Department of Medicine, University of California, Los Angeles, Los Angeles, California; and.
Department of Radiation Medicine and Applied Sciences, University of California, San Diego, San Diego, California.
J Natl Compr Canc Netw. 2020 May;18(5):569-574. doi: 10.6004/jnccn.2019.7524.
Patients with advanced esophageal cancer often experience pain and dysphagia, yet the optimal palliative management remains unclear. This retrospective study evaluated outcomes and adverse effects of palliative radiotherapy (RT) compared with esophageal stenting among a cohort of U.S. veterans with metastatic esophageal cancer.
We identified 1,957 veterans in the United States with metastatic esophageal cancer who received palliative RT to the esophagus or esophageal stenting, and assessed the risks of severe adverse effects, including esophageal fistula formation, perforation, obstruction, hemorrhage, and esophagitis. We determined palliative efficacy by evaluating pain and dysphagia scores before and after intervention. Multivariable analyses were used to control for potential confounding factors.
In our cohort, 1,593 patients underwent RT and 364 underwent esophageal stenting. The cumulative incidence of any severe adverse effect at 6 months was higher among patients who received stents compared with those who received RT (21.7% vs 12.4%; P<.0010). In multivariable analysis, patients who received stents had an increased risk of any severe adverse effect, including fistula, perforation, and hemorrhage (all P<.0500). Multivariable analysis also showed that, compared with stenting, RT was associated with more rapid and durable pain relief (P<.0010) with no difference in relief of dysphagia over time when accounting for pretreatment dysphagia scores (P=.1029).
Compared with esophageal stenting, RT was associated with a decreased risk of adverse effects, greater pain relief, and equivalent relief of moderate to severe dysphagia over time. Unmeasured patient- or tumor-related factors could have influenced the choice of intervention, thereby impacting our study outcomes. To our knowledge, this is the largest study to date analyzing the comparative risks and benefits of palliative RT and esophageal stenting among patients with metastatic esophageal cancer.
晚期食管癌患者常经历疼痛和吞咽困难，但最佳姑息治疗仍不明确。本回顾性研究评估了美国转移性食管癌患者接受姑息性放疗（RT）与食管支架置入的结局和不良反应。
我们在美国确定了 1957 名接受姑息性食管 RT 或食管支架置入的转移性食管癌退伍军人，并评估了严重不良反应（包括食管瘘形成、穿孔、梗阻、出血和食管炎）的风险。我们通过评估干预前后的疼痛和吞咽困难评分来确定姑息疗效。采用多变量分析控制潜在混杂因素。
在我们的队列中，1593 名患者接受了 RT，364 名患者接受了食管支架置入。支架组患者 6 个月时任何严重不良反应的累积发生率高于 RT 组（21.7% vs. 12.4%；P<.0010）。多变量分析显示，支架组患者发生任何严重不良反应（包括瘘、穿孔和出血）的风险均增加（均 P<.0500）。多变量分析还显示，与支架置入相比，RT 与更快和更持久的疼痛缓解相关（P<.0010），在考虑预处理吞咽困难评分时，与时间推移的吞咽困难缓解无差异（P=.1029）。
与食管支架置入相比，RT 与不良反应风险降低、疼痛缓解更大以及中重度吞咽困难缓解相当相关。未测量的患者或肿瘤相关因素可能影响干预选择，从而影响我们的研究结果。据我们所知，这是迄今为止分析转移性食管癌患者姑息性 RT 和食管支架置入的风险和获益的最大研究。
