Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 28, 2012; 18(12): 1404-1409
Published online Mar 28, 2012. doi: 10.3748/wjg.v18.i12.1404
Endoscopic stenting and concurrent chemoradiotherapy for advanced esophageal cancer: A case-control study
Xiang-Jun Jiang, Ming-Quan Song, Yong-Ning Xin, Yu-Qiang Gao, Zi-Yu Niu, Zi-Bin Tian
Xiang-Jun Jiang, Ming-Quan Song, Yong-Ning Xin, Yu-Qiang Gao, Zi-Yu Niu, Department of Gastroenterology, Qingdao Municipal Hospital affiliated to Qingdao University, Qingdao 266011, Shandong Province, China
Xiang-Jun Jiang, Ming-Quan Song, Yong-Ning Xin, Qingdao Key Laboratory of Digestive Diseases, Qingdao Municipal Hospital, Qingdao 266011, Shandong Province, China
Zi-Bin Tian, Department of Gastroenterology, Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, Shandong Province, China
Author contributions: Jiang XJ and Tian ZB designed the research; Song MQ, Xin YN, Gao YQ and Niu ZY performed the research and analyzed the data; Jiang XJ, Song MQ and Tian ZB wrote the paper.
Correspondence to: Zi-Bin Tian, Professor, Department of Gastroenterology, Affiliated Hospital of Qingdao University Medical College, 16 Jiangsu Road, Qingdao 266003, Shandong Province, China. tianzb@qdumh.qd.sd.cn
Telephone: +86-532-82911302 Fax: +86-532-82911302
Received: July 28, 2011
Revised: September 28, 2011
Accepted: January 18, 2012
Published online: March 28, 2012
Abstract

AIM: To evaluate the role of endoscopic stenting with or without concurrent 3-dimensional conformal chemoradiotherapy (3D-CRT) in patients with inoperable esophageal cancer.

METHODS: Advanced esophageal cancer patients indicated for esophagectomy received esophageal stents. A part of patients completed 3D-CRT after stenting. Efficacy was assessed by endoscopy and computed tomographic scan before and 4 wk after completion of the treatment. The median survival, 3D-CRT toxicity and complications were compared between 3D-CRT and control groups.

RESULTS: From 1999 to 2008, 99 consecutive patients with T3/T4 disease and unsuitable for esophagectomy were placed with esophageal stents. Sixty-seven patients received 3D-CRT, while 36 patients treated with endoscopic stents alone were recruited as controls. After 3D-CRT treatment, the median tumor volume of 3D-CRT patients were reduced significantly from 43.7 ± 10.2 cm3 to 28.8 ± 8.5 cm3 (P < 0.05). The complete and partial response rate was 85.1%, and no response was 14.9%. After 3D-CRT, the incidence rate of T2 and T3 disease evident on CT scan increased to 78.4% while T4 decreased from 66.7% to 21.6% (P < 0.05). 3D-CRT Karnofsky Performance Status improved in 3D-CRT patients compared with the control group (P = 0.031). 3D-CRT patients had a longer survival than the control group (251.7 d vs 91.1 d, P < 0.05). And the median half-year survival rate in 3D-CRT group (91%) was higher than in the control group (50%, P < 0.05). The most common toxicity was leukocytopenia in the 3D-CRT group (46.7% vs 18.8%, P = 0.008). The control group had a higher rate of restenosis than the 3D-CRT group (81.3% vs 9.0%, P < 0.05). The rate of nephrotoxicity was increased in 3D-CRT as compared with the control group (31.3% vs 15.6%, P < 0.05).

CONCLUSION: 3D-CRT can improve dysphagia in patients with inoperable esophageal carcinoma. 3D-CRT combined with stenting results in better survival as compared with endoscopic stents used alone.

Keywords: Esophageal Cancer; Stents; Chemoradiotherapy; Three-dimensional imaging; Case control study