AJR:198, February 2012
Ji Yeon Park1 Ji Hoon Shin, Ho-Young Song, Seong Yoon Yi, Jin Hyoung Kim
OBJECTIVE. The purpose of this study was to evaluate the characteristics of airway complications and survival with special reference to radiation therapy in the care of patients undergoing covered stent placement for malignant esophageal strictures.
MATERIALS AND METHODS. A total of 208 patients who underwent stent place¬ment with or without palliative radiation therapy for inoperable esophageal cancer were in¬cluded. The endpoints were frequency, type, and management of airway complications; as-sociation between occurrence of airway complications and radiation therapy history; and differences in stent-to-complication interval and survival period after esophageal stenting between patients who underwent radiation therapy before and those who underwent radiation therapy after stent placement.
RESULTS. Airway complications occurred in 23 patients (11.1%): 18 (78.3%) had esoph-agorespiratory fistula, three (13.0%) had airway narrowing, and two (8.7%) had both com-plications. The frequency of airway complications was significantly greater among patients who underwent RT than those who did not (p = 0.005) but was not significantly different be¬tween the radiation before stenting and radiation after stenting groups {p = 0.158). The me-dian stent-to-complication interval and survival period after esophageal stenting were signifi¬cantly shorter in the radiation before stenting group than in the radiation after stenting group (p = 0.002, p = 0.001).
CONCLUSION. Esophagorespiratory fistula is much more common than airway nar-rowing as an airway complication. The rate of complications increases significantly in asso¬ciation with radiation therapy among patients with malignant esophageal stricture. Clinicians need to be aware of earlier airway complications and poorer prognosis among patients who undergo radiation therapy before placement of an esophageal stent than in patients who un-dergo radiation after stent placement.