Both single-dose brachytherapy and self-expanding metal stent replacement are commonly used for palliation of esophageal obstruction due to inoperable cancer, but their relative merits are unknown.
Researchers from the Netherlands undertook a randomized trial to compare the outcomes of brachtherapy and stent placements in patients with esophageal cancer.
The researchers recruited 209 patients between December 1999 and June 2002 from 9 hospitals in the Netherlands.
The investigators included patients who had dysphagia from inoperable carcinoma of the esophagus or esophagogastric junction.
The research group randomly assigned stent placement to 108 participants and single-dose brachtherapy to 101 patients. The researchers followed the patients up after treatment.
The primary outcome was relief of dysphagia during follow-up and secondary outcomes were complications, treatment for persistent or recurrent dysphagia, health-related quality of life and costs.
|Stent placement had more complications than brachytherapy which was mainly due to an increased incidence of late haemorrhage|
In total, 9 patients (6 brachytherapy vs 3 stent replacement) did not receive their allocated treatments and no patients were lost to follow-up.
The researchers found that dysphagia improved more rapidly after stent placement than after brachytherapy, but long-term relief of dysphagia was better after brachytherapy.
In addition, stent placement had more complications than brachytherapy, 33% of patients as opposed to 21%, which was found to be mainly due to an increased incidence of late haemorrhage (13% vs 5%).
The researchers noted that the groups did not differ for persistent or recurrent dysphagia or for median survaival.
The group found that quality-of-life scores were in favour of brachytherapy compared with stent placement.
Total medical costs were much the same for stent placement (EU8215) and brachytherapy (EU8135).
Professor Kuipers, commenting on behalf of the team concluded, "Despite slow improvement, single-dose brachytherapy gave better long-term relief of dysphagia than metal stent placement."
"Since brachytherapy was also associated with fewer complications than stent placement, we recommend it as the primary treatment for palliation of dysphagia from esophageal cancer."