Role of Combined Approach with Radiotherapy and Metallic Stent in Palliation of Advanced Cases of Carcinoma Esophagus -APilot Study

ABSTRACT

Carcinoma esophagus presents with dysphagia and in 60% of patients, the aim of treatment is palliation. ThIs study was done to evaluate the feasibility and role of planned combined approach using radiotherapy with metallic stent in palliation of malignant dysphagia. Ten patients with histologically proven, locoregionally advanced esophageal carcinoma were selected. All patients underwent external radiotherapy followed by brachytherapy. The self-expanding metallic stent was placed under combined endoscopic and fluoroscopic guidance. A predetermined questionnaire to assess dysphagia, pain, reflux symptoms and quality of life was administered before the procedure, and thereafter at monthly intervals until death or last follow-up. 10/10 patients had grade III dysphagia at presentation. 4/10 patients underwent stent placement prior to any radiotherapy (group A), 4/1 0 patients had stent placement after external radiotherapy (group 8) and 2/1 0 had stent after completion of brachytherapy (group C). There was no difficulty in placing the stent despite the post-radiotherapy ulcerations and stricture in all the patients in group 8 and C. 8/8 patients in groups A and 8 had no difficulty in placing esophageal bougie for brachytherapy. The mean follow-up after stent placement was 9 months (4-24 months). There was complete disappearance of dysphagia in 4/4 patients in group A, 2/4 patients in group Band 0/2 patients in group C. The rest of patients had significant improvement in dysphagia score by atJeast two grades. For dysphagia grade. the mean progression free interval was recorded as 5 months for group A, 3 months for group Band 2 months for group C. Combining radiotherapy and metallic stent is a safe, simple and effective means to palliate malignant dysphagia. This raises an issue whether all patients with advanced carcinoma esophagus should preferably be pre planned for stent placement followed by radiotherapy for best results.