PALLIATION OF MALIGNANT DYSPHAGIA FROM ESOPHAGEAL CANCER

Palliative therapies for advanced oesophageal cancer include surgery, radiation therapy, chemotherapy, endoscopic procedures and combination s of these. Of the non-endoscopic modalities is external beam radiatio n therapy (EBRT) effective and non-invasive. A disadvantage is that re lief of dysphagia only occurs over a period of 4-6 weeks. Brachytherap y is more rapid in locally controlling tumour growth and in relieving dysphagia. One of the more commonly used endoscopic procedures is lase r therapy, which provides symptomatic relief with low complication rat es. Recurrent dysphagia is a problem necessitating repeated treatment sessions. Self-expanding metal stents offer a high degree of palliatio n and are associated with fewer complications compared with prosthetic tubes. Longer palliation and perhaps even longer survival might be ac hieved by the combination of different therapies. Most promising are t he combination of EBRT plus brachytherapy or chemoradiation. Now is th e time to determine which treatment (combination) is best for individu al patients.