Combined endoscopic laser therapy and brachytherapy for palliation of oesophageal carcinoma: a pilot study.

Palliative treatment for oesophageal malignancy aims to maximise symptom relief with minimal disturbance to the patient. Twenty one patients with oesophageal carcinoma were studied prospectively to assess the combined efficacy of laser and brachytherapy in the palliation of oesophageal carcinoma, 20 were unsuitable for resectional surgery because of tumour extent and one patient underwent the treatment protocol after myocardial infarction, for symptom relief before resection. Two patients died at hospital and the remaining 19 survived from 9 to 455 days (mean 140 days). All patients tolerated the procedure well and improvement in swallowing was noted in 19 who survived the procedure--an improvement that was maintained until their death. However, five patients required oesophageal dilatation after the initial treatment. Results were not affected by the histology of the tumour. In summary, combined endoscopic laser and brachytherapy is effective palliation for oesophageal carcinoma and may be particularly appropriate in those patients with cervical and upper thoracic tumours in whom intubation may be unsatisfactory.