Treatment outcomes of low-radial-force self-expandable metal stent placement and palliative radiotherapy for unresectable advanced esophageal squamous cell carcinoma with dysphagia.

BACKGROUND

Radiotherapy (RT) is preferred over stent placement for dysphagia in unresectable esophageal squamous cell carcinoma (ESCC); however, low-radial-force self-expandable metallic stents (SEMS) may offer safer and more effective palliation. We aimed to compare the outcomes of RT and low-radial-force SEMS in ESCC patients.

METHODS

This retrospective study included patients with unresectable ESCC and dysphagia who underwent palliative RT or low-radial-force SEMS placement between 2013 and 2023. Adverse events were compared, and treatment efficacy was assessed based on changes in Dysphagia Score (DS) and the duration of maintaining DS ≤ 1 among those who achieved it.

RESULTS

The stent and RT groups comprised 34 and 45 patients, respectively. Treatment-related adverse events of Grade ≥ 2 and ≥ 3 occurred in 29.4% and 5.8% in the stent group and 34.9% and 6.7% in the RT group, respectively, with no significant differences. After adjustment for baseline DS, the stent group showed significantly greater improvement at 1 month (p < 0.001), whereas no differences were observed at 2 or 3 months. DS ≤ 1 was achieved in 76.5% with stent and 44.4% with RT (p = 0.006). Maintenance of DS ≤ 1 was shorter with stent group when additional SEMS placement was considered an event (p = 0.006), whereas no difference was observed when additional SEMS was allowed (p = 0.898).

CONCLUSION

Low-radial-force SEMS is safe and effective for dysphagia in unresectable advanced ESCC, especially when early oral intake is needed, and can help prolong oral intake if additional SEMS is allowed.