Laser versus laser plus afterloading with iridium-192 in the palliative treatment of malignant stenosis of the esophagus: a prospective, randomized, and controlled study

Sander, R; Hagenmueller, Friedrich; Sander, Christoph; Rieß, Gotthard; Classen, Meinhard

doi:10.1016/s0016-5107(91)70775-x

Cited by 50 publications

(14 citation statements)

References 18 publications

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“…The idea behind this concept is that thermal laser therapy would reduce the tumor bulk with single dose brachytherapy (maximum dose of 10 Gy) leading to a sustained effect of laser therapy with a long-term improvement of the dysphagia score and a reduction in the need for repeated treatment sessions [57][58][59]. Laser therapy plus brachytherapy was compared with laser therapy alone in two prospective, randomized trials in 39 and 22 patients, respectively [60,61]. Both these studies showed a prolonged dysphagia-free interval after the combination of laser and brachytherapy, however this did not result in a difference in survival between the two treatment groups.…”

Section: Comparison Of Different Treatment Modalitiesmentioning

confidence: 99%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.

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Section: Comparison Of Different Treatment Modalitiesmentioning

confidence: 99%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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“…Th e interval between subsequent procedures in both groups was 5 weeks. Diff erent results aft er the same treatment were seen by Sander et al ( 21 ). Th e patients who received combined treatment needed three procedures per month to relieve dysphagia, whereas patients who were treated with the laser alone needed 1.8 procedures per month.…”

Section: Combination Therapy In Malignant Dysphagiamentioning

confidence: 80%

“…Th e most frequently used method was Nd:YAG laser photocoagulation combined with external beam radiotherapy or brachytherapy. In randomized trials, combination treatment approximately doubled the period to dysphagia recurrence compared with laser treatment alone ( 21,26,29 ).…”

Section: Discussionmentioning

confidence: 99%

Randomized Comparison of Three Palliative Regimens Including Brachytherapy, Photodynamic Therapy, and APC in Patients With Malignant Dysphagia (CONSORT 1a) (Revised II)

Rupiński

Zagórowicz

Reguła

et al. 2011

American Journal of Gastroenterology

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Because most esophageal cancers are diagnosed at an advanced stage, a majority of patients require palliative dysphagia treatment. Dysphagia severity and the need for repeated re-canalization procedures signifi cantly affect patients ' quality of life (QoL). The aim of this study was to establish whether combining argon plasma coagulation (APC) of the neoplastic esophageal tissue with another re-canalization method results in a longer dysphagia-free period compared with APC alone. METHODS:We conducted a randomized trial in 93 patients with malignant dysphagia. Patients were followed until death. We compared three regimens of esophageal re-canalization; APC combined with high dose rate (HDR) brachytherapy, APC combined with photodynamic therapy (PDT), and APC alone. The primary outcome measure was the dysphagia-free period following randomization. Secondary measures were survival, QoL, treatment-associated complications, and treatment tolerance. A per-protocol analysis was carried out. RESULTS:The time to fi rst dysphagia recurrence was signifi cantly different between each combination treatment group and the control group (overall test: P = 0.006; HDR vs. control, log-rank P = 0.002, PDT vs. control, log-rank P = 0.036), but not different between the combination groups (HDR vs. PDT, log-rank P = 0.36). The median time to fi rst dysphagia recurrence was 88, 59, and 35 days in the HDR, PDT, and control groups, respectively. There was no difference in overall survival between the study groups ( P = 0.27). No deaths, perforations, hemorrhages, or fi stula formations were attributed to treatment. The only major complication was fever, occurring in three PDT patients. Minor complications were observed signifi cantly more often in the combination treatment groups and included pain in both groups, transient dysphagia worsening, and skin sensitivity in the PDT group. The QoL 30 days after treatment in the HDR group was signifi cantly better than in the other groups.CONCLUSIONS: In patients with inoperable esophageal cancer, palliative combination treatment of dysphagia with APC and HDR or PDT was signifi cantly more effi cient than APC alone, and was safe and well tolerated. APC combined with HDR resulted in fewer complications and better QoL than APC with PDT or APC alone (CONSORT 1b).SUPPLEMENTARY MATERIAL is linked to the online version of the paper at

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“…A randomised study comparing laser therapy alone with laser therapy and palliative external radiotherapy (30 Gy in 10 fractions, half the typical dose used for radical treatment) showed that adding radiotherapy increased the average interval between laser treatments from 5 to 9 weeks [19] A randomised trial demonstrated an advantage in delaying recurrent dysphagia when laser treatment was associated to brachy-therapy. Either external beam radiotherapy or brachy-therapy after laser recanalization is suitable for individual clinical use on a type 2 level of evidence [19,20]. Others have reported that brachy-therapy in one or two fractions (total 10-15 Gy at 1 cm from the source) can more than double the interval between laser treatments with minimal morbidity [21,22].…”

Section: Discussionmentioning

confidence: 99%

Palliative therapy for esophageal cancer: laser therapy alone is associated with a better functional outcome

et al. 2015

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The aim of our study was to compare functional outcome and survival in patients who underwent laser therapy (LT) or laser therapy and esophageal stenting (LTES) to palliate inoperable esophageal cancer. Two hundred and twenty-seven consecutive patients who had endoscopic palliation for esophageal cancer were enrolled in this retrospective study. One hundred and sixty-four underwent LT alone and 63 had LTES. A dysphagia score was adopted (0: absolute dysphagia; 1: liquid diet; 2: semisolid diet; 3: free diet). Survival analysis and non parametric statistics were performed. Patients in the LTES group reported a significantly worse dysphagia score than LT patients (p < 0.01). LTES patients more frequently reported difficulty swallowing than LT patients (p < 0.01). No difference between LTES and LT groups was observed in terms of overall survival. Only radiotherapy resulted in a significant predictor of better survival (p = 0.007). Despite a similar survival, LTES is a predictor of a worse functional palliation than LT alone. Radiotherapy was associated with better survival in patients treated with LT. Therefore, these data seem to suggest that a combination of endoscopic LT and external radiotherapy may yield the best results in palliative care of advanced esophageal cancer.

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Laser versus laser plus afterloading with iridium-192 in the palliative treatment of malignant stenosis of the esophagus: a prospective, randomized, and controlled study

Cited by 50 publications

References 18 publications

Palliative therapy

Palliative therapy

Randomized Comparison of Three Palliative Regimens Including Brachytherapy, Photodynamic Therapy, and APC in Patients With Malignant Dysphagia (CONSORT 1a) (Revised II)

Palliative therapy for esophageal cancer: laser therapy alone is associated with a better functional outcome

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