RADIOTHERAPY ENHANCES LASER PALLIATION OF MALIGNANT DYSPHAGIA - A RANDOMIZED STUDY

Background/Aims-A major drawback of laser endoscopy in the palliation is the malignant dysphagia need repeated treatments. This study was de signed to test whether external beam radiotherapy would reduce the nec essity for repeated laser therapy. Patients/Methods-Sixty seven patien ts with inoperable oesophageal or gastric cardia cancers and satisfact ory swallowing after initial laser recanalisation were randomised to p alliative external beam radiotherapy (30 Gy in 10 fractions) or no rad iotherapy. All patients underwent a 'check' endoscopy five weeks after initial recanalisation and were subsequently re-endoscoped only for r ecurrent dysphagia, which occurred in 59 patients. Results-Dysphagia w as relieved equally well in both groups and the improvement was mainta ined with further endoscopic treatment. The initial dysphagia controll ed interval and the duration between procedures required to maintain l ifelong palliation (treatment interval) increased from five to nine we eks (median) in the radiotherapy group (p<0 . 01 both parameters). Rad iotherapy was well tolerated in all but three patients. One perforatio n occurred and two fistulae opened after dilatation in patients who re ceived radiotherapy. Conclusion-Additional radiotherapy reduces the ne cessity for therapeutic endoscopy for a patient's remaining life. It h as an important role in relatively well patients who are likely to sur vive long enough to benefit.