Radiotherapy enhances laser palliation of malignant dysphagia: a randomised study.

Sargeant, Ian; Tobias, Jeffrey; Blackman, Glen; Thorpe, Sally; Glover, J.R.; Bown, Stephen G.

doi:10.1136/gut.40.3.362

Cited by 46 publications

(14 citation statements)

References 11 publications

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“…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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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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“…The laser can act as a useful adjunct to intubation in patients with long impassable strictures [32]. Laser has been used in combination with dilatation [8], brachytherapy [7]and external radiotherapy [5]. …”

Section: Discussionmentioning

confidence: 99%

“…Most studies reporting experience and outcome of laser treatment for relief from dysphagia originate from tertiary referral units [5, 7, 8, 9, 11]. the aim of this study was to report the results of the use of laser in the relief from malignant dysphagia in a district general hospital set-up with minimal need for follow-up thus avoiding the main disadvantages of laser therapy: travel to tertiary referral centres and frequent hospital attendances.…”

Section: Introductionmentioning

confidence: 99%

“…Laser treatment enables nearly normal swallowing [6]. The major drawback of laser therapy is the need for repeated treatment at 4- to 6-week intervals to maintain good swallowing [5, 7]. Laser therapy is often done in tertiary referral centres [7, 8, 9]and is said to require special expertise that is not available in many peripheral hospitals [7].…”

Section: Introductionmentioning

confidence: 99%

“…Laser treatment offers rapid relief of the dysphagia, can often be performed as an outpatient procedure and does not have systemic effects [5]. Laser treatment enables nearly normal swallowing [6].…”

Section: Introductionmentioning

confidence: 99%

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Use of Laser in the Relief of Malignant Dysphagia: A District Hospital Experience

Aly¹,

Burgess²

2002

Dig Surg

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Background: Endoscopic laser treatment offers rapid relief from dysphagia. The major drawback of laser therapy is the need for repeated treatment at 4- to 6-week intervals. Laser therapy is often done in tertiary referral centres and is said to require special expertise that is not available in many peripheral hospitals. For smaller centres, intubation is likely to be the only treatment option even though it gives less quality of palliation. Aim: To report the experience of a district general hospital in laser treatment of malignant dysphagia. Methods: A retrospective study on patients who had laser therapy for relief from malignant dysphagia from march 1995 to January 2000 was performed in a district general hospital in the UK. Results: Forty patients (25 males and 15 females) with histologically proven oesophageal carcinoma were unsuitable for surgical resection. Trainees, under supervision, did 20% of the sessions. Treatment was done on a day case basis with no outpatient follow-up. The patients had direct access to the service whenever dysphagia got worse. The median number of sessions per patient was 4 (range 1–13). The median palliation period per session was 7 (range 1–32) weeks. The median total palliation period was 7 months. There was no procedure-related mortality. Conclusion: Laser therapy is a safe, easy to teach and learn technique for relief from malignant dysphagia. It can be done on a day case basis with minimum need for follow-up and hospital visits. Such a service could be provided in a district general hospital set-up once equipment and experience are available, thus saving patients from having to travel to specialist units.

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Interventions for dysphagia in oesophageal cancer

Sreedharan¹,

Harris²,

Crellin³

et al. 2009

Cochrane Database of Systematic Reviews

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Radiotherapy enhances laser palliation of malignant dysphagia: a randomised study.

Abstract: Background/Aims-A major drawback of

Cited by 46 publications

References 11 publications

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

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

Use of Laser in the Relief of Malignant Dysphagia: A District Hospital Experience

Interventions for dysphagia in oesophageal cancer

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