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

Thirty-nine patients with malignant stenoses of the esophagus (22 adenocarcinomas, 17 squamous cell carcinomas) were treated either with Nd:YAG laser recanalization alone (N = 20) or with laser recanalization and subsequent endoluminal afterloading irradiation with iridium-192 at a dose of 3 x 7 Gy (6 x 7 Gy). Squamous cell carcinoma patients in the afterloading group showed a prolonged dysphagia-free first interval (65 vs. 30 days, p less than 0.03), while patients with an adenocarcinoma did not share this benefit, and had a need for more frequent endoscopic procedures (p less than 0.05). The complication of esophagitis was only seen following afterloading treatment (21%, N = 4). Re-stenosis occurred in all patients. Neither the duration of relative dysphagia nor survival time was prolonged after endoluminal irradiation in adenocarcinoma or squamous cell carcinoma patients. After prior laser recanalization, palliative afterloading treatment with iridium-192 would seem helpful only in cases of squamous cell carcinoma with a high performance status with the aim of prolonging the first dysphagia-free interval.

RCT Entities:   Population Interventions Outcomes