Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial
Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial
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DOI：
10.1111/j.1442-2050.2005.00467.x
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发表时间：
2005-01-01
影响因子：
2.6
通讯作者：
Ruth, M
中科院分区：
文献类型：
--
作者：
Bergquist, H;Wenger, U;Ruth, M
食道癌通常表现为晚期疾病，预后很差，只有10%-15%的患者能存活5年。因此，在很大一部分患者中，姑息治疗是唯一可用的选择。本研究的目的是前瞻性地比较自膨式支架置入术和腔内近距离放射治疗对生活质量和特定症状的影响。65例晚期食道癌或胃食管结合部癌患者被随机分为两组，分别接受超柔可膨胀支架或高剂量率腔内放射治疗，剂量为7Gyx3，疗程2~4周。分别于入选时、入选后1、3、6、9、12个月进行临床评估和健康相关生活质量(HRQL)评定。采用标准化问卷(欧洲癌症研究与治疗组织生活质量调查问卷CORE 30、欧洲癌症研究与治疗组织生活质量调查问卷食道模块和医院焦虑抑郁量表)测量患者的生活质量。28例患者完成支架治疗，24例患者完成近距离放射治疗。接受支架治疗的患者在1个月的随访中吞咽困难的HRQL评分显著提高(P<；0.05)，但大多数其他HRQL评分，包括功能和症状评分，都有所恶化。在接受近距离放射治疗的患者中，在3个月的随访中，吞咽困难相关的评分有所改善，而其他评分的显著变化则很少。两组患者的中位生存期相似(约120天)。总而言之，与腔内近距离放射治疗相比，置入自膨式金属支架可以更迅速地缓解吞咽困难，但近距离放射治疗组的HRQL更稳定。
Esophageal cancer often presents as advanced stage disease with a dismal prognosis, with only 10-15% of patients surviving 5 years. Therefore, in a large proportion of patients, palliative treatment is the only option available. The aim of this study was to prospectively compare the palliative effect of self-expandable stent placement with that of endoluminal brachytherapy regarding the effect on quality of life and on specific symptoms. Sixty-five patients with advanced cancer of the esophagus or gastroesophageal junction were randomized to treatment with either an Ultraflex expandable stent or high-dose-rate endoluminal brachytherapy with 7 Gy x 3 given in 2-4 weeks. Clinical assessment and health-related quality of life (HRQL) were measured at inclusion and 1, 3, 6, 9 and 12 months later. The HRQL was measured with standardized questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Oesophageal Module and Hospital Anxiety and Depression Scale). Twenty-eight patients completed the stent treatment and 24 patients the brachytherapy. The group of patients treated with stent reported significantly better HRQL scores for dysphagia (P < 0.05) at the 1-month follow-up, but most other HRQL scores, including functioning and symptom scales, deteriorated. Among brachytherapy-treated patients, improvement was found for the dysphagia-related scores at the 3-months follow-up, whereas other significant changes of scores were few. The median survival time was comparable in the two groups (around 120 days). In conclusion, insertion of self-expandable metal stents offered a more instant relief of dysphagia compared to endoluminal brachytherapy, but HRQL was more stable in the brachytherapy group.