TREATMENT OF UNRESECTABLE CARCINOMA OF THE ESOPHAGUS OR THE GASTROESOPHAGEAL JUNCTION BY MESH STENTS WITH OR WITHOUT RADIOCHEMOTHERAPY

The palliative treatment of malignant stenoses of the upper gastrointe stinal tract by self-expanding metal stents is a novel procedure with effective relief of dysphagia in most patients. There is little follow -up information with respect to the factors influencing clinical outco me and survival rates. Survival rates of 40 consecutive patients treat ed with 53 mesh stents were analyzed with regard to their degree of dy sphagia (grades 0-3), quality of life (Karnofsky score)? and the effec t of additional radiation and chemotherapy. Following stent placement dysphagia improved in 36 of 40 patients. Endoscopic reinterventions fo r worsening of dysphagia were necessary in 23 patients during a median follow-up period of 74 days (range 51-149). There was a trend towards superior survival time in younger patients (<60 years) with high Karn ofsky score (greater than or equal to 70). Patients receiving concurre nt radiation and chemotherapy (n=12) experienced prolonged survival (m edian 318 days after diagnosis? 225 days after stent) compared with pa tients of equal tumour staging, but without additional therapy (n=17; median 157 days after diagnosis, p<0.001; 138 days after stent, p<0.05 ). The combination of endoscopic stenting with additional radiation an d chemotherapy was associated with improved survival. A randomized tri al is warranted.