Radioactive Self-Expanding Stents Give Superior Palliation in Patients With Unresectable Cancer of the Esophagus but Should Be Used With Caution if They Have Had Prior Radiotherapy

Abstract

Self-expandable stents loaded with 125I (iodine 125) seeds may combine the advantages of the immediate relief of esophageal dysphagia with stent placement and radiation therapy with brachytherapy. We compared the self-expanding irradiation stent with a conventional self-expandable covered stent in patients with malignant dysphagia due to recurrent esophageal cancer. The patients with recurrent esophageal cancer suffering from dysphagia (≥grade 2) were enrolled and placed with a stent loaded with 125I seeds (irradiation stent group) or a conventional covered stent (traditional stent group). After stent placement, the outcomes were compared in terms of relief of dysphagia, survival time, and complications related to the procedure. Primary stent placements were successful in 29 of 31 (93.5%) cases in the irradiation stent group and 30 of 32 (93.8%) cases in the traditional stent group. The dysphagia grades significantly improved in both groups within the first month after stent placement but were better in the irradiation stent group than in the traditional stent group after 3 months (p=0 .04). The median survival was 4 months in the radiation stent group and 3 months in the traditional stent group (p=0.06). Bleeding occurred in 35.5% versus 21.9% patients in the irradiation stent group versus the traditional stent group during follow-up (p=0.232). This study indicated that the radiation stent had a potential benefit of a longer dysphagia relief period. However, no significant survival benefits were observed in the radiation stent group and the high incidence rate of massive hemorrhages further limited its application in patients with malignant dysphagia due to recurrent esophageal cancer.