Brachytherapy after laser recanalization versus external beam radiotherapy after laser recanalization versus laser alone in inoperable oesophagocardial cancer: a controlled pilot study.
OBJECTIVE
To compare the results of combined laser/radiation therapy with laser treatment alone, and to evaluate the potential benefit of brachytherapy vs. external beam radiotherapy after laser recanalization in patients with dysphagia due to oesophagocardial cancer.


METHODS
Twenty patients with grade 4 malignant dysphagia caused by oesophagocardial cancer underwent Nd: YAG laser desobstruction up to grade 0-1. Ten of them were referred afterwards for external beam radiotherapy at a dose of 30 Gy for 10 sessions, while the remaining were administered endocavitary afteloading brachytherapy at a dose of 2x7.5 Gy. Twenty preselected patients (to maximally match the above group), who successfully underwent laser re-establishment of the continuity, served as controls to the groups described. Criteria for evaluation were: mean interval to re-stenosis, mean number of additional laser procedures needed, mean survival and Karnofski's performance status (PS). Patients were followed to death. Statistical analysis was carried out with the Student's t-test.


RESULTS
It was found that laser plus brachytherapy increased almost 3 times the interval to re-stenosis and decreased almost 2 times the need of additional laser usage in comparison to laser alone. It was also found that laser plus brachytherapy is statistically superior option to laser plus external beam radiotherapy.


CONCLUSIONS
Laser plus brachytherapy has the potential to become a single modality-single session treatment for the relief of dysphagia in patients with stage IV oesophagocardial cancer.
Chakarova
A
A
Department of Radiology, National Oncological Cancer Center Hospital, Sofia, Bulgaria.
Karanov
S
S
Petkova
E
E
Bakardjiev
S
S
Bogdanov
G
G