The Comparison of Value of Brachytherapy and Endoscopic Stenting With SEMS in Palliative Treatment of Dysphagia Resulting From Adenocarcinoma of the Esophago-Gastric Junction
Over the past two decades it has been observed a clear trend in the increasing incidence of
adenocarcinoma of the esophagus and esophago-gastric junction. More than half of these
patients already have inoperable disease at presentation. Most of them need palliative
treatment to relieve progressive dysphagia. Presently, endoscopic placement of a covered
selfexpanding metal stent is the most commonly used method for treatment of malignant
dysphagia. Cancer overgrowth and stent migration are the most common complications of
endoscopic stenting and they occur more frequently with longer time from stenting. Specific
location at esophago-gastric junction at the end point of the propulsive force after swallow
may predispose stents for easier migration to the stomach. Additionally, the advances in
chemotherapy have resulted in improved median survival of advanced adenocarcinoma ot the
stomach and esophago-gastric junction even up to 10-12 months increasing a potential for
higher chance for occurrence of stent complications. Brachytherapy has been proved to be a
valuable and durable method to treat malignant dysphagia resulting from esophageal and
mainly squamous cell cancer. For many years irradiation was not recommended for
adenocarcinoma of the esophagus and esophago-gastric junction due to their putative low
sensitivity to radiotherapy. Recently external beam radiation has been incorporated to a
combined modality therapy regimens also for adenocarcinoma of the esophagus. Thus,
brachytherapy could be an attractive and durable method for improving swallowing in
adenocarcinoma of the esophago-gastric junction, as well. Single-dose brachytherapy and
endoscopic stenting with SEMS in relieving dysphagia resulting from clearly defined
adenocarcinoma of the esophago-gastric junction have not been compared yet.
Interventional
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
The highest improvement of dysphagia grade
1 year
No
Tomasz Skoczylas, MD, PhD
Principal Investigator
Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Alimentary Tract, Medical University of Lublin
Poland: Ethics Committee
EGC-DYS-0254/281/2011-MUL
NCT01786278
February 2013
December 2017
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