Shmueli E, Srivastava E, Dawes P J, Clague M, Matthewson K, Record C O
Department of Gastroenterology, Royal Victoria Infirmary, Newcastle Upon Tyne.
Gut. 1996 Jun;38(6):803-5. doi: 10.1136/gut.38.6.803.
Laser treatment for malignant dysphagia is limited by recurrent intraluminal tumour requiring repeated treatment at four to eight week intervals.
To reduce the need for follow up treatment and to improve survival, patients successfully palliated by laser were treated with intraluminal radiotherapy.
32 patients with inoperable oesophageal carcinoma (18 adeno and 14 squamous cell carcinoma).
The patients were initially palliated by a median of three laser treatments. They were then treated with intraluminal radiotherapy, receiving 10-15 Gy at 1 cm from the source as a single treatment with the Selectron system. Patients with squamous cell carcinoma also received external radiotherapy (30 to 50 Gy).
After the radiotherapy nine patients survived a median of 22 (range 4-40) weeks without requiring any further endoscopic treatment. The remaining patients survived a median of 40 (range 4-102) weeks and required a median of three follow up endoscopic treatments over that time. Eleven patients developed fibrous strictures with no intraluminal tumour and were treated by dilatation. Twelve patients required dilatation and repeat laser therapy for a combination of fibrous stricture and recurrent intraluminal tumour. Six patients eventually required Atkinson tubes.
The combination of laser treatment with intraluminal radiotherapy provides good palliation and may reduce the need for repeated endoscopic treatment. Fibrous stricture formation is a common complication.
恶性吞咽困难的激光治疗受到腔内肿瘤复发的限制，需要每隔四到八周重复治疗。
为了减少后续治疗的需求并提高生存率，对经激光成功缓解症状的患者进行腔内放射治疗。
32例无法手术的食管癌患者（18例腺癌和14例鳞状细胞癌）。
患者最初平均接受三次激光治疗。然后接受腔内放射治疗，使用Selectron系统单次治疗，在距源1厘米处接受10 - 15戈瑞的剂量。鳞状细胞癌患者还接受了外照射放疗（30至50戈瑞）。
放疗后，9例患者存活，中位生存期为22周（范围4 - 40周），无需任何进一步的内镜治疗。其余患者中位生存期为40周（范围4 - 102周），在此期间平均需要三次随访内镜治疗。11例患者出现无腔内肿瘤的纤维性狭窄，接受了扩张治疗。12例患者因纤维性狭窄和腔内肿瘤复发需要扩张和重复激光治疗。6例患者最终需要放置阿特金森管。
激光治疗与腔内放射治疗相结合可提供良好的姑息治疗效果，并可能减少重复内镜治疗的需求。纤维性狭窄形成是一种常见并发症。
