ND-YAG LASER IN TREATMENT OF RECTAL-CANCER - ARE THERE FEATURES PREDICTING A CURATIVE RESULT

In the present study we report the results of Nd:YAG laser treatment i n 36 patients with rectal carcinoma in whom negative biopsies were obt ained at the end of the treatment. The laser (100-W maximal power outp ut) was applied through a flexible endoscope during 20- to 40-min sess ions repeated every three days until the lesion was destroyed complete ly. Follow-up examinations, including endoscopy with biopsies, liver a nd endorectal ultrasonography and chest x-ray were performed every thr ee months during the first year and thereafter once a year. Between 19 80 and 1991, 272 patients were treated. All were unfit for surgery bec ause of metastasis (78), recurrence after an other procedure (54), ass ociated conditions, or old age (140). No circumferential tumors of any size were obliterated, but among the 139 patients presenting with a n oncircumferential lesion less than 7 cm in diameter, negative biopsies were obtained after laser treatment in 36 patients (26%). Of these 36 patients, eight had been treated previously by surgery (5) or radioth erapy (3). Mean follow-up is 37 months (range 12-71). Recurrences were observed in four cases. Seven patients died during the study but only one death was related to the cancer (pelvic extension 19 months after treatment). Endorectal ultrasonography was performed prior to treatme nt in 15 patients and showed no invasion of the rectal wall deeper tha n the submucosa. After treatment, endorectal ultrasonography in 22 pat ients showed significant changes corresponding to cicatricial pattern in 60% of controlled patients. These changes disappeared by three mont hs except in three patients in each of whom a echo-guided biopsy ruled out a local recurrence. No complication of laser therapy was observed in these 36 patients. Laser treatment is effective for noncircumferen tial carcinomas smaller than 7 cm in diameter and not deeply invading the rectal wall. Such therapy, however, seems most appropriate for pat ients who are unfit for surgery.