Endoscopic Nd:YAG laser therapy as palliation for esophagogastric cancer. Parameters affecting initial outcome.

Endoscopic neodymium:yttrium aluminum garnet laser therapy has been shown to be a technically feasible treatment option for relieving blockage in patients with malignant obstruction of the esophagus or gastric cardia. In an attempt to identify factors that would predict clinical benefit or risk, or both, 60 patients were evaluated retrospectively. Thirty-five patients (mean age 65.3 yr, range 47-89 yr) with biopsy-proven squamous cell carcinoma and 25 patients (mean age 61.1 yr, range 47-82 yr) with adenocarcinoma of the gastric cardia were evaluated. Most patients had had previous radiotherapy or surgery, and all had incurable disease. The following parameters were assessed: (a) tumor histology, (b) endoscopic appearance, (c) location, (d) clinical setting. There was no difference in response to treatment between squamous cell carcinoma and adenocarcinoma. Technically it was easier to treat mucosal tumors than to treat submucosal tumors. Also, the outcome was better in mucosal tumors. Results were least good and the technical difficulty greatest for tumors of the cervical esophagus. Tumors at the gastroesophageal junction were problematic if there was horizontal angulation. The best response occurred for tumors in a straight segment of mid-esophagus and distal esophagus, particularly if they were less than or equal to 5 cm in length. It is possible to identify parameters that affect the initial outcome.