Best palliation in esophageal cancer: surgery, stenting, radiation, or what?

Palliation of patients with obstructing or fistulizing esophageal cancer is not easy. Median survival cannot be expected to be longer than 3-6 months, regardless of which therapy is carried out. Self-expandable metal stents have revolutionized the treatment of these patients because of easy insertion, relatively low complication rates and reasonably good functional results. Plastic tubes are mainly indicated in situations in which removal may be needed. The palliative effect of external beam radiation is well established, endoesophageal brachytherapy having the advantage of delivering a high dose in a short time. More recently, there has been increasing interest in locally destructive therapies, mostly in combination with palliative radiation or radiochemotherapy. Obviously, a single best palliation for every situation does not exist. The most appropriate method to alleviate symptoms must be worked out for each individual patient depending on the specific patient situation and the specific expertise of the physician.