Expandable metal stents versus laser combined with radiotherapy for palliation of unresectable esophageal cancer: A prospective randomized trial

Background/Aims: Because of the snort life expectancy of patients with esop hageal cancer, relief of dysphagia associated with low morbidity and mortal ity must be the aim of any therapeutic strategy. Methodology: A total of 39 patients with unresectable esophageal cancer wer e randomly allocated to either receive combined laser-percutaneous radiothe rapy (group 1, n=21) or to have a self-expanding metal stent placed (group 2, n=18). Some patients in group 2 required initial laser therapy (group 2a , n=8. Treatment efficacy was evaluated on the basis of improved dysphagia, restenosis, hospital stay, survival time and costs. Results: Both treatments were able to significantly improve dysphagia. Rest enosis occurred in 43% of Background/Aims: Because of the short life group 1 and 22% of group 2 patients. In group 1, 2 patients had severe bleeding e pisodes and 2 patients developed esophago-tracheal fistulas. One group 1 pa tient died due to uncontrollable bleeding and 1 patient to recurrent aspira tion. No treatment-related death was observed in group 2. Hospital stay was 30.0 (mean: 5.4) days in group 1, 18.9 (mean: 4.2) days in group 2a and 7. 1 (mean: 3.1) days in group 2b. There was no statistical difference between the 3 groups with regard to survival. Costs were highest in group 1 and lo west in group 2b. Conclusions: The treatment of unresectable esophageal cancer with self-expa nding metal stents appears to be simple, safe, as good as laser combined wi th radiotherapy and cost efficient.