Systematic Efficacy and safety of stenting and additional oncological treatment versus stenting alone in unresectable esophageal cancer: A meta-analysis and systematic review

Aim: To compare the efficacy and safety of stent insertion alone to stent insertion combined with any active oncological treatment in the palliative care of esophageal cancer. Methods: A meta-analysis and systematic review were performed according to the PRISMA Statement. Comparative studies with patients receiving stent insertion alone (control group) were compared to patients receiving oncological therapy in addition to stent placement (intervention group). For mean dysphagia grade before stenting, weighted mean differences (WMD), for the complications of stenting, risk ratios (RR) were calculated, both were interpreted with 95% confidence intervals (CI). Whenever possible, subgroup analyses were performed for studies with irradiation stents as intervention. Survival, late dysphagia, esophageal perforation and medical costs were analyzed via systematic review. The protocol of the study was registered prior on PROSPERO. Results: 17 studies with 1177 esophageal cancer patients were included in the final analysis, with 629 and 548 in the control and intervention groups, respectively. We found no significant difference in any complications of stenting between the two groups. 13 studies reported mean or median survival, and 8 found that combined therapy resulted in a significantly longer life expectancy. In the other 5 studies, there was no difference in survival between the two groups. Furthermore, additional treatment may be more effective in the long-term relief of dysphagia than stenting alone. Conclusions: Irradiation stents may prolong survival, and stenting combined with oncological treatment does not increase the risk of complications as compared to stenting alone. However, further studies are warranted. Core tip: Esophageal cancer is the eighth most common type of malignancy worldwide, and its prognosis is very poor. This suggests that palliative treatment modalities are paramount in its treatment. Self expanding metal stents play an important role in the management of dysphagia caused by the tumor. However, it is unclear whether any additional oncological therapy should be administered to patients besides stenting. In this meta-analysis and systematic review, we evaluated the safety and efficacy of additional oncological therapies alongside stenting versus stenting alone in case of unresectable esophageal cancer. (c) 2020 Published by Elsevier B.V. Radiotherapy and Oncology 147 (2020) 169-177