Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer

Obstructing esophageal cancer produces severe dysphagia with ensuing death within 90 days. Palliation is possible with modalities like stent placement , laser, and photodynamic therapy. However, these treatments have a high ra te of complications, and the overall mortality is not altered. A new altern ative treatment evaluated in this study is endoscopic intratumoral injectio n with cisplatin/epinephrine (CDDP/epi) gel. CDDP/epi gel injections were a dministered weekly for 3 to 8 weeks in nine patients, median age, 72 years; mean tumor volume (+/-SEM), 41.44 (+/-22.4) cm(3). Eight patients had stag e IV, and one had stage III esophageal carcinoma. The mean dysphagia score (+/-SEM) was 3.5 (+/-0.17). All patients were followed up until death. Dysp hagia resolved in eight patients with reduction in mean dysphagia score (+/ -SEM) from 3.5 (+/-0.17) to 0.75 (+/-0.28; p = 0.005). Tumor volume was red uced by 75% in one patient and by 50% in two patients. The median survival was 4 months. The longest follow-up has been 15 months (458 days). In this pilot study, intratumoral injection of CDDP/epi gel restored swallowing in eight of nine patients and was an effective and safe outpatient treatment i n patients with obstructive esophageal cancer.