Stents palliated, improved survival for inoperable esophageal cancer

Researchers working with patients in Kenya found that self-expanding metal stents reduced dysphagia and increased survival to more than eight months in patients with inoperable esophageal cancer in a resource-limited setting.

White et al collected data on 951 patients with inoperable esophageal cancer who received 1,000 stents from 1999 to 2008. The hospital where patients were treated did not have chemoradiation available. Median follow-up was 207 days and researchers obtained long-term information on 334 patients.

The mean pre-endoscopy dysphagia score was 3.3, with 96% of patients scoring three or above. Following the placement of stents, 90% of the patients who were still alive at the most recent followed-up reported a mean dysphagia score of 1.0. Family members told researchers that dysphagia had improved for 77% of patients who had died; mean dysphagia score was 1.8.

Median survival was 250 days, which compares favorably to Western countries where survival ranges from 49 to 186 days, the researchers wrote. The reported median survival of 8.4 months with self-expanding metal stents is superior to other modalities for advanced disease including photodynamic therapy (4.8 months), laser therapy (4.1 months to 4.6 months) and single-dose brachytherapy (4.9 months to 7.9 months). The researchers cautioned that brachytherapy had outperformed stents in some randomized trials, producing fewer complications and a better quality of life.

The researchers warned about the potential for bias in the results as only 35% of patients were reached for long-term follow-up. They concluded, however, that stents “are an appropriate palliative technology for resource-limited settings.”

White RE. Lancet. 2009;10:240-246.