The researchers assessed the value of adjunctive brachytherapy in prolonging palliation of malignant dysphagia by endoscopic laser therapy.
They reported their findings in the February issue of Gut.
Some 22 patients with advanced malignant dysphagia due to adenocarcinoma of the esophagus or gastric cardia, and unsuitable for surgery or radical chemoradiotherapy, were included in the trial.
Patients able to eat a soft diet after laser recanalization were randomized to no further therapy or a single treatment with brachytherapy (10 Gy).
Results were judged on the quality and duration of dysphagia palliation, need for subsequent intervention, complications, and survival.
The median dysphagia score for all patients, 2 weeks after initial treatment, was 1 (some solids).
|Median dysphagia palliated interval:|
Brachytherapy group: 19 weeks
Controls: 5 weeks
The median dysphagia palliated interval, from the end of initial treatment to recurrent dysphagia or death, increased from 5 weeks (control group) to 19 weeks (brachytherapy group).
The researchers found that 3 patients had some odynophagia for up to 6 weeks after brachytherapy.
However, there was no other treatment-related morbidity or mortality.
Further intervention was required in 10 of 11 control patients (median of 5 further procedures), compared with 7 of 11 brachytherapy patients (median of 2 further procedures).
There was found to be no difference in survival between the control and brachytherapy groups (median, 20 weeks and 26 weeks, respectively).
Dr G. M. Spencer, of the Royal Free and University College Medical School, London, concluded on behalf of the group, "Laser therapy followed by brachytherapy is a safe, straightforward, and effective option for palliating advanced malignant dysphagia, which is complementary to stent insertion."