STAGED DELIVERY OF ND-YAG LASER THERAPY FOR PALLIATION OF ADVANCED RECTAL-CARCINOMA

PURPOSE: This study was designed to assess the degree of symptom relie f, complication rate, and survival time of patients who undergo pallia tion with the neodymium-yttrium aluminum garnet (Nd:YAG) laser for adv anced rectal cancer. METHODS: Charts of 41 consecutive patients with a dvanced rectal cancer treated by this method were reviewed. RESULTS: T hirty-three patients received laser treatment for a primary tumor, and eight received laser palliation for local recurrence following previo us surgery. Mean number of treatments delivered was 2 (range, 1-6) for patients with a primary lesion and 2 (range, 1-4) for those patients with local recurrence. In patients in whom more than one delivery was required, subsequent procedures were deferred for more than six weeks. Morbidity rate was 2 percent, with no procedure-related mortality. Me dian survival time was 19 (range, 1-60) months for patients with a pri mary tumor and 7 (range, 3-38) months for patients with local recurren ce. Four patients subsequently elected to undergo palliative surgery, and five other patients had a loop colostomy fanned because of large-b owel obstruction after a mean of 24 (range, 18-41) months. Nd:YAG lase r treatment offered adequate laser palliation for 78 percent of patien ts in this series. However, patients who survive for more than 24 mont hs after their first laser treatment are more likely to require pallia tive surgery. CONCLUSIONS: The majority of patients undergoing laser a blation for palliation do not require large numbers of treatment sessi ons. By delaying the interval between treatments, morbidity and mortal ity rates are negligible. Most patients avoid a stoma or defer the dar e of requiring one before their death with this therapy.