Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancer

Esophageal stenting in previously irradiated patients is known to cause more severe complications than those in patients who were not irradiated. But there are few reports regarding the results of stent placement before radiation therapy. Three patients with stage T4 esophageal cancer with direct invasion to the trachea and/or aorta underwent radiation therapy after stent placement. Two of the three patients had received systemic chemotherapy before radiation therapy. Fifty-one to 66Gy of radiation therapy was administrated 15 to 66 days after the stent placement. The initial response to radiation therapy was no change (NC) or progressive disease (PD). All patients died of bleeding or pneumonia caused by perforation at the site of the stents 17 to 79 days after the radiation therapy. It is strongly suggested that even in patients with locally advanced esophageal cancer with severe dysphagia, radiation therapy should precede stent placement, because the consequences of radiation therapy after stent placement are devastating, and radiation therapy alone can, potentially, resolve the symptoms.