title: Prospective, randomized trial of palliative treatment for unresectable cancer of the esophagus.
abstract: To evaluate the best method of palliation for obstructing nonresectable squamous cell carcinoma of the mid or distal esophagus, 27 patients were prospectively randomized to one of three treatment arms: (1) esophageal intubation with an Atkinson tube (AT, 10 patients), (2) esophageal intubation followed by radiation therapy (AT/RT, 8 patients), and (3) endoscopic laser therapy followed by irradiation (L/RT, 9 patients). Pretreatment characteristics were similar in the three groups. There was no procedure-related mortality. There were eight total complications related to the tube and none related to laser treatment (p = 0.02). Mean survival was 119 days in the AT group, 72 days in the AT/RT group, and 169 days in the L/RT arm (p = not significant). Quality of survival was most dependent on swallowing ability, and the swallowing score increased by 2.3 units in the AT group, 1.8 units in the AT/RT group, and 1.4 units in the L/RT group (p = not significant). Adding RT to laser therapy significantly increased time in treatment (mean, 38.7 days) when compared with the AT group (mean, 12.5 days) (p less than 0.001). However, only 1 patient required repeat laser ablation. It is concluded that AT and L/RT result in good palliation as measured by relief of dysphagia and survival time. However, morbidity of AT is significantly greater than that of L/RT. Laser and radiation therapy with a reduced total dosage of RT or with a change in fractionation schedule to limit treatment time is the preferred method of palliation.
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425.
authors.forename: C E
authors.initials: CE
authors.lastname: Reed
authors.forename: W H
authors.initials: WH
authors.lastname: Marsh
authors.forename: L S
authors.initials: LS
authors.lastname: Carlson
authors.forename: C H
authors.initials: CH
authors.lastname: Seymore
authors.forename: J M
authors.initials: JM
authors.lastname: Kratz
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053685:Laser Therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D015996:Survival Rate; D015430:Weight Gain