Tan C C, Freeman J G, Holmes G K, Benghiat A
Derby City General Hospital, Department of Medicine, Derbyshire Royal Infirmary.
Singapore Med J. 1998 May;39(5):202-7.
BACKGROUND/AIM OF STUDY: Laser therapy is effective in relieving malignant dysphagia, but repeated treatments at 4 to 6 week intervals are usually required. This prospective randomised trial is designed to determine if addition of brachytherapy offers any advantages over laser therapy alone.
Patients with inoperable carcinoma of the oesophagus were randomised to receive either endoscopic Nd:YAG laser therapy alone, or laser followed by brachytherapy. Patients who developed worsening dysphagia during follow-up were offered further treatment as appropriate.
Fourteen patients were randomised to receive laser only, and 12 to receive laser followed by brachytherapy. Of these 12, one was lost to follow-up and four did not receive brachytherapy because they were unfit, had extension into the cardia or had mainly extrinsic compression. These 4 are included on an 'intention-to-treat' basis. The mean therapeutic interval for the brachytherapy group was significantly longer, 83 days compared to 36 days for the laser group (p = 0.026). There were no differences in the degree of dysphagia relief, number of endoscopic procedures or survival times.
The preliminary results of this trial suggest that brachytherapy in addition to laser therapy prolongs the first therapeutic interval. However, no long-term advantages have been shown.
研究背景/目的：激光治疗在缓解恶性吞咽困难方面有效，但通常需要每隔4至6周重复治疗。本前瞻性随机试验旨在确定联合近距离放射治疗是否比单纯激光治疗具有任何优势。
将无法手术的食管癌患者随机分为两组，一组仅接受内镜下钕：钇铝石榴石激光治疗，另一组先接受激光治疗，随后接受近距离放射治疗。对随访期间吞咽困难加重的患者给予适当的进一步治疗。
14例患者随机接受单纯激光治疗，12例患者随机接受激光治疗后再接受近距离放射治疗。在这12例患者中，1例失访，4例因身体状况不佳、病变累及贲门或主要为外压性病变而未接受近距离放射治疗。这4例患者按“意向性治疗”原则纳入研究。近距离放射治疗组的平均治疗间隔明显更长，为83天，而激光治疗组为36天（p = 0.026）。两组在吞咽困难缓解程度、内镜检查次数或生存时间方面无差异。
该试验的初步结果表明，激光治疗联合近距离放射治疗可延长首次治疗间隔。然而，尚未显示出长期优势。
