Esophageal cancer as a cause of death is the 6 th place among all malignant tumors. The prognosis of this tumor is very unfavorable: Worldwide 5-year survival rate - less than 10%. Most-RP appears dysphagia, which usually indicates already locally advanced process. In some regions of ER occurs most often. These regions include Kenya, where the RP takes first place in frequency among all cancers. In this country, about 90% of patients first seek medical attention when the tumor is inoperable. However, only few of them have access to radiotherapy and chemotherapy. Therefore, in Kenya and similar countries is highly relevant search techniques of palliative care for patients with esophageal cancer. One such method may be already well-proven use of metal self-expanding stent (Baron T. et al., 2001; Conio M. et al. 2007).
Methods and progress in the study.
C 1999 to 2008, in the hospital Tenwek in Bomet (Kenya), stents were installed in 951 consecutive patients with esophageal cancer who have dysphagia. Age of patients ranged over from 20 to 99 years (median - 62 years).
Patients underwent esophagoscopy. If the tumor is impossible to pass the endoscope with a diameter 9.8 mm, the lumen of the esophagus in a given place gradually expanded dilator after the wire-guide. It then sets the stent under direct endoscopic control.
The indications for stent thought: distant metastases, tracheoesophageal fistula, paralysis of the phrenic or recurrent laryngeal nerve. Relative indications for this procedure (as an alternative to surgical treatment) were: age> 80 years, marked cachexia, decreased exercise tolerance, expressed concomitant diseases, HIV infection. Absolute contraindication to stent was the germination of tumors of the upper esophageal sphincter. Relative contra indication was extensive involvement of the cardiac portion of the stomach. At follow-up to evaluate the degree of dysphagia, incidence of complications and mortality. To assess the degree of dysphagia to apply the scale Ogilvie: 0 points - the patient can swallow a normal diet, 1 - to swallow some solid foods, 2 - is a can allow sole semi-liquid diet, 3 - can swallow only liquids, 4 - could not even swallow saliva. Average score of dysphagia before stent placement was equal to 3,3.
Follow-up after stent placement was possible to roughly one-third of patients (334, i.e .35%), mean follow-up with about seven months. Over 195, patients could be traced back to the end of their lives. 139 patients were alive at last observation. The average overall survival by Kaplan-Meier was about eight months (250 days). Median survival of patients with tracheoesophageal fistula was significantly lower - less than five months (142 days).
Most patients (90%) after stent placement there is a weakening of dysphagia: its average score decreased to 1.0 in patients who were alive at last observations, and to 1.8 in patients who have died.
In 34 patients during endoscopic procedures expanding esophageal perforation occurred that body. 1 of them died shortly after setting the stent. 17 of these 34 patients could observe later. 9 of them were alive at the time of last observation (mean observation period of approximately six months - 187 days); 8 died with a median survival time of more than eight months (261 days). Another 2 patients died, the authors say, because this production stent (one with symptoms of empyema and confusion, the second was the sudden death from unspecified causes).
Each sixth of the 334 patients subsequently observed (median time after stent placement - less than five months - 144 days) developed symptoms of germination of the tumor through the stent to the narrowing of the esophagus. 30 patients were re-stenting, 4 - the third installation of the stent.
Male sex and age not more than 50 years were factors in the relatively poor prognosis.
Application of self-expanding stents may have a pronounced palliative effect in patients with advanced esophageal cancer, the frequency of complications in this small. Study limitations include the fact that almost 2 / 3 patients were lost to follow up. Therefore, the results need to be checked in subsequent scientific papers.
White RE et al. Stents as sole therapy for esophageal cancer: a prospective analysis of outcomes after placement. Lancet Oncol. 2009; February 17,10: 240-46
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