Adams Emily, Lavoie-Gagnon Héloïse, Islam Farhana, Humer Michael, Mou Benjamin, Koulis Theodora A, Kim David, Atrchian Siavash
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Département de Radiobiologie et Médecine Nucléaire, Université de Sherbrooke/Centre Hospitalier Universitaire de L'Université Sherbrooke (CHUS), Sherbrooke, QC, Canada.
J Gastrointest Cancer. 2025 Apr 18;56(1):102. doi: 10.1007/s12029-025-01228-6.
Self-expandable metallic stents (SEMS) provide immediate but nondurable dysphagia relief in esophageal cancer, while external beam radiotherapy (EBRT) provides slower, more durable dysphagia relief. While the combination of SEMS with EBRT would seem to offer both rapid and durable dysphagia relief in the palliative setting, there remains controversy on its safety and efficacy. We investigated patient outcomes regarding EBRT after SEMS placement in patients with incurable esophageal cancer at a regional Canadian cancer program.
We conducted a single-centre retrospective chart review from January 2010 to July 2020 to compare stent-related complications and survival in patients with incurable esophageal cancer treated with SEMS alone or SEMS + EBRT at Kelowna General Hospital.
66 patients were included in the SEMS alone group and 26 in the SEMS + EBRT group. Patients treated with SEMS alone showed an average of 3.05 fewer stent-related complications compared to patients who received SEMS + EBRT. The SEMS alone group also had 9.05 greater odds of experiencing higher grade complications compared to the SEMS + EBRT group (p < 0.001). Patients in the SEMS + EBRT group survived significantly longer than those treated with SEMS alone, with a median overall survival of 163.5 days and 65 days, respectively.
SEMS monotherapy was associated with significantly fewer, yet higher grade stent-related complications compared to palliative EBRT after SEMS placement. SEMS + EBRT treatment was associated with significantly prolonged survival compared to SEMS alone. Prospective studies are needed to confirm these findings.
自膨式金属支架（SEMS）能立即缓解食管癌患者的吞咽困难，但效果不持久，而外照射放疗（EBRT）缓解吞咽困难的速度较慢，但效果更持久。虽然在姑息治疗中，SEMS与EBRT联合使用似乎能快速且持久地缓解吞咽困难，但其安全性和疗效仍存在争议。我们在加拿大一个地区癌症项目中，对无法治愈的食管癌患者在放置SEMS后接受EBRT的患者结局进行了调查。
我们进行了一项单中心回顾性病历审查，时间跨度为2010年1月至2020年7月，以比较在基洛纳总医院接受单纯SEMS或SEMS + EBRT治疗的无法治愈的食管癌患者的支架相关并发症和生存率。
单纯SEMS组纳入66例患者，SEMS + EBRT组纳入26例患者。与接受SEMS + EBRT的患者相比，单纯接受SEMS治疗的患者支架相关并发症平均少3.05例。与SEMS + EBRT组相比，单纯SEMS组发生更高级别并发症的几率也高9.05（p < 0.001）。SEMS + EBRT组患者的生存期明显长于单纯接受SEMS治疗的患者，中位总生存期分别为163.5天和65天。
与放置SEMS后进行姑息性EBRT相比，SEMS单一疗法相关的支架相关并发症明显较少，但级别更高。与单纯SEMS相比，SEMS + EBRT治疗可显著延长生存期。需要进行前瞻性研究来证实这些发现。
