Assessment of Stent Patency and Patient Survival Over Time
Patients were discharged from the hospital 24 to 48 h after the procedure and were seen by their general practioners at least twice a month. In addition, they were seen at our clinic monthly or more frequently ifa deterioration in the clinical course indicated recurrent obstruction. All general practioners were informed about the stent position and were asked to regularly record the state of ventilation of the lung distal to the stent. When a patient died, the cause of death and stent patency were assessed by autopsy and/or through an interview with the general practioner and the physician certifying the patients death.
Adjuvant Radiotherapy After Stent Insertion
As the majority of patients referred to us for local treatment had either undergone previous percutaneous radiotherapy or did not qualify for radiotherapy (esophageal cancers with tumor progression into the trachea, metastatic lesions unresponsive to irradiation), we initially just observed patients after stent insertion and performed repeated laser treatments and/or stent replacements if necessary. In six of eight patients treated in this way, the airways distal or proximal to the stents were occluded by recurrent tumor growth after a median follow-up of 2 months. We thus changed our treatment policy and subsequently sent all eligible patients for adjuvant radiotherapy. Patients without previous radiotherapy underwent conventional percutaneous radiotherapy to the mediastinum, including the stented area. All others received either additional small volume-high precision percutaneous radiotherapy up to a total cumulative dose of <50 Gray or past this l42Iridium high-dose rate brachytherapv. Adjuvant radiotherapy was started not later than 2 weeks after stent placement to prevent early tumor recurrence around the openings of the stent.