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Title: Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture

Abstract

Objective: This study was designed to compare the clinical effectiveness of intraluminal radioactive stent loaded with iodine-125 seeds implantation versus covered stent alone insertion in patients with malignant esophageal stricture. Methods: We studied two groups of patients with malignant esophageal stricture. Group A comprised 28 patients (19 men and 9 women) who underwent intraluminal radioactive stent loaded with iodine-125 seeds implantation and were followed prospectively. Group B comprised 30 patients (18 men and 12 women) who had previously received covered stent alone insertion; these patients were evaluated retrospectively. There was no crossover between the two groups during follow-up. Informed consent was obtained from each patient, and our institutional review board approved the study. The dysphagia score, overall survival rates, complication rates, and reintervention rates were compared in the two groups. Results: There were no significant differences between the two groups in terms of baseline characteristics. Stent placement was technically successful and well tolerated in all patients. The dysphagia score was improved in both groups after stent placement. The median survival was significantly longer in group A than in group B: 11 versus 4.9 months, respectively (P < 0.001). The complications of chest pain, esophageal reflux, and stent migration was moremore » frequent in group B, but this difference did not reach statistical significance. There was no statistical difference in reintervention between two groups. Conclusions: Intraluminal radioactive stent loaded with iodine-125 seeds implantation was a feasible and practical management in treating malignant esophageal stricture and was superior to covered stent alone insertion, as measured by survival.« less

Authors:
 [1];  [2];  [3];  [4]; ;  [5];  [1]
  1. Soochow University, School of Radiation Medicine and Public Health (China)
  2. Shanghai Ruijin Hospital Luwan Branch, Department of General Surgery (China)
  3. Shanghai Dahua Hospital, Department of Interventional Oncology (China)
  4. Shanghai Jiao Tong University, Nuclear Medicine, School of Medicine (China)
  5. Shanghai Ruijin Hospital, Department of Radiology (China)
Publication Date:
OSTI Identifier:
21608572
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 35; Journal Issue: 2; Other Information: DOI: 10.1007/s00270-011-0146-6; Copyright (c) 2012 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEST; ESOPHAGUS; IODINE 125; MEN; PAIN; PATIENTS; WOMEN; ANIMALS; BETA DECAY RADIOISOTOPES; BODY; DAYS LIVING RADIOISOTOPES; DIGESTIVE SYSTEM; ELECTRON CAPTURE RADIOISOTOPES; FEMALES; INTERMEDIATE MASS NUCLEI; INTERNAL CONVERSION RADIOISOTOPES; IODINE ISOTOPES; ISOTOPES; MALES; MAMMALS; MAN; NUCLEI; ODD-EVEN NUCLEI; ORGANS; PRIMATES; RADIOISOTOPES; SYMPTOMS; VERTEBRATES

Citation Formats

Wang Zhongmin, E-mail: wzm0722@hotmail.com, Huang Xunbo, E-mail: huangxunbo0722@hotmail.com, Cao Jun, E-mail: caojun88888@hotmail.com, Huang Gang, E-mail: huanggang0722@hotmail.com, Chen Kemin, E-mail: ckm0722@hotmail.com, LIu Yu, E-mail: jadetiger_1258@126.com, and Liu Fenju, E-mail: liufenju0722@hotmail.com. Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture. United States: N. p., 2012. Web. doi:10.1007/S00270-011-0146-6.
Wang Zhongmin, E-mail: wzm0722@hotmail.com, Huang Xunbo, E-mail: huangxunbo0722@hotmail.com, Cao Jun, E-mail: caojun88888@hotmail.com, Huang Gang, E-mail: huanggang0722@hotmail.com, Chen Kemin, E-mail: ckm0722@hotmail.com, LIu Yu, E-mail: jadetiger_1258@126.com, & Liu Fenju, E-mail: liufenju0722@hotmail.com. Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture. United States. doi:10.1007/S00270-011-0146-6.
Wang Zhongmin, E-mail: wzm0722@hotmail.com, Huang Xunbo, E-mail: huangxunbo0722@hotmail.com, Cao Jun, E-mail: caojun88888@hotmail.com, Huang Gang, E-mail: huanggang0722@hotmail.com, Chen Kemin, E-mail: ckm0722@hotmail.com, LIu Yu, E-mail: jadetiger_1258@126.com, and Liu Fenju, E-mail: liufenju0722@hotmail.com. 2012. "Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture". United States. doi:10.1007/S00270-011-0146-6.
@article{osti_21608572,
title = {Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture},
author = {Wang Zhongmin, E-mail: wzm0722@hotmail.com and Huang Xunbo, E-mail: huangxunbo0722@hotmail.com and Cao Jun, E-mail: caojun88888@hotmail.com and Huang Gang, E-mail: huanggang0722@hotmail.com and Chen Kemin, E-mail: ckm0722@hotmail.com and LIu Yu, E-mail: jadetiger_1258@126.com and Liu Fenju, E-mail: liufenju0722@hotmail.com},
abstractNote = {Objective: This study was designed to compare the clinical effectiveness of intraluminal radioactive stent loaded with iodine-125 seeds implantation versus covered stent alone insertion in patients with malignant esophageal stricture. Methods: We studied two groups of patients with malignant esophageal stricture. Group A comprised 28 patients (19 men and 9 women) who underwent intraluminal radioactive stent loaded with iodine-125 seeds implantation and were followed prospectively. Group B comprised 30 patients (18 men and 12 women) who had previously received covered stent alone insertion; these patients were evaluated retrospectively. There was no crossover between the two groups during follow-up. Informed consent was obtained from each patient, and our institutional review board approved the study. The dysphagia score, overall survival rates, complication rates, and reintervention rates were compared in the two groups. Results: There were no significant differences between the two groups in terms of baseline characteristics. Stent placement was technically successful and well tolerated in all patients. The dysphagia score was improved in both groups after stent placement. The median survival was significantly longer in group A than in group B: 11 versus 4.9 months, respectively (P < 0.001). The complications of chest pain, esophageal reflux, and stent migration was more frequent in group B, but this difference did not reach statistical significance. There was no statistical difference in reintervention between two groups. Conclusions: Intraluminal radioactive stent loaded with iodine-125 seeds implantation was a feasible and practical management in treating malignant esophageal stricture and was superior to covered stent alone insertion, as measured by survival.},
doi = {10.1007/S00270-011-0146-6},
journal = {Cardiovascular and Interventional Radiology},
number = 2,
volume = 35,
place = {United States},
year = 2012,
month = 4
}
  • A patient suffering from esophagorespiratory fistula after bougienage of a benign stricture at the site of the anastomosis between a jejunal interposition and the esophagus was referred for interventional treatment. A prototype nitinol stent centrally covered with Dacron was implanted under regional anesthesia and fluoroscopic guidance. The self-expanding prosthesis dilated the stenosis completely and closed the fistula, with consequent improvement in respiratory and nutritional status and thus the general quality of life. The patient was able to eat and drink normally until death 3 months later due to progression of his underlying malignant disease.
  • Many patients with malignant gastroduodenal obstruction have an unresectable primary lesion and distant metastases, which may prompt palliative management to allow the patient to eat and to improve the quality of life. Intraluminal metallic stent implantation (MSI) under fluoroscopic guidance has been reported to be an effective option for symptomatic relief in these patients, with a good safety record. An alternative, dual interventional therapy (DIT), has been used during the last decade, in which prosthesis insertion is followed by intra-arterial chemotherapy via the tumor-feeding arteries. The aim of this study was to compare success rates, complication rates, and survival timemore » between MSI and DIT in patients who presented with gastroduodenal obstruction from advanced upper gastrointestinal tract cancer. All consecutive patients with malignant gastroduodenal obstruction seen at our center between October 2002 and August 2007 were retrospectively studied. Patients were treated palliatively by either MSI or DIT by the patient's or the next of kin's decision. Outcomes included technical and clinical success, complication rates, and survival. Of the 164 patients with malignant gastric and duodenal outlet obstructions, 80 (49%) underwent stent insertion as the primary therapy, while the remaining 84 (51%) received DIT. Clinical characteristics were similar between the two groups. In the MSI cohort initial stent implantation was successful in 73 patients (91%), two stents were used in 5 patients, and delayed additional stent insertion for stent obstruction related to tumor overgrowth was required in 3 patients during follow-up. In the DIT cohort the technical success rate was 94%, 3 patients required two stents, and stent obstruction occurred in 2 patients after initial stent placement. Early postprocedural clinical success, indicated by average dysphagia score, improved significantly in both groups: MSI group, from 4.56 to 1.51 (P < 0.01); and DIT group, from 4.38 to 1.48 (p < 0.01). There were no short-term complications. Late complications including hematemesis (n = 3), migration (n = 12), and stent occlusion due to tumor overgrowth (n = 5) were evenly distributed between the groups. In the DIT group chemotherapy-induced neutropenia and transient renal dysfunction were detected in six patients, which improved after symptomatic management. Mean survival time after the procedure was 5.9 and 11.1 months for MSI and DIT, respectively (P < 0.001). In conclusion, both MSI and DIT offer effective palliation for malignant gastroduodenal obstruction, but DIT appears to offer superior survival over MSI alone. Ideally, a prospective randomized trial comparing these two techniques should be carried out to validate this result.« less
  • Partially covered Gianturco stents were used successfully in two patients to treat tracheobronchial strictures caused by intraluminal tumor growth. The stents were accurately placed without complications. The covered portion of the stent compressed the tumor, and prevented tumor ingrowth until the patients' deaths. This stent seems to act as effective palliation for tracheobronchial stricture caused by intraluminal tumor.
  • In order to treat fistulated esophageal cancer using a flexible stent, a covered flexible stent was constructed by wrapping a nitinol stent with a thin sheet of Gore-Tex, preserving the stents original advantages of flexibility and a low-profile introducer system. This stent was used to perform standard radiotherapy in a case of fistulated esophageal cancer.
  • To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a meanmore » of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two groups. Viabil stent-grafts proved to be significantly superior to Wallstents for the palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, with comparable cost and complication rates. Appropriate patient selection should be performed prior to stent placement.« less