PALLIATIVE THERAPY FOR ESOPHAGEAL CANCER: PROSTHESIS IS ASSOCIATED TO A WORSE FUNCTIONAL OUTCOME

INTRODUCTION: Nowadays, esophagectomy and neoadjuvant-therapy is the standard care for esopahageal cancer but distant metastasis or invasion of others organs are controindications for surgery. Moreover, severe co-morbidities may make difficult or even impossible such an extensive surgical procedure. Currently, endoscopic palliation may be performed with laser therapy or prosthesis positioning or a combination of both. AIMS & METHODS: The aims of our study were to compare functional outcome and survival in patients underwent to laser-therapy, prosthesis positioning and combinated approach. Two-hundred fifty-three consecutive patients who had endoscopic palliation for esophageal cancer from 1994 to 2012 in our Surgical Endoscopy Unit were enrolled in this retrospective study. Histotype was squamocellular carcinoma in 96 patients, while in the remaning cases it was adenocarcinoma. One-hundred sixty-three patients underwent laser therapy alone, 26 patients underwent prosthesis positioning alone and 63 underwent to both procedures in combination. Eighteen patients also had chemotherapy alone, 48 patients also had radiotherapy and 22 had also a combination of radiochemotherapy. A dysphagia score was created (0: absolute dysphagia; 1: liquid diet; 2: semisolid diet; 3: free diet). Survival analysis and non parametric statistics were performed. RESULTS: The primary endpoint was a dysphagia score and patients who had a prosthesis positioned reported a significantly lower score (p<0.01) than patients who did not have any prosthesis. Moreover, patients who had laser therapy alone had a better dysphagia than patients who had laser therapy and prosthesis positioning (p<0.01). Survival analysis did not show any difference between laser therapy, prosthesis positioning or the combination of both in term of overall survival. Only radiotherapy, revealed to be a significant predictor of better survival in these patients. (p = 0.03). CONCLUSION: Our study showed that in spite of a similar survival prosthesis positioning is associated to a worse fuctional palliation than laser therapy. Radiotherapy alone was associated to a benefit in survival in patients with not resectable esophageal cancer. Therefore, these data seemed to suggest that a combination of endoscopic laser therapy and external radiotherapy may yield the best results in palliative care of advanced esophageal cancer.