A RANDOMIZED COMPARISON OF DILATATION ALONE VERSUS DILATATION PLUS LASER IN PATIENTS RECEIVING CHEMOTHERAPY AND EXTERNAL-BEAM RADIATION FORESOPHAGEAL-CARCINOMA

Most patients with carcinoma of the esophagus have advanced disease at presentation. Since cure is usually not possible, the goal of treatme nt is the palliation of dysphagia. Palliative modalities include bougi es, balloons, stents, tumor probe, laser, surgery, chemotherapy, and r adiation. In recent years, combined chemotherapy and radiation has sho wn promising results. However, the relief of dysphagia is slow and fre quently incomplete. We compared the effectiveness of dilatation alone versus dilatation plus Nd-YAG laser therapy for the relief of dysphagi a while assessing the role of chemotherapy and radiation as an adjunct to surgery. Fifteen patients with squamous cell carcinoma of esophagu s who were deemed fit for intensive chemotherapy and radiation were ra ndomized to receive either dilatation alone (N = 7) or dilatation plus laser (N = 8); the end-point for initial success was the passage of a 45 French Savary dilator, and the relief of dysphagia. At entry, 13 o f these 15 patients were judged potentially resectable. However, after chemotherapy and radiation, only 3 of 13 (20%) patients could be offe red surgery; the remainder were considered too poor a surgical risk. F ollow-up was for 30 months, or until death. Further dilatations were p erformed as needed for relief of dysphagia. No difference was observed between the laser plus dilatation and the dilatation alone group with respect to the degree of dysphagia, weight record, quality of life in dex (Karnofsky score), or mortality rate. Our results indicate that in patients undergoing chemotherapy and radiation for esophageal carcino ma, dilatation alone provides adequate palliation of dysphagia, and in these patients, chemotherapy and radiation is a poor adjunct to surgi cal treatment.