Intratumoral Therapy of Cisplatin/Epinephrine Injectable Gel for Palliation in Patients With Obstructive Esophageal Cancer

Abstract

Obstructing esophageal cancer produces severe dysphagia with ensuing death within 90 days. Palliation is possible with modalities like stent placement, laser, and photodynamic therapy. However, these treatments have a high rate of complications, and the overall mortality is not altered. A new alternative treatment evaluated in this study is endoscopic intratumoral injection with cisplatin/epinephrine (CDDP/epi) gel. CDDP/epi gel injections were administered weekly for 3 to 8 weeks in nine patients, median age, 72 years; mean tumor volume (+/-SEM), 41.44 (+/-22.4) cm3. Eight patients had stage IV, and one had stage III esophageal carcinoma. The mean dysphagia score (+/-SEM) was 3.5 (+/-0.17). All patients were followed up until death. Dysphagia resolved in eight patients with reduction in mean dysphagia score (+/-SEM) from 3.5 (+/-0.17) to 0.75 (+/-0.28; p = 0.005). Tumor volume was reduced by 75% in one patient and by 50% in two patients. The median survival was 4 months. The longest follow-up has been 15 months (458 days). In this pilot study, intratumoral injection of CDDP/epi gel restored swallowing in eight of nine patients and was an effective and safe outpatient treatment in patients with obstructive esophageal cancer.

Oesophageal cancer: an overview of a deadly disease

“…Additionally, chemotherapy, radiation therapy, brachytherapy, direct ethanol injection, endoscopic intubation or stenting, and palliative surgery have all been utilized in the treatment of OC not amenable to resection (87)(88)(89)(90)(91)(92). The simple fact that so many options exist would certainly seem to imply that there is no clear consensus on the most effective palliative technique.…”

Intratumoral administration of cisplatin through a bronchoscope followed by irradiation for treatment of inoperable non-small cell obstructive lung cancer

“…In this study, patients were treated with cisplatin solution (at a concentration of 4 mg/ml) injected Tumor volume was calculated on CAT scan by using the formula 0.5 × L × W × H where L is the greatest length, W the greatest width, and H is the greatest depth or height of the tumor [21].…”

Palliative endoscopic interventions in esophageal cancer

“…Only one-third of the patients experienced subjective improvement in their ability to swallow. In a series of nine patients, published by Monga et al [53], dysphagia resolved in eight patients after a weekly administration of cisplatin=epinephrine gel for three to eight weeks. At the present stage, this intervention has to be assessed as experimental.…”