Treatment of unresectable carcinoma of the esophagus or the gastroesophageal junction by mesh stents with or without radiochemotherapy.

The palliative treatment of malignant stenoses of the upper gastrointestinal tract by self-expanding metal stents is a novel procedure with effective relief of dysphagia in most patients. There is little follow-up information with respect to the factors influencing clinical outcome and survival rates. Survival rates of 40 consecutive patients treated with 53 mesh stents were analyzed with regard to their degree of dysphagia (grades 0-3), quality of life (Karnofsky score), and the effect of additional radiation and chemotherapy. Following stent placement dysphagia improved in 36 of 40 patients. Endoscopic reinterventions for worsening of dysphagia were necessary in 23 patients during a median follow-up period of 74 days (range 51-149). There was a trend towards superior survival time in younger patients (<60 years) with high Karnofsky score ( 70). Patients receiving concurrent radiation and chemotherapy (n=12) experienced prolonged survival (median 318 days after diagnosis, 225 days after stent) compared with patients of equal tumour staging, but without additional therapy (n=17; median 157 days after diagnosis, p<0.001; 138 days after stent, p<0.05). The combination of endoscopic stenting with additional radiation and chemotherapy was associated with improved survival. A randomized trial is warranted.