Journal of

Case Reports and Images in Oncology

 
     
Case Series
 
Fatal complications of endoluminal stent insertion before preoperative chemoradiotherapy for distal esophageal cancer: A case series
Vladimir Valakh1, Juhi Mittal2
1MD, Attending Physician, Division of Radiation Oncology, Allegheny Health Network Cancer Institute, 320 East North Avenue, Pittsburgh, PA, USA.
2MD, Assistant Professor, Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, USA.

Article ID: 100028Z10VV2016
doi:10.5348/Z10-2016-28-CS-19

Address correspondence to:
Vladimir Valakh
4800 Friendship ave. Pittsburgh
PA 15224
USA

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How to cite this article:
Valakh V, Mittal J. Fatal complications of endoluminal stent insertion before preoperative chemoradiotherapy for distal esophageal cancer: A case series. J Case Rep Images Oncology 2016;2:79–83.


Abstract
Introduction: Stents are used for palliation of incurable esophageal cancer. In many centers stenting is also performed for dysphagia prior to curative treatment. We report two cases of unexpected mortality due to stenting before preoperative chemoradiotherapy.
Case Series: In Case 1, a 68-year-old male presented with stage IIIA (T3, N1, M0) adenocarcinoma of the distal esophagus. A fully covered self-expanding metal stent was inserted. Esophagectomy following neoadjuvant concurrent chemoradiation was recommended. The patient received 50.4 Gy/28 fractions of radiotherapy with weekly paclitaxel and carboplatin. Fifteen days after completion, he was admitted with a rapidly developed right pleural effusion and expired in intensive care unit. The cause of death was esophageal perforation in the region of the stent. In case 2, a 69-year-old female was diagnosed with stage IIA (T3, N0, M0) adenocarcinoma of the distal esophagus. Esophagectomy after neoadjuvant concurrent chemoradiation was prescribed. A fully covered self-expanding metal stent was then inserted across gastroesophageal junction. Plan was for 50.4 Gy/28 fractions with weekly paclitaxel and carboplatin. After fraction #19, she came to the hospital with dyspnea and was diagnosed with necrotizing pneumonia of the right middle lobe, and the patient expired on hospice. The cause of death was aspiration pneumonia due to incompetence of stented lower esophageal sphincter.
Conclusion: We have presented two cases of on-treatment mortality due to stents placed into the distal esophagus before the initiation of curative-intent neoadjuvant chemoradiotherapy. Our institutional practices were modified to exclude recommendations for stenting of any curable distal esophageal cancers prior to treatment.

Keywords: Esophageal cancer, Iatrogenic complications, Radiation therapy, Stents


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Author Contributions:
Vladimir Valakh – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Juhi Mittal – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Vladimir Valakh et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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