ENDOSCOPIC ND-YAG LASER THERAPY AS PALLIATIVE TREATMENT FOR ESOPHAGEAL AND CARDIAL CANCER

Background: Progressive dysphagia is the most important symptom in ino perable cases of carcinoma of the esophagus and cardia. Treatment for the relief of dysphagia is chosen based on the lowest mortality and mo rbidity. This paper describes a consecutive series of patients with es ophageal or cardial cancer, without a documented tracheoesophageal fis tula, who were referred for palliative laser therapy. Alternative pall iative treatments are discussed, as well as factors involved in succes sful laser treatment. Material and Methods: Over a five year period, 1 04 patients were treated endoscopically with the Nd-YAG laser for symp tomatic improvement dysphagia caused by malignant tumors of the esopha gus or cardia. Results: After the initial laser therapy, good improvem ent was achieved in 78 patients (75%) and fair improvement in 17 patie nts (16%). Eighty-three patients with significant improvement were fol lowed until death. In 42 of these 83 patients, the initial laser thera py was the only treatment given; the remaining 41 patients required ei ther additional laser treatment or other palliative therapy. Conclusio n: Laser treatment for palliation in esophageal and cardial cancer is promising. Given the proper circumstances, it may lay the framework fo r many other important treatment modalities.