LASER PHOTOCOAGULATION IN THE TREATMENT OF MALIGNANT DYSPHAGIA

Background: Dysphagia secondary to carcinoma of the oesophagous and ga stric cardia is the principal symptom requiring palliation in those pa tients who present with late-stage disease or who are unfit for surger y. The primary aim of the present study was to determine the safety an d efficacy of laser photocoagulation in the palliation of malignant dy sphagia. Secondary aims were to look at reasons for failure and predic tors of outcome; to determine the most appropriate second line therapy for treatment failures; and to look at the results of treatment for e arly stage disease. Methods: Sixty-seven patients treated over a 6-yea r period with endoscopic Nd:YAG laser photocoagulation were evaluated and the quality of swallowing assessed before and at intervals after t reatment. Results: Ninety per cent of patients achieved successful ini tial palliation. This was sustained in 76% after 3 months of treatment . Within a month before death 71% of patients were palliated but 29% r equired the addition of second-line treatment to achieve this. Complic ations were infrequent. There were no deaths attributable to laser tre atment. Five of 10 patients treated with radiotherapy developed fibrou s stricturing that required endoscopic dilatation. No variables were i ndependently predictive for treatment failure. Six patients with early stage disease experienced prolonged survival. Conclusions: We conclud e that laser photocoagulation offers safe and effective palliation of malignant dysphagia in this group of patients and is appropriate as fi rst-line therapy.