Endoscopic Nd-YAG laser therapy as palliative treatment for esophageal and cardial cancer

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Abstract
The aim of this study was to report long-term results of endoscopic Nd-YAG laser therapy in the palliative treatment of 144 esophageal and cardial carcinomas and to define parameters that could predict the long-term outcome in order to better define the indications and limitations of Nd-YAG laser therapy for esophagocardial cancer. One hundred nineteen men and 25 women were treated. The mean age was 67±12 years. Histology showed 94 patients with squamous cell carcinoma and 50 with cardial or esophageal adenocarcinoma. Improvement of dysphagia was achieved in 119 of the 144 patients (83%) after a median of 2.9 sessions. For the 105 patients initially symptomatically improved by the first laser course, the cumulative probability of remaining symptomatically improved at three and six months was respectively 38.5±5% and 22±4%. Four perforations and nine esophagotracheal fistulas occurred. In the stepwise regression analysis (Cox model), among 11 variables, three variables had an independent prognostic value at six months. The importance of improvement after the initial laser treatment (P<0.005) and the presence of an adenocarcinoma (P<0.05) were positively correlated with the symptom improvement duration. The initial tumor length (P<0.07) was negatively correlated with the symptomatic improvement duration. Therefore, in inoperable patients, we think that laser therapy should be proposed first for adenocarcinoma and for squamous cell carcinoma <6 cm in length. On the other hand, in patients with squamous cell carcinoma 3⩾6 cm in length and in patients with only fair symptomatic improvement after the initial laser course, controlled randomized trials of other methods of palliation are needed.