Gastrointestinal Cancer

PD 05 - GI 2 - Poster Discussion

1044 - Palliative Radiation Therapy Compared to Esophageal Stent Placement in the Management of Patients With Metastatic Esophageal Cancer

Monday, October 22
11:33 AM - 11:39 AM
Location: Room 217 A/B

Palliative Radiation Therapy Compared to Esophageal Stent Placement in the Management of Patients With Metastatic Esophageal Cancer
E. Martin1, A. Bruggeman2, V. Nalawade2, R. R. Sarkar2, and J. D. Murphy2; 1Department of Medicine, University of California, San Diego, La Jolla, CA, 2Department of Radiation Medicine, University of California, San Diego, La Jolla, CA

Purpose/Objective(s): Optimal palliative management of patients with metastatic esophageal cancer has yet to be determined. The purpose of this study was to retrospectively assess local complications after palliative radiation therapy and/or esophageal stent placement among a large multi-institutional cohort of veterans with metastatic esophageal cancer.

Materials/Methods: We identified 2,110 veterans with stage IV esophageal cancer diagnosed between 2000 and 2015 from a nationwide Veterans Affairs database. We included all patients who received palliative radiation therapy to the esophagus or underwent esophageal stent placement. We evaluated the rates of long-term complications after radiation or stent placement including esophageal fistula, perforation, obstruction, upper GI bleeding, and esophagitis. We used a competing risk analysis to determine the impact of radiation or stent placement on long-term complications using unadjusted cumulative incidence analyses and multivariable Fine-Gray regression models. Multivariable models were adjusted for potential confounding factors including patient age, race, tumor histology, and history of alcohol or tobacco use.

Results: Among the entire cohort, 1,623 (76.9%) underwent palliative radiation therapy to the esophagus, 323 (15.3%) underwent esophageal stent placement, and 164 (7.8%) underwent both radiation therapy and stent placement. Patient characteristics did not vary significantly between patients who received radiation or stent placement. The unadjusted six-month cumulative incidence of toxicity was higher for patients who underwent stent placement compared to those receiving radiation for any severe toxicity (21.7% vs 12.4%, p=0.0003), fistula formation (1.6% vs 0.7%, p=0.066), esophageal perforation (2.2% vs 0.2%, p<0.0001), and upper GI bleeding (9.0% vs 3.9%, p=0.014). The increased risk of toxicity among patients who underwent stent placement compared to radiation persisted on multivariable analysis with any severe toxicity (subdistribution hazard ratio [SDHR] 1.51; 95% CI 1.17-1.95; p=0.0014), fistula formation (SDHR 3.6; 95% CI 1.5-8.5; p=0.004), esophageal perforation (SDHR 16.89; 95% CI 3.90-72.25; p<0.0001), and upper GI bleeding (SDHR 1.51; 95% CI 1.01-2.26; p=0.046).

Conclusion: This retrospective study found that esophageal stent placement was associated with an increased risk of long-term complications compared to radiation among patients with metastatic esophageal cancer. Unmeasured patient or tumor-related factors could influence the choice of radiation versus stent placement, which could in turn bias the results of this study. However, these findings suggest potential differences in long-term outcomes among palliative procedures for metastatic esophageal cancer patients.

Author Disclosure: E. Martin: None. A. Bruggeman: None. V. Nalawade: None.

Emily Martin, MD

Disclosure:
No relationships to disclose.

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