Palliation of patients with dysphagia due to advanced esophageal cancer by endoscopic injection of cisplatin/epinephrine injectable gel

Background: The aim of therapy for advanced esophageal cancer is relief of dysphagia with minimal treatment-related morbidity. This study assessed the efficacy of endoscopic intratumoral injection of cisplatin/epinephrine gel to relieve obstruction and improve swallowing. The gel is designed to minimize diffusion of active drug away from the tumor injection site. Methods: Patients with inoperable esophageal cancer and dysphagia caused by exophytic esophageal tumor underwent up to 6 weekly endoscopic injections of the gel. Response was documented objectively (exophytic tumor volume, lumen size, dysphagia grade) and subjectively (achievement of treatment goal). Results: Twenty-four patients were treated. Primary evaluation criteria for 18 evaluable patients were as follows: dysphagia grade improved in 4 (duration 30 to 45 days) and stabilized in 11; lumen patency improved in 6 (duration 29 to 56 days) and stabilized in 10; exophytic tumor volume decreased in 8 (duration 29 to 114 days). Eight patients felt that their ability to swallow improved. One patient with intramural and exophytic tumor developed a tracheoesophageal fistula, possibly related to treatment. Other complications were tolerable and self-limited. No nephrotoxicty or severe nausea/vomiting typical of systemic administration of cisplatin occurred. Conclusions: Endoscopic injection of cisplatin/epinephrine gel is a straightforward procedure with standard equipment and techniques, which can provide palliation for patients with exophytic malignant tumors of the esophagus. Assessment of this method in conjunction with other therapeutic options such as brachytherapy is warranted.