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Japanese Journal of Clinical Oncology 31:270-274 (2001)
© 2001 Foundation for Promotion of Cancer Research

Self-expandable Metallic Stents for Patients with Recurrent Esophageal Carcinoma After Failure of Primary Chemoradiotherapy

Manabu Muto1, Atsushi Ohtsu1, Yoshinori Miyata2, Yasukazu Shioyama3, Narikazu Boku1 and Shigeaki Yoshida1,+

1Department of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba and Departments of 2Gastroenterology and 3Radiology, Ibaraki Prefectural Central Hospital, Tomobe, Ibaraki, Japan

Background: Recent advances in chemoradiotherapy for esophageal carcinoma have resulted in improved survival rates. However, there are few options for recurrent dysphagia due to refractory carcinoma after failure of primary chemoradiotherapy. The aim of this study was to evaluate the safety and efficacy of self-expandable metallic stent placement for patients with recurrent esophageal carcinoma where definitive chemoradiotherapy has failed.

Methods: Thirteen consecutive patients with recurrent squamous cell carcinoma of the esophagus, in whom self-expandable metallic stents were placed after failure of primary chemoradiotherapy, were studied retrospectively. All patients had esophageal obstruction or malignant fistula.

Results: The oral alimentation status of nine of 13 patients (69%) improved after successful placement of the stent. Following placement of the stent, fever (>38°C) and severe chest pain occurred in 85% (11/13) of the patients. In all patients examined, C-reactive protein was elevated within 1 week of the operation. Esophageal perforation occurred in three patients. Stent-related mediastinitis and pneumonia developed in six (46%) and three (23%) patients, respectively. Seven of the 13 patients (54%) died of stent-related pulmonary complications.

Conclusion: Although the placement of a self-expandable metallic stent for patients with recurrent esophageal carcinoma after failure of chemoradiotherapy improved their oral alimentation status, we found that this treatment increases the risk of life-threatening pulmonary complications.

+ For reprints and all correspondence: Manabu Muto, Department of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, 5–1 Kashiwanoha 6-chome, Kashiwa 277-8577, Japan. E-mail: mmuto@east.ncc.go.jp


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