Esophageal Palliation—Photodynamic Therapy/Stents/Brachytherapy
Section snippets
Photodynamic therapy
Photodynamic therapy (PDT) is a two-stage process. In the first stage, the photosensitzer porfimer sodium is administered intravenously. The next stage is 48 hours after the initial injection. Because of differences in tumor vascular supply and lymphatic clearance, the photosensitizer is selectively retained in the tumor at 48 hours. Flexible endoscopy is then performed to visualize the tumor, and light is delivered to the tumor through a flexible gastroscope with an optical fiber (Fig. 1). The
Brachytherapy
Brachytherapy enables patients to obtain the benefits of radiation to decrease or obliterate the local tumor burden, without the harmful effects of collateral damage resulting from external beam radiation. Current brachytherapy catheters involve emission of high doses of radiation very close to the catheter. Within a very short distance, the dose exponentially decreases. This results in very little damage to the surrounding tissue. Although the role of brachytherapy for cure is limited, with
Expandable metal stents
Expandable metal stents are made of metal alloys, and are compressed and restrained on a delivery device. After positioning, expansion occurs, and the stents embed themselves in the tumor and surrounding tissue with radial pressure, and are eventually incorporated into the wall of the organ (Fig. 4).
Raijman and coworkers [24] reported experience in 101 metal esophageal stents. Dysphagia score was improved in all patients. Success in treating esophago-respiratory fistulae was seen in all
Summary
The optimal treatment for malignant dysphagia should be safe, effective, cost-effective, and have minimal morbidity. Photodynamic therapy, brachytherapy, and esophageal stenting all represent viable options for the palliation of malignant dysphagia. Characterization of the patients and their tumors allows individualization of the treatment and the selection of the optimal treatment for each individual patient. Institutional resources and expertise also are significant factors in treatment.
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Cited by (15)
Salvage high-dose-rate brachytherapy for esophageal cancer in previously irradiated patients: A retrospective analysis
2015, BrachytherapyCitation Excerpt :Relapses are difficult to treat; salvage surgery can provide a higher survival rate compared with no surgery but is associated with serious postoperative morbidity and mortality (2–4). The use of a palliative expandable esophageal stent or photodynamic therapy is also treatment options (5). In some cases, persistent disease or a relapse seem to be limited to the wall of the esophagus and may then be accessible to esophageal brachytherapy if the patient is unfit for salvage surgery.
Oesophageal carcinoma
2013, The LancetCitation Excerpt :Further work is required to define the role of endoscopic therapies with curative intent for oesophageal carcinoma.6,122,123 Endoscopic palliative treatments for dysphagia in patients with oesophageal carcinoma include oesophageal dilatation, esophageal stents, photodynamic therapy, neodymium-doped yttrium aluminium garnet (Nd:YAG) laser therapy, and brachytherapy.124 Self-expanding metal stents are the most commonly used oesophageal stents.125
Polyflex Expandable Stents in the Treatment of Esophageal Disease: Initial Experience
2008, Annals of Thoracic SurgeryAngiography and Interventional Radiology of the Hollow Viscera
2007, Textbook of Gastrointestinal RadiologyQuality of life after oesophageal stenting in patients with palliative oesophageal cancer
2021, New Zealand Medical JournalTreatment for unresectable or metastatic oesophageal cancer: Current evidence and trends
2018, Nature Reviews Gastroenterology and Hepatology