A team from Edinburgh, Scotland, compared thermal ablative therapy to expandable metal stents in the palliative treatment of patients with esophageal carcinoma.
They assessed survival, relief of dysphagia, quality of life, and cost in each subject.
Some 65 patients with histologically proven, inoperable esophageal and esophagogastric cancer were enrolled in the study.
Endoscopy, barium contrast radiography, and CT of the thorax and abdomen were used to initially assess all subjects.
Dysphagia and quality of life were serially assessed at monthly intervals.
Patients were randomized to either repeated thermal tumor ablation (TTA) or insertion of an expandable metal stent
Median survival was significantly longer for patients who underwent TTA; 125 days versus 68 days for those in whom a stent was inserted. However, relief of dysphagia was disappointing in both groups.
|Median survival after treatment:|
Thermal ablation: 125 days
Stent insertion: 68 days
| Gastrointestinal Endoscopy |
Several patients in both groups had serious treatment-related complications and required further therapy.
The researchers found that median length of hospital stay and cost were greater for patients treated by TTA.
Health-related quality of life was globally impaired in both groups at randomization, and deteriorated significantly in the stent group.
Patients with stents were found to report pain more commonly.
Dr Helen J. Dallal, of the Western General Hospital, Edinburgh, said on behalf of the group, "The palliation of patients with advanced esophageal and esophagogastric cancer remains unsatisfactory."
"Health-related quality of life deteriorated in the stent group but not in the TTA group.
"Patients treated by TTA live longer than patients treated by stent insertion, but the cost of TTA is higher," she concluded.