Spencer G M, Thorpe S M, Sargeant I R, Blackman G M, Solano J, Tobias J S, Bown S G
National Medical Laser Centre, University College London Medical School, London.
Gut. 1996 Nov;39(5):726-31. doi: 10.1136/gut.39.5.726.
Palliation of malignant dysphagia is possible by a variety of methods although all have significant drawbacks. Laser therapy is an effective and safe treatment but has to be repeated at four to five weekly intervals to maintain palliation. A means of augmenting the benefits while reducing the need for repeat treatments would be highly beneficial to these patients.
To prospectively explore the safety and efficacy of intraluminal radiotherapy (brachytherapy) when used to augment laser recanalisation for malignant dysphagia.
Nineteen patients with dysphagia due to advanced adenocarcinoma of the oesophagus or cardia were recruited.
All patients received laser recanalisation until able to swallow a soft diet or better, before the application of a single dose of brachytherapy (10 Gy at 1 cm from the source). Patients were followed up and treated promptly by further endoscopic means in the event of their dysphagia worsening.
Six patients (32%) required no further treatment until death at a median of 10 weeks (range 1-20 weeks). Further therapy was required at a median of 11 weeks (range 4-37 weeks) after brachytherapy for those 13 patients with recurrent dysphagia. Subsequent symptom control required endoscopic intervention at an average of once every nine weeks. There was no mortality associated with laser or brachytherapy. Median survival from initial treatment and including the one survivor was 36 weeks (range 5-132 weeks).
Laser plus brachytherapy offers a safe and effective means of palliating malignant dysphagia due to adenocarcinoma, with a longer dysphagia free interval than historical controls treated with laser alone.
尽管各种缓解恶性吞咽困难的方法都有明显缺点，但仍可采用多种方法实现。激光治疗是一种有效且安全的治疗方法，但必须每隔四到五周重复进行以维持缓解效果。增强治疗效果同时减少重复治疗需求的方法对这些患者将非常有益。
前瞻性地探索腔内放射治疗（近距离放射治疗）用于增强激光再通术治疗恶性吞咽困难的安全性和有效性。
招募了19例因食管或贲门晚期腺癌导致吞咽困难的患者。
所有患者均接受激光再通术，直至能够吞咽软食或情况更好，然后给予单剂量近距离放射治疗（距源1厘米处10 Gy）。对患者进行随访，若吞咽困难恶化则通过进一步的内镜手段及时治疗。
6例患者（32%）直至死亡都无需进一步治疗，中位生存期为10周（范围1 - 20周）。对于13例复发性吞咽困难的患者，近距离放射治疗后中位11周（范围4 - 37周）需要进一步治疗。后续症状控制平均每九周需要进行一次内镜干预。激光或近距离放射治疗均未导致死亡。从初始治疗开始计算，包括1例幸存者在内的中位生存期为36周（范围5 - 132周）。
激光联合近距离放射治疗为缓解腺癌所致恶性吞咽困难提供了一种安全有效的方法，与单纯接受激光治疗的历史对照相比，无吞咽困难间隔期更长。
