***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To investigate whether a combination of self-exp and ing metal stent ( SEMS ) and brachytherapy provided more rapid and prolonged effect on dysphagia without increased pain compared to brachytherapy alone in patients with incurable oesophageal cancer . METHODS 41 Patients were r and omised to SEMS followed by brachytherapy , 8 Gy × 3 ( n=21 ) or brachytherapy alone , 8 Gy × 3 ( n=20 ) . Change in dysphagia and pain three and seven weeks after r and omisation ( FU1 and FU2 ) was assessed by patient-reported outcome . Dysphagia , other symptoms and health-related quality of life were assessed every four weeks thereafter . The study was closed before the estimated patient-number was reached due to slow recruitment . RESULTS Patients  receiving SEMS followed by brachytherapy had significantly improved dysphagia at FU1 compared to patients receiving brachytherapy alone ( n=35 ) . Difference in pain was not observed . At FU2 , patients in both arms ( n=21 ) had less dysphagia . Four patients in the combined treatment arm experienced manageable complications , no complications occurred after brachytherapy alone . CONCLUSION For the relief of dysphagia , SEMS followed by brachytherapy is preferable and safe for patients in need of immediate alleviation , while brachytherapy with or without preceding SEMS provides relief within a few weeks after treatment PURPOSE To prospect ively compare the response to treatment with a self-exp and able esophageal stent loaded with iodine 125 ( (125)I ) seeds for intraluminal brachytherapy versus the response to treatment with a conventional self-exp and able covered stent in patients with advanced esophageal cancer . MATERIAL S AND METHODS The study protocol was approved by the institutional ethics committee , and informed consent was obtained from each patient . Patients from one institution who had dysphagia caused by inoperable esophageal cancer were r and omly assigned to receive treatment with a stent loaded with (125)I seeds ( irradiation stent group ) or a conventional covered stent ( control group ) . After stent implantation , the outcomes were measured in terms of relief of dysphagia , survival time , and complications related to the procedure . Dysphagia was assigned a grade . A P value of less than .05 was considered to indicate a significant difference . RESULTS The stent was successfully placed in the diseased esophagus in all 53 patients ( 27 patients in the irradiation stent group and 26 patients in the control group ) . The dysphagia grade s significantly improved in both groups within the 1st month after stent placement but were better in the irradiation stent group than in the control group after 2 months ( P < .05 ) . The median and mean survival times were better in the irradiation stent group than in the control group , and the differences were significant ( P < .001 ) . Hemorrhage occurred in 16 ( 30 % ) patients in both groups combined during follow-up . CONCLUSION In patients with advanced esophageal cancer , treatment with an esophageal stent loaded with (125)I seeds , compared with that with a conventional covered stent , has potential benefit in that it allows a slightly longer relief of dysphagia and extended survival Objective To relieve dysphagia is the main goal in palliative treatment of patients with incurable cancer of the oesophagus or the gastro-oesophageal junction . The aim of this prospect i ve , r and omized multicentre study was to compare stent placement and brachytherapy regarding health economy and clinical outcomes . Methods Patients with incurable cancer of the oesophagus or gastro-oesophageal junction were r and omized to receive a self-exp and able metallic stent or 3 × 7 Gy brachytherapy . At clinical follow-up visits , dysphagia was scored and health care consumptions were recorded . Costs were based on hospital debits . Total lifetime healthcare consumption costs and costs for the initial treatments were calculated and a sensitivity analysis was conducted . Results Thirty patients were r and omized to each treatment group . There was no difference in survival or complication rates between the two treatment strategies . There was a significant difference in the change of dysphagia scores between the time of inclusion and the 1-month follow-up visit , in favour of the stented group ( P=0.03 ) . This difference had disappeared at 3 months . Median total lifetime costs were & U20AC;17 690 for the stented group compared with & U20AC;33 171 for the brachytherapy group ( P=0.005 ) . This difference was due to higher costs for the initial treatment ( & U20AC;4615 versus & U20AC;23 857 , P<0.0001 ) . Sensitivity analyses showed that the charges for a brachytherapy session had to be reduced from & U20AC;6092 to & U20AC;4222 ( 31 % ) to make this therapeutic concept cost-competitive . Conclusion Stenting is currently more cost-effective compared with fractionated 3 × 7 Gy brachytherapy for patients with incurable cancer of the oesophagus and gastro-oesophageal junction Metal stent placement and single dose brachytherapy are commonly used treatment modalities for the palliation of inoperable oesophageal carcinoma . We investigated generic and disease-specific health-related quality of life ( HRQoL ) after these palliative treatments . Patients with dysphagia from inoperable oesophageal carcinoma were r and omised to placement of a covered Ultraflex stent ( n = 108 ) or single dose ( 12 Gy ) brachytherapy ( n = 101 ) . We obtained longitudinal data on disease-specific ( dysphagia score , European Organisation for Research and Treatment of Cancer ( EORTC ) OES-23 , visual analogue pain scale ) and generic ( EORTC Quality of Life-Core 30 Question naire ( QLQ-C30 ) , Euroqol (EQ)-5D ) HRQoL at monthly home visits by a specially-trained research nurse . We compared HRQoL between the two treatments and analysed changes in HRQoL during follow-up . Dysphagia improved more rapidly after stent placement than after brachytherapy , but long-term relief of dysphagia was better after brachytherapy . For generic HRQoL , there was an overall significant difference in favour of brachytherapy on four out of five functional scales of the EORTC QLQ-C30 ( role , emotional , cognitive and social ) ( P < 0.05 ) . Generic HRQoL deteriorated over time on all functional scales of the EORTC QLQ C-30 and EQ-5D , in particular physical and role functioning ( on average -23 and -24 on a 100 points scale during 0.5 years of follow-up ) . This decline was more pronounced in the stent group . Major improvements were seen on the dysphagia and eating scales of the EORTC OES-23 , in contrast to other scales of this disease-specific measure , which remained almost stable during follow-up . Reported levels of chest or abdominal pain remained stable during follow-up in both treatment groups , general pain levels increased to a minor extent . The effects of single dose brachytherapy on HRQoL compared favourably to those of stent placement for the palliation of oesophageal cancer . Future studies on palliative care for oesophageal cancer should at least include generic HRQoL scales , since these were more responsive in measuring patients ' functioning and well-being during follow-up than disease-specific HRQoL scales OBJECTIVE To evaluate the benefits of post-stenting radiotherapy and /or chemotherapy for unresectable esophageal carcinoma . METHODS Fifty-three patients with unresectable esophageal carcinoma were r and omly divided into two groups : patients in group A ( n = 27 ) were treated with stenting alone , and those in group B ( n = 26 ) were treated with stenting followed by radiotherapy and /or chemotherapy . Comparison was made by assessing their survival time , quality of life ( QOL ) , degree of dysphagia , and stenting-related morbidity , respectively . RESULTS There was no statistically significant improvement in dysphagia and QOL between the two groups . Although there was no difference in the frequency of stenting-related complications , re-stenosis occurred much less frequently in group B patients ( P = 0.007 ) . The mean survival time of patients was 245 + /- 41 days and 262 + /- 43 days in group A and group B , respectively . There was no significant difference between the two groups ( P = 0.813 ) . CONCLUSION Besides decreased recurrence of stenosis , post-stenting radiotherapy and /or chemotherapy does not provide additional benefits for survival BACKGROUND Brachytherapy was found to be preferable to metal stent placement for the palliation of dysphagia because of inoperable esophageal cancer in the r and omized SIREC trial . The benefit of brachytherapy , however , only occurred after a relatively long survival . The objective is to develop a model that distinguishes patients with a poor prognosis from those with a relatively good prognosis . METHODS Survival was analyzed with Cox regression analysis . Dysphagia-adjusted survival ( alive with no or mild dysphagia ) was studied with Kaplan-Meier analysis . Patient data is from the multicenter , r and omized , controlled trial ( SIREC , n = 209 ) and a consecutive series ( n = 396 ) . Patients received a stent or single-dose brachytherapy . RESULTS Significant prognostic factors for survival included tumor length , World Health Organization performance score , and the presence of metastases ( multivariable p < 0.001 ) . A simple score , which also included age and gender , could satisfactorily separate patients with a poor , intermediate , and relatively good prognosis within the SIREC trial . For the poor prognosis group , the difference in dysphagia-adjusted survival was 23 days in favor of stent placement compared with brachytherapy ( 77 vs. 54 days , p = 0.16 ) . For the other prognostic groups , brachytherapy result ed in a better dysphagia-adjusted survival . CONCLUSIONS A simple prognostic score may help to identify patients with a poor prognosis in whom stent placement is at least equivalent to brachytherapy . If further vali date d , this score can provide an evidence -based tool for the selection of palliative treatment in esophageal cancer patients Background A majority of patients with esophageal cancer present with inoperable disease and require rapid and long-lasting palliation of dysphagia . Study aim To compare the duration of relief of dysphagia in patients with inoperable esophageal cancer treated with esophageal stenting alone or a combination of esophageal stenting and external beam radiotherapy ( EBRT )  , and to assess overall survival , treatment-related complications , and quality of life ( QOL ) in the two groups . Patients and methods Patients with inoperable esophageal cancer and with high grade dysphagia were r and omized to receive esophageal stenting with self-exp and able metal stent ( Ultraflex ) alone ( Group I ) , versus a combination of stenting followed by EBRT ( 30 gray in ten divided fractions over 2 weeks ) ( Group II ) . Dysphagia relief , overall survival , QOL ( using European Organisation for Research and Treatment of Cancer Quality of Life Question naire-C30 , version 3 ) , and treatment-related complications were assessed in the two groups . Results From April 2007 to March 2009 , 84 patients were r and omized to receive esophageal stent alone ( 42 patients ) or a combination of stent and EBRT ( 42 patients ) . The two groups were comparable in demographics , tumor characteristics , indications for palliative treatment , and pretreatment dysphagia score . Dysphagia scores improved significantly in both groups following stent insertion . However , dysphagia relief was more sustained in Group II than in Group I ( 7 vs. 3 months , p = 0.002 ) . Overall median survival was significantly higher in Group II than in Group I ( 180 vs. 120 days , p = 0.009 ) . Addition of radiotherapy following stenting prolonged the mean dysphagia-free survival ( 118.6 ± 55.8 vs. 96.8 ± 43.0 days , p = 0.054 ) . There was significant improvement in all QOL parameters at 1 week after stenting . The QOL , however , significantly declined immediately after radiotherapy . There was no treatment-related mortality , and the incidence of complications was similar in the two groups . Conclusion Post-stenting EBRT effectively prolongs duration of dysphagia relief and improves overall survival in inoperable esophageal cancer SUMMARY Esophageal cancer often presents as advanced stage disease with a dismal prognosis , with only 10 - 15 % of patients surviving 5 years . Therefore , in a large proportion of patients , palliative treatment is the only option available . The aim of this study was to prospect ively compare the palliative effect of self-exp and able stent placement with that of endoluminal brachytherapy regarding the effect on quality of life and on specific symptoms . Sixty-five patients with advanced cancer of the esophagus or gastroesophageal junction were r and omized to treatment with either an Ultraflex exp and able stent or high-dose-rate endoluminal brachytherapy with 7 Gy x 3 given in 2 - 4 
    Output:
    
Stents combination therapy was also associated with a more favorable overall survival .
The risks of stent migration , aspiration pneumonia , and restenosis were lower in the stents combination group compared to stents alone , while the risks of severe pain , hemorrhage , and fistula formation were higher .
Changes in dysphagia scores and overall survival did not differ significantly in the brachytherapy-alone vs stents-alone comparison .
The risk of fistula formation and hemorrhage were higher in the stents-alone group , while the risk of perforation was lower , compared to brachytherapy alone .
Quality of life improvements were seen in all treatment groups , but were not pooled in analysis due to differing methods of measurement .
Discussion While there appears to be no immediate short-term differences , those who live longer than 3 months experience a significant improvement in dysphagia score using a stents combination therapy approach vs stents alone .
The combination therapy significantly improves the overall survival as well as showed improvements in quality of life scores .