In patients with advanced esophageal cancer, brachytherapy using a self-expandable esophageal stent loaded with iodine-125 seeds prolongs relief from dysphagia and extends overall survival, according to a study by Chinese researchers published in the May issue of
Radiology. Building on their previous preclinical work, Dr. Gao-Jun Teng and colleagues at Southeast University, Nanjing, randomly assigned 53 patients with unresectable esophageal tumors or metastatic disease, or who were too sick to undergo surgery, to receive either a conventional covered esophageal stent or an esophageal stent loaded with I-125 seeds.
The patients and all caregivers except for the interventional radiologists were blinded to the type of stent used. Stent placement was successful in all 53 patients. Although partial stent migration occurred in five patients, no loss of I-125 seeds took place at any time.
Within the first month following the procedure, palliation of dysphagia was significant and equal in both groups. Although dysphagia scores subsequently increased in both groups, these scores increased more rapidly in the control group (p < 0.05). The patients in the brachytherapy-stent group were able to eat without serious difficulty for at least six months following the procedure.
Among patients experiencing stent restenosis, this occurred later in the I-125 stent group (mean onset 4.75 months) than in the control group (mean onset 2.0 months).
Median survival in the irradiated-stent group was seven months, while that in the control group was four months (p < 0.001).
"With increased survival combined with decreased dysphagia grades," the researchers conclude, "our study findings indicate that therapy with an irradiation stent loaded with I-125 seeds has potential benefit in patients with advanced esophageal cancer. We believe further investigation of this treatment modality is indicated."
