Esophageal cancer is a rare and often fatal cancer. Even when detected in the early stages when surgical resection is feasible, the 5 year overall survival rate range from 10% to 36%. Treatment may also include chemotherapy and radiation therapy to attenuate disease progression. In patients who have difficulty swallowing (dysphagia) the insertion of a stent may be necessary.
A new phase 3 clinical trial however, may provide new hope for some patients with advanced esophageal cancer.
Zhu et al performed a multicenter, single-blind, randomized, phase 3 trial in which 160 patients with unresectable advanced esophageal cancer from 16 Chinese hospitals were treated with a conventional stent or a stent loaded with 125-iodine seeds. In theory, it was hoped that the stent would provide relief for the dysphagia while the addition of the 125- iodine seeds would provide a local radiotherapeutic effect on the tumors. The primary endpoint in the study was overall survival.
Median overall survival was 177 days (95% CI 153–201) in the irradiation group (n=73) versus 147 days (124–170) in the control group (n=75; p=0.0046). Medial follow-up was 138 days (72-207). Major complications and side-effects of the treatment were severe chest pain (23% of patients in the irradiation group vs 20% of the control group), fistula formation (8% vs 7%), aspiration pneumonia (15% vs 19%), hemorrhage (7% vs 7%), and recurrent dysphagia (28% vs 27%). None of the adverse events were significantly different between the two groups.
The authors of the study concluded that “The findings of our study showed that inserting a novel oesophageal stent coated with 125-iodine seeds was well tolerated, provided relief of dysphagia, and prolonged survival when compared with insertion of a conventional covered self expandable metallic stent in patients with unresectable oesophageal cancer.”
To obtain a reprint of this study, visit http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2814%2970131-7/abstract
In the United States, there are about 18,170 new esophageal cancer cases diagnosed each year (14,660 in men and 3,510 in women) and approximately 15,450 deaths from esophageal cancer (12,450 in men and 3,000 in women). It is considered a rare disease in the United States but it is more common in other regions of the world, including China. For more information esophageal cancer, visit http://www.cancer.org/cancer/esophaguscancer/index
Zhu H-D, Guo J-H, Mao A-W, et al. Conventional stents versus stents loaded with 125-iodine seeds for the treatment of unresectable oesophageal cancer: a multicenter, randomized phase 3 trial. Lancet Oncol.