ORIGINAL RESEARCH Palliative Stenting With or Without Radiotherapy for Inoperable Esophageal Carcinoma: A Randomized Trial Amit Javed & Sujoy Pal & Nihar Ranjan Dash & Vineet Ahuja & Bidhu Kalyan Mohanti & Sreenivas Vishnubhatla & Peush Sahni & Tushar Kanti Chattopadhyay Published online: 14 September 2010 # Springer Science+Business Media, LLC 2010 Abstract Background A majority of patients with esophageal cancer present with inoperable disease and require rapid and long- lasting palliation of dysphagia. Study aim To compare the duration of relief of dysphagia in patientswith inoperablesophageal cancertreated with esophageal stenting alone or a combination of esophageal stenting and external beam radiotherapy (EBRT), and to assess overall survival, treatment-related complications, and quality of life (QOL) in the two groups. Patients and methods Patients with inoperable esophageal cancer and with high grade dysphagia were randomized to receiveesophageal stenting with self-expandable metal stent(Ultraflex) alone (Group I), versus a combination of stentingfollowedby EBRT (30 gray in ten divided fractions over 2 weeks) (Group II). Dysphagia relief, overal survival, QOL (using European Organisation for Research and Treatment of CancerQuality ofLife Questionnaire- C30,version 3), and treatment-related complications were assessed in the two groups. Results From April 2007 to March 2009, 84 patients were randomized to receive esophageal stentalone (42 patients) or a combination of stent and EBRT (42 patients). The two groups were comparable in demographics, tumor characte istics,indications for palliative treatment, and pretreatment dysphagia score. Dysphagia scores improved significantly in both groups following stent insertion. However, dysphagia relief was more sustained in Group II than in Group I (7 vs. 3 months, p=0.002). Overall median survival was significa higher in Group II than in Group I (180 vs. 120 days, p= 0.009). Addition of radiotherapy following stenting prolong the mean dysphagia-free survival (118.6 ± 55.8 vs. 96.8 ± 43.0 days, p = 0.054). There was significant improvement in all QOL parameters at 1 week after stenting. The QOL, however, significantly declined immediately after radio- therapy. There was no treatment-related mortality, and the incidence of complications was similar in the two groups. Conclusion Post-stenting EBRT effectively prolongs dura- tion ofdysphagia relief and improves overall survivalin inoperable esophageal cancer. Keywords Esophageal cancer . Dysphagia . Stents . Radiotherapy . Randomized controlled trial Introduction Esophageal cancer is an aggressive gastrointestinal malig- nancy with a poor prognosis. This is mainly due to its A. Javed (*) : S. Pal : N. R. Dash : P. Sahni : T. K. Chattopadhyay Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India e-mail: javedamitdr@gmail.com V. Ahuja Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India B. K. Mohanti Department of Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India S. Vishnubhatla Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India J Gastrointest Canc (2012) 43:63–69 DOI 10.1007/s12029-010-9206-4