Palliative techniques in esophageal cancer

Abstract

Today, curative treatment of esophageal cancer can be achieved by surgery. Dysphagia doesn’t seen until tumor diameter reaches at least 50% of esophagus diameter so curative treatment with esophagectomy can’t be provided in most patients. Spreading to remote areas is usually seen when the disease diagnosed. In patients that curative treatment is not possible, palliative tratment methods are used to control tumor associated symptoms and systemic symptoms. Palliative treatment choice of malignant dysphagia in esophageal cancer patients varies according to disease stage, tumor location, general condition of patient, physician’s experience. Palliative treatment of esophagus cancer can be grouped under four main headings. These are lumen reconstruction, surgery, chemotherapy and radiotherapy

Keywords

• Esophageal cancer
• Palliation
• Stent
• Chemotherapy
• Radiotherapy
• Surgery

Özofagus kanserinde palyatif teknikler

Abstract

Günümüzde özofagus kanserinin küratif tedavisi cerrahi ile sağlanabilmektedir. Özofagus çapının en az % 50’si tümör ile tutuluncaya kadar disfaji görülmemesi nedeniyle hastaların çoğunda özofajektomi ile küratif tedavi sağlanamamaktadır. Hastalık teşhis edildiğinde genellikle uzak bölgelere yayılım gösterdiği tespit edilmektedir. Küratif tedavinin mümkün olmadığı hastalarda tümörle ilgili ve sistemik semptomların kontrol altına alınabilmesi için palyatif tedavi metotları geliştirilmiştir. Özofagus kanserli hastalarda malign disfajinin palyasyonunda tedavi seçimi hastalığın evresi, tümör lokalizasyonu, hastanın genel durumu ve hekimin tecrübesine göre değişmektedir. Özofagus kanserinin palyatif tedavisi dört ana başlık altında toplanabilir. Bunlar lümenin yeniden oluşturulması, cerrahi, kemoterapi ve radyoterapidir. 

Keywords

• Özofagus kanseri
• Palyasyon
• Stent
• Kemoterapi
• Radyoterapi
• Cerrahi

References

1. Acunas, B., Rozanes, I., Akpinar, S., Tunaci, A., Tunaci, M., Acunaş, G., 1996. Palliation of malignant esophageal strictures with self-expanding nitinol stents: Drawbacks and complications. Radiology. 199, 648-652.
2. Adam, A., Ellul, J., Watkinson, A.F., Tan, B.S., Morgan, R.A., Saunders, M.P., Mason, R.C., 1997. Palliation of inoperable oesophageal carcinoma: A prospective randomised trial of Laser therapy and stent placement. Radiology. 202, 344-348.
3. Alderson, D., Wright, P.D., 1990. Lazer recannalisation verses endoscopic intubation in the palliation of malignant dysphagia. Br. J. Surg. 77, 1151- 1153.
4. Baron, T.H., 2001. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N. Engl. J. Med. 344, 1681-1687.
5. Bethge, N., Sommer, A., Vakil, N., 1997. A prospective trial of self-expanding metal stents in the palliation of malignant esophageal strictures near the upper esophageal sphincter. Gastrointest. Endosc. 45, 300-303.
6. Bisgaard, T., Wojdemann, M., Heindorff, H., Svendsen, L.B., 1997. Nonsurgical treatment of esophageal perforations after endoscopic palliation in ad- vanced esophageal cancer. Endosc. 29, 155-159.
7. Boyce, H.W. Jr., 1984. Palliation of advanced esophageal cancer. Semin. Oncol. 11, 186-195.
8. Burt, M., Diehl, W., Martini, N., Bains, M.S., Ginsberg, R.J., McCormack, P.M., Rusch, V.W., 1991. Malignant esophagorespiratory fistula: Management options and survival. Ann. Thorac. Surg. 52, 1222-1229.

9. Cantero, R., Torres, A.J., Hernando, F., Gallego, J., Lezana, A., Suarez, A., Balibrea, J.L., 1999. Palliative treatment of esophageal cancer: Self-expanding metal stents versus Postlethwait technique. Hepatogastroenterology. 46, 971-976.
10. Cassidy, D.E., Nord, H.J., Boyce, H.W., 1981. Management of malignant esophageal strictures: Role of esophageal dilation and peroral prosthesis. Gas- troenterology. 75, 173.
11. Conlan, A.A., Nicolaou, N., Delikaris, P.G., Pool, R., 1984. Pessimism concerning palliative bypass procedures for established malignant esophagorespi- ratory fistulas: A report of 18 patients. Ann. Thorac. Surg. 37, 108-110.
12. Cottier, D.J., Carter, C.R., Smith, J.S., Anderson, J.R., 1997. The combination of laser recanalization and endoluminal intubation in the palliation of malignant dysphagia. J.R.Coll. Surg. Edinb. 2, 19-20.
13. Currazoni, A., Bonavina, C., Segalin, A., 1999. Endoscopic palliation of oesophageal cancer: Results of a prospective comparison of Nd: YAG Lazer and ethanol injection. Eur. J. Surg. 165, 351-356.
14. Decker, P., Lippler, J., Decker, D., Hirner, A., 2001. Use of the Polyflex stent in the palliative therapy of esophageal carcinoma: Results in 14 cases and review of the literature. Surg. Endosc. 15, 1444-1447.
15. Domschke, W., Foerster, E.C., Matek, W., Rodl, W., 1990. Self-expanding mesh stent for esophageal cancer stenosis. Endosc. 22, 134–136.
16. Dormann, A.J., Eisendrath, P., Wigginghaus, B., Huchzermeyer, H., 2003. Palliation of esophageal carcinoma with a new self-expanding plastic stent. Endoscopy. 35, 207-211.
17. Dorta, G., Binek, J., Blum, A.L., Bühler, H., Felley, C.P., Koelz, H.R., Lammer, F., Lang, C., Meier, R., Meyenberger, C., Meyer-Wyss, B., Michetti, P., Protiva, P., Scheurer, U., Weber, B., Wiesel, P., Vogel, S., 1997. Comparison between esophageal Wallstent and Ultraflex stents in the treatment of malignant stenoses of the esophagus and cardia. Endosc. 29, 149-154.
18. Ell, C., Riemann, J.F., Lux, G., Demling, L., 1986. Palliative laser treatment of malignant stenoses in the upper gastrointestinal tract. Endoscopy. 21- 26.
19. Eroğlu, A., Türkyılmaz, A., Aydın, Y., 2009. Özofagus hastalıklarında stent uygulamaları. Turkiye Klinikleri. J. Thor. Surg-Special Topics. 2, 95-99.
20. Eroglu, A., Turkyilmaz, A., Aydin, Y., Yekeler, E., Karaoglanoglu, N., 2009. Current management of esophageal perforation: 20 years experience. Dis. Esophagus. 22, 374-380.
21. Fleischer, D., Kesler. F., Haye, O., 1982. Endoscopic Nd: YAG laser therapy for carcinoma of the esophagus: A new palliative approach. Am. J. Surg. 143, 280-283.
22. Fleisher, D., 1987. A comparison of endoscopic laser therapy and BICAP tumor probe therapy for esophageal cancer. Am. J. Gastroenterol. 82, 608- 612.
23. Frenkel, J.L., Daly, B.D.T., Fernando, H.C., 2009. Palliative options and procedures. In Sugarbaker, D.J., Bueno, R., Krasna, M.J., Mentzer, S.J., Zellos, L., ed. Adult chest surgery, McGraw Hill Cos. 125-134
24. Giral, A., Kalaycı, C., 2002. Özofagusun kanser dışı hastalıklarında cerrahi tedavi. İç: Yüksel, M., Başoğlu, A. ed. Özofagus hastalıklarının tıbbi ve cer- rahi tedavisi. 309-320.
25. Giuli, R., Gignoux, M., 1980. Treatment of carcinoma of the esophagus: Retrospective study of 2400 patients. Ann. Surg. 192, 44-52.
26. Golder, M., Tekkis, P.P., Kennedy, C., Lath, S., Toye, R., Steger, A.C., 2001. Chest pain following oesophageal stenting for malignant dysphagia. Clin. Radiol. 56, 202-205.
27. Heit, H.A., Johnson, L.F., Siegel, S.R., Boyce, H.W. Jr., 1978. Palliative dilation for dysphagia in esophageal carcinoma. Ann. Intern. Med. 89, 629- 631.
28. Hernandez, L.V., Jacobson, J.W., Haris, M.S., 2000. Comparison among the perforation rates of Maloney, balloon, and Savary dilation of esophageal strictures. Gastrointest. Endosc. 51, 460-462.
29. Homs, M.Y., Wahab, P.J., Kuipers, E.J., Steyerberg, E.W., Grool, T.A., Haringsma, J., Siersema, P.D., 2004. Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: A randomized trial. Gastrointest. Endosc. 60, 695–702.
30. Horvath, O.P., Lukacs, L., 1996. Palliation of esophageal cancer: palliative resection and bypass surgery. Dis. Esophagus. 9, 117–122.
31. Hirai, T., Yamashita, Y., Mukaida, H., Kawano, K., Toge, T., Niimoto, M., Hattori, T., 1989. Bypass operation for advanced esophageal cancer an analysis of 93 cases. Jpn. J. Surg. 19, 182-188.
32. Homs, M.Y., Steyerberg, E.W., Eijkenboom, W.M., Tilanus, H.W., Stalpers, L.J., Bartelsman, J.F., van Lanschot, J.J., Wijrdeman, H.K., Mulder, C.J., Reinders, J.G., Boot, H., Aleman, B.M., Kuipers, E.J., Siersema, P.D., 2004. Single-dose brachytherapy versus metal stent placement for the pallia- tion of dysphagia from oesophageal cancer: Multicentre randomised trial. Lancet. 364, 1497-1504.
33. Ilson, D.H., Saltz, L., Enzinger, P., Huang, Y., Kornblith, A., Gollub, M., O’Reilly, E., Schwartz, G., DeGroff, J., Gonzalez, G., Kelsen, D.P., 1999. Phase II trial of weekly irinotecan plus cisplatin in advanced esophageal cancer. J. Clin. Oncol. 17, 3270-3275.
34. Ilson, D.H., Forastiere, A., Arquette, M., Costa, F., Heelan, R., Huang, Y., Kelsen, D.P., 2000. A phase II trial of paclitaxel and cisplatin in patients with advanced carcinoma of the esophagus. Cancer J. 6, 316-323.
35. Iwasa, M., Ohmori, Y., Iwasa, Y., Yamamoto, A., Inoue, A., Maeda, H., Kume, M., Ogoshi, S., Nishioka, A., Ogawa, Y., Yoshida, S., 1998. Effect of multidisciplinary treatment with high dose rate intraluminal brachytherapy on survival in patients with unresectable esophageal cancer. Dig. Surg. 15, 227-235.
36. Javle, M., Ailawadhi, S., Yang, G.Y., Nwogu, C.E., Schiff, M.D., Nava, H.R., 2006. Palliation of malignant dysphagia in esophageal cancer: A literature- based review. J. Support Oncol. 4, 365-379.
37. Jensen, D.M., Machicado, G., Randall, G., Tung, L.A., English-Zych, S., 1988. Comparison of low-power YAG laser and BICAP tumor probe for pallia- tion of esophageal cancer strictures. Gastroenterology. 94, 1263-1270.
38. Johnston, J.H., Fleisher, D., Petrini, J., Nord, J., 1987. Palliative bipolar electrocoagulation therapy of obstructing esophageal cancer. Gastrointest. En- dosc. 33, 349-353.
39. Kawasaki, R., Sano, A., Matsumoto, S., 2003. Long-term outcomes and complications of metallic stents for malignant esophageal stenoses. Kobe J. Med. Sci. 49, 133-142.
40. Kirschner, M., 1920. Ein neues verfahren der oesophagus plastik. Arch. Klin. Chir. 114, 606–663.
41. Knyrim, K., Wagner, H.J., Bethge, N., Keymling, M., Vakil, N., 1993. A controlled trial of an expansile metal stent for palliation of esophageal obstruc- tion due to inoperable cancer. N. Engl. J. Med. 329, 1302-1307.
42. Korst, R.J., Ginsberg, R.J., 2005. Surgical Palliation of inoperable carcinoma of the esophagus. In Shields, T.W., LoCicero, J., Ponn, R.B., Rusch, V.W., ed. General Thoracic Surgery, vol 2, 6th ed. Philadelphia. Lippincott Williams and Wilkins 2313-2324.
43. Laasch, H.U., Marriott, A., Wilbraham, L., Tunnah, S., England, R.E., Martin, D.F., 2002. Effectiveness of open versus antireflux stents for palliation of distal esophageal carcinoma and prevention of symptomatic gastroesophageal reflux. Radiology. 225, 359.
44. Litle, V.R., Luketich, J.D., Christie, N.A., Buenaventura, P.O., Alvelo-Rivera, M., McCaughan, J.S., Nguyen, N.T., Fernando, H.C., 2003. Photodynamic therapy as palliation for esophageal cancer: Experience in 215 patients. Ann. Thorac. Surg. 76, 1687-1693.
45. Lightdale, C.J., Heier, S.K., Marcon, N.E., McCaughan, J.S.Jr., Gerdes, H., Overholt, B.F., Sivak, M.V.Jr., Stiegmann, G.V., Nava, H.R., 1995. Photody- namic therapy with porfimer sodium versus thermal ablation therapy with Nd: YAG laser for palliation of esophageal cancer: A multicenter random- ized trial. Gastrointest. Endosc. 42, 507-512.
46. Loizou, L.A., Grigg, D., Atkinson, M., Robertson, C., Bown, S.G., 1991. A prospective comparison of laser therapy and intubation in endoscopic pallia- tion for malignant dysphagia. Gastroenterology. 100, 1303-1310.
47. Mayoral, W., Fleischer, D., Salcedo, J. 2000. Nonmalignant obstruction is a common problem with metal stents in the treatment of oesophageal cancer. Gastrointest. Endosc. 51, 556-559.
48. McCaughan, J.S.Jr., Ellison, E.C., Guy, J.T., Hicks, W.J., Jones, J.J., Laufman, L.R., May, E., Nims, T.A., Spiridonidis, C.H., Williams, T.E., 1996. Pho- todynamic therapy for esophageal malignancy; a prospective twelve-year study. Ann. Thorac. Surg. 62, 1005-1010.
49. Meunier, B., Spiliopoulos, Y., Stasik, C., Lakéhal, M., Malledant, Y., Launois, B., 1996. Retrosternal bypass operation for unresectable squamous cell cancer of the esophagus. Ann. Thorac. Surg. 62, 373-377.
50. Minsky, B.D., Pajak, T.F., Ginsberg, R.J., Pisansky, T.M., Martenson, J., Komaki, R., Okawara, G., Rosenthal, S.A., Kelsen, D.P., 2002. INT 0123 (Radia- tion Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: High-dose versus standard-dose radiation therapy. J. Clin. Oncol. 20, 1167-1174.
51. Murthy, S., Gonzalez-Stawinski, G.V., Rozas, M.S., Gildea, T.R., Dumot, J.A., 2007. Palliation of malignant aerodigestive fistulae with self-expanding metallic stents. Dis. Esophagus. 20, 386-389.
52. Mulle, J.M., Erasmi, J., Stelzner, M., Zieren, U., Pichlmaier, H., 1990. Surgical therapy of esophageal carcinoma. Br. J. Surg. 77, 845-857.
53. O’Rourke, I.C., Tiver, K., Bull, C., Gebski, V., Langlands, A.O., 1988. Swallowing performance after radiation therapy for carciınoma of the esophagus. Cancer. 61, 2022-2026.
54. Overgaard, J., 1980. Simultaneous and sequential hyperthermia and radiation treatment of an experimental tumor and its surrounding normal tissue in vivo. Int. J. Radiat. Oncol. 6, 1507-1515.
55. Overgaard, J., Nielsen, O.S., Lindegaard, J.C., 1987. Biological basis for rational design of clinical treatment with combined hyperthermia and radiation. NATO ASI Ser. E. 127, 54-79.
56. Ökten, İ., 2003. Özofagus kanserleri. İç: Ökten, İ., Güngör, A., Göğüs Cerrahisi. Cilt 2, 1247-1226.
57. Okunaka, T., Kato, H., Conaka, C., Yamamoto, H., Bonaminio, A., Eckhauser, M.L., 1990. Photodynamic therapy of esophageal carcinoma. Surg. En- dosc. 4, 150-153.
58. Rahmani, E.Y., Rex, D.K., Lehman, G.A., 1999. Z-stent for malignant esophageal obstruction. Gastrointest. Endosc. Clin. N. Am. 9, 395-402.
59. Sabharwal, T., Hamady, M.S., Chui, S., Atkinson, S., Mason, R., Adam, A., 2003. A randomized prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut. 52, 922-926.
60. Sabharwal, T., Morales, J.P., Irani, F.G., Adam, A., 2005. Qualitiy improvoment guidelines for placement of esophageal stents. Cardiovasc. Inter. Rad. 28, 284-288.
61. Sander, R., Hagenmueller, F., Sander, C., Riess, G., Classen, M., 1991. Laser versus laser plus afterloading with iridium-192 in the palliative treatment of malignant stenosis of the esophagus: A prospective, randomized, and controlled study. Gastrointest. Endosc. 37, 433-440.
62. Schmassmann, A., Meyenberger, C., Knuchel, J., Binek, J., Lammer, F., Kleiner, B., Hürlimann, S., Inauen, W., Hammer, B., Scheurer, U., Halter, F., 1997. Self expandable metal stents in malignant esophageal obstruction: A comparison between two stent types. Am. J. Gastroenterol. 92, 400-406.
63. Shin, J.H., Song, H.Y., Ko, G.Y., Lim, J.O., Yoon, H.K., Sung, K.B., 2004. Esophagorespiratory fistula: Long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology. 232, 252-259.
64. Shim, C.S., Jung, I.S., Cheon, Y.K., Ryu, C.B., Hong, S.J., Kim, J.O., Cho, J.Y., Lee, J.S., Lee, M.S., Kim, B.S., 2005. Management of malignant stricture of the esophagogastric junction with a newly designed self-expanding metal stent with an antireflux mechanism. Endosc. 37, 335-339.
65. Siersema, P.D., Hop, W.C., van Blankenstein, M., van Tilburg, A.J., Bac, D.J., Homs, M.Y., Kuipers, E.J., 2001. A Comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: A prospective randomized study. Gastrointest. En- dosc. 54, 145-153.
66. Siersema, P.D., Hop, W.C., Dees, J., Tilanus, H.W., van Blankenstein, M., 1998. Coated self-expanding metal stents versus latex prostheses for esophago- gastric cancer with special reference to prior radiation and chemotherapy: A controlled, prospective study. Gastrointest. Endosc. 47, 113-120.
67. Spencer, G.M., Thorpe, S.M., Blackman, G.M., Solano, J., Tobias, J.S., Lovat, L.B., Bown, S.G., 2002. Laser augmented by brachytherapy versus laser alone in the palliation of adenocarcinoma of the oesophagus and cardia: A randomised study. Gut. 50, 224-227.
68. Spiridonidis, C.H., Laufman, L.R., Jones, J., Rhodes, V.A., Wallace, K., Nicol, S., 1998. Phase I study of docetaxel dose escalation in combination with fixed weekly gemcitabine in patients with advanced malignancies. J. Clin. Oncol. 16, 3866-3873.
69. Song, H.Y., Jung, H.Y., Park, S.I., Kim, S.B., Lee, D.H., Kang, S.G., II Min, Y., 2000. Covered retrievable expandable nitinol stents in patients with benign esophageal strictures: Initial experience. Radiology. 217, 551-557.
70. Stoller, J.L., Brumwell, M.L., 1984. Palliation after operation and after radiotherapy for cancer of the esophagus. Can. J. Surg. 27, 491-495.
71. Sur, R.K., Donde, B., Levin, V.C., Mannell, A., 1998. Fractionated high dose rate intraluminal brachytherapy in palliation of advanced esophageal cancer. Int. J. Radiat. Oncol. 40, 447-453.
72. Tan, B.S., Mason, R.C., Adam, A., 1996. Minimally invasive therapy for advanced oesophageal malignancy. Clin. Radiol. 51, 828-836.
73. Tebbutt, N.C., Norman, A., Cunningham, D., Iveson, T., Seymour, M., Hickish, T., Harper, P., Maisey, N., Mochlinski, K., Prior, Y., Hill, M., 2002. A multicentre, randomised phase III trial comparing protracted venous infusion (PVI) 5-fluorouracil (5-FU) with PVI 5-FU plus mitomycin C in pa- tients with inoperable oesophago-gastric cancer. Ann. Oncol. 13, 1568-1575.
74. Therasse, E., Oliva, V.L., Lafontaine, E., Perreault, P., Giroux, M.F., Soulez, G., 2003. Balloon dilation and stent placement for esophageal lesions: Indi- cations, methods, and results. Radiographics. 23, 89-105.
75. Tomaselli, F., Maier, A., Sankin, O., Woltsche, M., Pinter, H., Smolle-Jüttner, F.M., 2001. Successful endoscopical sealing of malignant esophageotra- cheal fistulae by using a covered self-expandable stenting system. Eur. J. Cardiothorac. Surg. 20, 734-738.
76. Turhal, N.S., 2002. Özofagus kanserinde kemoterapi ve kemoradyoterapi uygulamaları. Özofagus hastalıklarının tıbbi ve cerrahi tedavisi. 321-328.
77. Turkyilmaz,, A., Eroglu, A., Aydin, Y., Kurt, A., Bilen, Y., Karaoglanoglu, N., 2010. Complications of metallic stent placement in malignant esophageal stricture and their management. Surg. Laparo. Endo. Per. 20, 10-15.
78. Turkyilmaz, A., Eroglu, A., Aydin, Y., Tekinbas, C., Muharrem Erol, M., Karaoglanoglu, N., 2009. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis. Esophagus. 22, 119–26.
79. Turkyilmaz, A., Aydin, Y., Eroglu, A., Bilen, Y., Karaoglanoglu, N., 2009. Palliative management of esophagorespiratory fistula in esophageal malig- nancy. Surg. Laparo. Endo. Per. 19, 364-367.
80. Watkinson, A., Ellul, J., Entwisle, K., Farrugia, M., Mason, R., Adam, A., 1995. Oesophageal carcinoma: Initial results with covered self expanding endoprostheses. Radiology. 195, 821–827.
81. Wengrower, D., Fiorini, A., Valero, J., Waldbaum, C., Chopita, N., Landoni, N., Judchack, S., Goldin, E., 1988. EsophaCoil: long-term results in 81 patients. Gastrointest. Endosc. 48, 376-382.
82. Wang, M.Q., Sze, D.Y., Wang, Z.P., Wang, Z.Q., Gao, Y.A., Dake, M.D., 2001. Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas. J. Vasc. Interv. Radiol. 12, 465-474.
83. Verschuur, E.M., Kuipers, E.J., Siersema, P.D., 2007. Esophageal stents for malignant strictures close to the upper esophagealsphincter. Gastrointest. Endosc. 66, 1082-1090.