[Brachytherapy treatment planning calculation (125)I particle esophageal stent dosimetric study]

Meta-analysis of efficacy and complications of intraluminal radioactive stent and common covered stent in treatment of advanced esophageal cancer

BACKGROUND

The main symptom of advanced esophageal cancer is dysphagia. Because there is no indication for surgery, in order to improve the patient's symptoms and quality of life, esophageal stent therapy has become the main palliative treatment. Based on the results of many studies, it can be speculated that intraluminal radioactive stent is better since it combines the function of ordinary stent and brachytherapy.

AIM

To evaluate the difference in the curative effect and complications between intraluminal radioactive stent (iodine 125 particle scaffold) and common covered stent in patients with mid-advanced esophageal cancer.

METHODS

A computer search of the electronic databases PubMed (1989/2020-03), Web of Science (2000/2020-03), Wiley Online Library (1992/2020-03), CNKI database (1978/2020-03), Wanfang database (1997/2020-03), and VIP database (2000/2020-03) and a manual search of Cochrance library were performed to retrieve articles using the method recommended by the Cochrance System Evaluator's Manual (version 4.2.2). The Oxford's 2011 evidence level assessment was used to evaluate the quality of the included articles, and Meta-analysis was performed using Revman 5.3 software.

RESULTS

Ten articles were finally included, with a total of 943 patients involved. Among the patients, 449 were implanted with an intraluminal radioactive stent and 494 were implanted with a common covered stent. A meta-analysis of 10 articles showed that the average survival time of the intraluminal radioactive stent group was 3.91 mo longer than that of the common covered stent group (95%CI: 1.68-6.13, Z = 3.44, P = 0.0006), and the median survival time was 3.12 mo longer 95%CI: 1.78-4.47, Z = 4.57, P = 0.0001). The dysphagia scores of the two groups of patients were significantly reduced within 1 and 3 mo after the stent was placed (P < 0.05), but there was no statistical difference between the two groups (P > 0.05). After stenting, there was no statistically significant difference in the incidence of pain (odds ratio [OR] = 0.89, 95%CI: 0.65-1.21, Z = 0.77, P = 0.44), bleeding (OR = 0.80, 95%CI: 0.52-1.22, Z = 1.03, P = 0.30), perforation (OR = 1.16, 95%CI: 0.55-2.43, Z = 0.39, P = 0.70), or stent displacement (R = 0.66, 95%CI: 0.31-1.38, Z = 1.10, P = 0.27) between the intraluminal radioactive stent group and the common covered stent group; but there was a statistical difference in the incidence of restenosis [OR = 0.61 , 95%CI (0.42-0.87), Z = 3.73 P = 0.006] between them.

CONCLUSION

The use of intraluminal radioactive stent in the treatment of advanced esophageal cancer can prolong the average survival time and median survival time of patients, and signficantly reduce the incidence of restenosis after surgery; however, the two types of stents have no significant difference in relieving the symptoms of dysphagia within 1-3 mo or in reducing postoperative complications such as pain, hemorrhage, perforation, and stent displacement.