Palliation of dysphagia in metastatic oesogastric cancers: An international multidisciplinary position.

Antonin Levy, Anna D Wagner, Cyrus Chargari, Markus Moehler, Marcel Verheij, Jérôme Durand-Labrunie, Manon Kissel, Erick Chirat, Pascal Burtin, Michel Ducreux, Valérie Boige, Magnus Nilsson, Narikazu Boku, Ian Chau, Eric Deutsch

Journal: European journal of cancer (Oxford, England : 1990) 2020;135():103-112

PMID: 32563014

Full Text on Elsevier Science View on PubMed

Abstract

Malignant dysphagia is the most common symptom in advanced oesogastric cancers patients. Relief of dysphagia allows quality of life improvement, nutritional replenishment and potentially improves prognosis. Chemotherapy alone is effective and should be prioritised in patients with metastatic disease a good performance status, and its impact on dysphagia should be determined before further interventions are planned. Regarding local treatments, the insertion of a covered self-expandable metallic stent is the most commonly used alternative, as it allows for the rapid relief of severe dysphagia. Although several randomised trials have highlighted the role of oesophageal brachytherapy, this technique is often not easily accessible. Contemporary trials are ongoing to better define the role of external radiation therapy. While awaiting these results, external radiation therapy can be considered as a second-best option for patients with a life-expectancy > 3 months. It is important to offer nutritional support and to integrate quality of life measures in the palliative management of dysphagia. This multidisciplinary international position paper aims to propose a decision-making process and highlight randomised trials for the management of malignant dysphagia in metastatic oesogastric cancer patients.

Address: Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France. Electronic address: [email protected].; Department of Oncology, Division of medical oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.; Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France.; Department of Gastroenterology and Hepatology, Universitätsmedizin, Mainz, Germany.; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.; Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.; Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.; Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France; Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.; Division of Surgery, CLINTEC, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.; Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.; Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK.

DOI: 10.1016/j.ejca.2020.04.032

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MeSH Terms: Antineoplastic Agents, Brachytherapy, Consensus, Deglutition, Deglutition Disorders, Esophageal Neoplasms, Humans, Neoplasm Metastasis, Nutritional Support, Palliative Care, Quality of Life, Recovery of Function, Self Expandable Metallic Stents, Treatment Outcome