A retrospective study comparing expandable metal stenting with radiation therapy in advanced oesophageal carcinoma in a regional South African hospital
| dataset.nrf.grant | Introduction: Oesophageal cancer causes much morbidity and mortality in South Africa. This disease has a 5-year survival of less than 10% despite improvements in therapy. Most patients present with advanced disease and are suitable only for palliative care. Current standard of palliative care for patients with end-stage oesophageal cancer that present with dysphagia include brachytherapy and stenting. Brachytherapy improves survival and has a more stable quality of life in the long term when compared to stenting. Conversely stenting has a more acute relief of dysphagia. In South Africa many patients with malignant dysphagia face socio-economic constraints that cause delays in therapy, especially in patients from rural areas. Many prospective randomized trials of palliative treatment have been done in the developed world, not taking into account socio-economic constraints. We present a study from Tshepong Hospital (Klerksdorp, North West province), a secondary hospital in South Africa. The aim of the dissertation was to compare radiation therapy versus stenting for the palliative treatment of advanced oesophageal cancer with malignant dysphagia in the South African context, especially looking at the impact of socioeconomic constraints on patient management. Patients and methods We retrospectively reviewed the data on 30 patients seen between February 2005 and January 2008. All patients presented with inoperable oesophageal cancer and were palliated with either radiotherapy (N=12) or stenting (N=18). 6 Due to delays in treatment with radiotherapy, stenting was introduced in the unit as an alternative treatment option. Radiotherapy included either external beam radiotherapy or brachytherapy. We compared the number of admissions, length of hospital stay and time from when first seen to intervention as primary outcomes. Results Patients presented with either grade III or IV dysphagia. The median age was 64 in the stent group and 72 in the radiotherapy group. The majority of patients were male in both groups. All patients had confirmed squamous cell carcinoma. The number of admissions, length of hospital stay and days to procedure were significantly lower in the stent group (p=0.018, p=0.0072 and p=0.0108 respectively). The time before intervention was 6 days in the stent group versus 49 in the radiation therapy group. No major complications as a result of brachytherapy were reported. Conversely, complications in the stent group included chest pain, tumour overgrowth, stent migration and death. Conclusion Patients with malignant dysphagia have a limited lifespan and focus should be on improving the quality of life in these patients. Patients undergoing radiotherapy have a significantly longer hospital stay and longer wait to treatment. With socio-economic constraints imposed upon the health sectors of the developing world, we conclude that stenting is a feasible option in this situation. Adopting a prognostic score might help in identifying patients with a poor prognosis. Either the situation should be improved or stenting should become the preferred treatment. | |
| dc.contributor.author | Liakos, Dimitri | |
| dc.date.accessioned | 2015-04-07T08:56:51Z | |
| dc.date.available | 2015-04-07T08:56:51Z | |
| dc.date.issued | 2012 | |
| dc.description | A research report submitted to the Faculty of Medicine, University of the Witwatersrand, in partial fulfillment of the requirements for the Degree of Master of Medicine in the division of General Surgery. Johannesburg 2012 | |
| dc.description.abstract | Oesophageal cancer causes much morbidity and mortality in South Africa. This disease has a 5-year survival of less than 10% despite improvements in therapy. Most patients present with advanced disease and are suitable only for palliative care. Current standard of palliative care for patients with end-stage oesophageal cancer that present with dysphagia include brachytherapy and stenting. Brachytherapy improves survival and has a more stable quality of life in the long term when compared to stenting. Conversely stenting has a more acute relief of dysphagia. In South Africa many patients with malignant dysphagia face socio-economic constraints that cause delays in therapy, especially in patients from rural areas. Many prospective randomized trials of palliative treatment have been done in the developed world, not taking into account socio-economic constraints. We present a study from Tshepong Hospital (Klerksdorp, North West province), a secondary hospital in South Africa. | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10539/17379 | |
| dc.language.iso | en | en_ZA |
| dc.subject.mesh | Esophageal Neoplasms | |
| dc.subject.mesh | Esophageal Stenosis | |
| dc.title | A retrospective study comparing expandable metal stenting with radiation therapy in advanced oesophageal carcinoma in a regional South African hospital | en_ZA |
| dc.type | Thesis | en_ZA |