Does chemo-radiation therapy (ChXRT) increase the incidence of complications after self-expanding coated stents (cEES) in the management of malignant esophageal strictures?

Placement of uncoated or coated expandable esophageal stents (cEES) is the preferred palliative treatment of malignant dysphagia. An increased incidence of complications after EES may occur with concomitant ChXRT. We reviewed our data of 51 pts who received cEES. There were 33M, 18 W, mean age 65.1 y (range 25-90). Forty one had esophageal cancer (23 squamous), 2 XRT-strictures for breast and lung cancer, and 8 with metastatic cancer with esophageal invasion. The location was proximal in 6, midesophageal in 16, distal in 17, and GE Jct in 13. Twelve patients had a digestive-respiratory fistula (DRF). The mean stricture length was 5.2 cms. Previous Rx included ChXRT in 31, surgery in 13, laser in 7, and noncoated EES in 5. Correct cEES placement was achieved in 50. Forty four cEES were placed after dilation to 38-42 Fr, In 1, the cEES was placed too distal, requiring a second cEES. Among the 20 pts without ChXRT, 2 developed tumor overgrowth, 1 gastric ulceration, 1 cEES migration, and 2 required gastrostomies for persistent dysphagia (1) and severe pneumonia and respiratory insufficiency in a pt with DRF (1): Among the 31 pts with ChXRT, 2 developed tumor overgrowth, 1 esophageal tear, 1 tumor bleeding, 2 cEES migration, and 2 required gastrostomies for continued dysphagia. All pts with persistent dysphagia had patent stents. All tumor overgrowths were treated with second cEES. Two of the 6 pts with ChXRT and complications were receiving ChXRT at the time of cEES placement. Thus, 3/20 (15%) without ChXRT and 6/31 (19.3%) pts with ChXRT developed complications. In conclusion, the use of ChXRT does not appear to increase the rate of cEES related complications. A prospective evaluation is under study.