LASER AND BRACHYTHERAPY IN THE PALLIATION OF ADENOCARCINOMA OF THE ESOPHAGUS AND CARDIA

Background-Palliation of malignant dysphagia is possible by a variety of methods although all have significant drawbacks. Laser therapy is a n effective and safe treatment but has to be repeated at four to five weekly intervals to maintain palliation. A means of augmenting the ben efits while reducing the need for repeat treatments would be highly be neficial to these patients. Aims-To prospectively explore the safety a nd efficacy of intraluminal radiotherapy (brachytherapy) when used to augment laser recanalisation for malignant dysphagia. Patients-Ninetee n patients with dysphagia due to advanced adenocarcinoma of the oesoph agus or cardia were recruited. Methods-All patients received laser rec analisation until able to swallow a soft diet or better, before the ap plication of a single dose of brachytherapy (10 Gy at 1 cm from the so urce). Patients were followed up and treated promptly by further endos copic means in the event of their dysphagia worsening. Results-Six pat ients (32%) required no further treatment until death at a median of 1 0 weeks (range 1-20 weeks). Further therapy was required at a median o f 11 weeks (range 4-37 weeks) after brachytherapy for those 13 patient s with recurrent dysphagia. Subsequent symptom control required endosc opic intervention at an average of once every nine weeks. There was no mortality associated with laser or brachytherapy. Median survival fro m initial treatment and including the one survivor was 36 weeks (range 5-132 weeks). Conclusions-Laser plus brachytherapy offers a safe and effective means of palliating malignant dysphagia due to adenocarcinom a, with a longer dysphagia free interval than historical controls trea ted with laser alone.