title: A randomized comparison of dilatation alone versus dilatation plus laser in patients receiving chemotherapy and external beam radiation for esophageal carcinoma.
abstract: Most patients with carcinoma of the esophagus have advanced disease at presentation. Since cure is usually not possible, the goal of treatment is the palliation of dysphagia. Palliative modalities include bougies, balloons, stents, tumor probe, laser, surgery, chemotherapy, and radiation. In recent years, combined chemotherapy and radiation has shown promising results. However, the relief of dysphagia is slow and frequently incomplete. We compared the effectiveness of dilatation alone versus dilatation plus Nd-YAG laser therapy for the relief of dysphagia while assessing the role of chemotherapy and radiation as an adjunct to surgery. Fifteen patients with squamous cell carcinoma of esophagus who were deemed fit for intensive chemotherapy and radiation were randomized 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 of these 15 patients were judged potentially resectable. However, after chemotherapy and radiation, only 3 of 13 (20%) patients could be offered surgery; the remainder were considered too poor a surgical risk. Follow-up was for 30 months, or until death. Further dilatations were performed 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 index (Karnofsky score), or mortality rate. Our results indicate that in patients undergoing chemotherapy and radiation for esophageal carcinoma, dilatation alone provides adequate palliation of dysphagia, and in these patients, chemotherapy and radiation is a poor adjunct to surgical treatment.
authors.affiliation: Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Anand
authors.forename: Z A
authors.initials: ZA
authors.lastname: Saeed
authors.forename: P A
authors.initials: PA
authors.lastname: Michaletz
authors.forename: C B
authors.initials: CB
authors.lastname: Winchester
authors.forename: M A
authors.initials: MA
authors.lastname: Doherty
authors.forename: J H
authors.initials: JH
authors.lastname: Liem
authors.forename: D Y
authors.initials: DY
authors.lastname: Graham
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002404:Catheterization; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004106:Dilatation; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome