PALLIATION OF CARCINOMA OF THE ESOPHAGUS WITH BRACHYTHERAPY AND THE DIDCOTT DILATOR

Forty-one patients with oesophageal cancer who developed strictures af ter high dose rate intraluminal brachytherapy were dilated using a slo w continuous dilator (Didcott dilator). After dilatation, all patients were evaluated monthly for relief of dysphagia. At the end of the 1st month, 41 patients were evaluable: 28 had no dysphagia while 13 had i mprovement; at the end of the 2nd month, 40 were evaluable, 26 had no dysphagia while 14 had improvement; at the end of the 3rd month, 34 pa tients were evaluable, 24 had no dysphagia while 10 had improved. Thre e patients developed worsening of dysphagia owing to tumour recurrence among 32 patients who were evaluable at the end of the 4th month. Fiv e patients developed worsening of dysphagia among the 26 patients who were evaluable at the 5th month due to tumour. These patients were dil ated with the Didcott dilator and were treated with further brachyther apy. At the end of the 6th month, 14 patients were evaluable; seven ha d no dysphagia, while seven had improvement over their presenting dysp hagia scores. Slow continuous dilatation using the Didcott dilator is very effective in the dilatation of strictures after high dose rate in traluminal brachytherapy. Dilatation is prolonged and sustained and a single dilatation is usually enough to maintain patency.