Prospective randomized clinical trial comparing brachytherapy and laser photoablation for palliation of esophageal cancer.

Twenty-three consecutive patients with advanced esophageal cancer were randomized to receive either endoluminal irradiation or laser photoablation treatment. Initial improvement in dysphagia scores was observed in 83% (brachytherapy) and 91% (laser). This improvement in dysphagia was maintained at 2 months in 75% (brachytherapy) and 81% (laser). Performance scores improved in 33% (brachytherapy) and 36% (laser). Both treatments were well tolerated, required a minimum of inpatient treatment time, and allowed patients to die without terminal admission to district referral centers. Retreatments were three times as common with laser therapy, but the frequency of treatment failures was equal. Minor complications, especially transient early dysphagia, was more common in the brachytherapy group, although the only major complication (perforation) occurred in the laser group. No procedure-related deaths occurred in either group.