title: Endoscopic Nd:YAG laser with aggressive multimodality therapy for locally advanced esophageal cancer.
abstract: BACKGROUND
  Laser therapy of esophageal carcinoma has been limited to management of malignant dysphagia. To investigate its cytoreductive potential, Nd:YAG laser tumor debulking was added to multimodality therapy.
  
  
  METHODS
  From 1994-1998, 29 patients with advanced locoregional esophageal carcinoma were enrolled in a prospective experimental study of high-dose neoadjuvant chemoradiotherapy together with endoscopic Nd:YAG laser photoablation. Comparisons were made to a retrospective cohort of 31 patients treated from 1990 to 1994 who underwent similar neoadjuvant chemoradiotherapy without laser debulking.
  
  
  RESULTS
  Laser dosage ranged from 3457 to 67,443 J (mean 21,832 [SD 16,999]) delivered in 1 to 6 (mean 2.6 [1.4]) treatment sessions. Actuarial analysis showed improved survival in the laser-treated group versus the reference group (30.1 months vs. 16.5 months; p = 0.047). Multivariable analysis of the impact of age, T-stage, N-stage, completion of neoadjuvant therapy, and laser debulking that included all patients in both treatment groups showed completion of therapy to be the most significant variable associated with survival. There were 3 complications related to laser therapy. Relief of dysphagia was achieved in 19 of 29 patients (66%) in the laser group versus 13 of 31 (42%) in the reference group.
  
  
  CONCLUSIONS
  Malignant dysphagia may be more effectively treated by the addition of Nd:YAG laser therapy to aggressive multimodality therapy. Improved survival with the addition of laser debulking warrants longer follow-up and a prospective comparative trial.
authors.affiliation: Medical and Cardiothoracic Surgical Services, Veterans Affairs Medical Center, Washington, DC 20422, USA.
authors.forename: Pendleton
authors.initials: P
authors.lastname: Alexander
authors.forename: William
authors.initials: W
authors.lastname: Mayoral
authors.forename: Harold F
authors.initials: HF
authors.lastname: Reilly
authors.forename: Robert
authors.initials: R
authors.lastname: Wadleigh
authors.forename: Gregory
authors.initials: G
authors.lastname: Trachiotis
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Lipman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D015996:Survival Rate