Objective: It is still unclear whether prior radiation and/or chemotherapy (RTCT) increases the risk of complications after the placement of self-expanding metal stents in patients with inoperable oesophagogastric carcinoma. We evaluated the influence of prior RTCT on the outcome of stent placement in a large group of patients. Methods: From October 1994 to December 2000, 200 patients underwent placement of self-expanding metal stents for malignant dysphagia, and were followed prospectively. Forty-nine of these patients had received prior RTCT (chemotherapy n = 35, radiation therapy n = 8, or both n = 6). Results: At 4 weeks after stenting, the dysphagia score had improved similarly in patients with or without prior RTCT, from a median of 3 to 0 (P < 0.001). The occurrence of major complications (bleeding, perforation, fistula formation, fever and severe pain) was not different between patients with or without prior RTCT (29% vs 21%; relative risk (RR) = 1.15 (95% CI 0.54-2.46; P = 0.72)), as was the occurrence of recurrent dysphagia due to tumour overgrowth, stent migration, or impaction of a food bolus (35% vs 27%; RR = 1.49 (95% CI 0.71-3.13; P = 0.29)). Median survival of both patient groups after stent placement was similar (110 vs 93 days; RR = 0.90 (95% CI 0.60-1.34; P = 0.60) for prior RTCT versus no prior treatment). Only minor complications (mainly mild retrosternal pain) occurred more frequently in patients with prior RTCT (41% vs 15%; RR = 2.12 (95% CI 1.06-4.25; P = 0.035)). Conclusions: Both the incidence of life-threatening complications and survival after placement of self-expanding metal stents for oesophagogastric carcinoma are not affected by prior RTCT, but retrosternal pain occurs more frequently in patients who had previously undergone RTCT.

Chemotherapy, Dysphagia, Oesophageal carcinoma, Palliation, Radiation, Stent
dx.doi.org/10.1097/00042737-200402000-00007, hdl.handle.net/1765/62926
European Journal of Gastroenterology and Hepatology
Department of Gastroenterology & Hepatology

Homs, M.Y.V, Hansen, B.E, van Blankenstein, M, Haringsma, J, Kuipers, E.J, & Siersema, P.D. (2004). Prior radiation and/or chemotheray has no effect on the outcome of metal stent placement for oesophagogastric carcinoma. European Journal of Gastroenterology and Hepatology, 16(2), 163–170. doi:10.1097/00042737-200402000-00007