ISSN:
1573-2568
Keywords:
CARCINOMA
;
ESOPHAGUS
;
DYSPHAGIA
;
DILATATION
;
LASER
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Most patients with carcinoma of the esophagushave advanced disease at presentation. Since cure isusually not possible, the goal of treatment is thepalliation of dysphagia. Palliative modalities include bougies, balloons, stents, tumor probe, laser,surgery, chemotherapy, and radiation. In recent years,combined chemotherapy and radiation has shown promisingresults. However, the relief of dysphagia is slow and frequently incomplete. We compared theeffectiveness of dilatation alone versus dilatation plusNd-YAG laser therapy for the relief of dysphagia whileassessing the role of chemotherapy and radiation as an adjunct to surgery. Fifteen patients withsquamous cell carcinoma of esophagus who were deemed fitfor intensive chemotherapy and radiation were randomizedto receive either dilatation alone (N = 7) or dilatation plus laser (N = 8); theend-point for initial success was the passage of a 45French Savary dilator, and the relief of dysphagia. Atentry, 13 of these 15 patients were judged potentially resectable. However, after chemotherapy andradiation, only 3 of 13 (20%) patients could be offeredsurgery; the remainder were considered too poor asurgical risk. Follow-up was for 30 months, or until death. Further dilatations were performed asneeded for relief of dysphagia. No difference wasobserved between the laser plus dilatation and thedilatation alone group with respect to the degree ofdysphagia, weight record, quality of life index (Karnofskyscore), or mortality rate. Our results indicate that inpatients undergoing chemotherapy and radiation foresophageal carcinoma, dilatation alone provides adequate palliation of dysphagia, and in thesepatients, chemotherapy and radiation is a poor adjunctto surgical treatment.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1026618706464
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