulted in dramatic changes in the way early esophageal cancer is managed as well as in the palliation of dysphagia related to advanced esophageal cancer. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are effective therapies for accurate histopathologic staging and provide a potential for complete cure. Mucosal ablative techniques (radiofrequency ablation and cryotherapy) are effective adjuncts to EMR and ESD and reduce the occurrence of synchronous and metachronous lesions within the Barrett esophagus. The successes of these techniques have made endoscopic therapy the primary means of management of early esophageal cancer.
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Affiliation(s)
- Brintha K Enestvedt
- Division of Gastroenterology, Temple University, Philadelphia, PA 19140, USA.
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Yoon HY, Cheon YK, Choi HJ, Shim CS. Role of photodynamic therapy in the palliation of obstructing esophageal cancer. Korean J Intern Med 2012; 27:278-84. [PMID: 23019392 PMCID: PMC3443720 DOI: 10.3904/kjim.2012.27.3.278] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/09/2011] [Accepted: 01/02/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIMS The aim of this non-randomized study was to determine the role of photodynamic therapy (PDT) in a multimodal approach for the palliation of advanced esophageal carcinoma. METHODS Twenty consecutive patients with obstructing esophageal cancer were enrolled in this study. Each subject had dysphagia, and nine could not swallow fluid. External beam radiotherapy or a self-expandable metal stent was used following PDT for dysphagia due to recurrence of the malignancy. RESULTS At 4 weeks post-PDT, a significant improvement in the dysphagia score was observed in 90% of patients, from 2.75 ± 0.91 to 1.05 ± 0.83 (p < 0.05). Patients with recurrent dysphagia underwent stent insertion at an average of 63 days (range, 37 to 90). The rate of major complications was 10%. Two esophageal strictures occurred, which were treated by placement of a modified expandable stent across the stricture. The median survival in these cases was 7.0 ± 0.6 months. One patient that was treated with PDT and radiotherapy is alive and showed a complete tumor response. CONCLUSIONS PDT as a multimodality treatment is safe and effective for relieving malignant esophageal obstruction with minimal complications.
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Affiliation(s)
- Hyeon Young Yoon
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Young Koog Cheon
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Jin Choi
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Chan Sup Shim
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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