Palliative treatment of malignant stenoses of the upper gastrointestinal tract using a combination of laser and afterloading therapy.

Forty-eight patients with malignant stenoses of the esophagus and cardio-esophageal junction were submitted to endocavitary afterloading treatment after prior endoscopic recanalization with the laser. An intraluminal reduction in tumor mass, and rapid elimination of dysphagia proved possible. This technique represents an alternative to the endoscopic implantation of an endoprosthesis. The afterloading tube is placed endoscopically under direct vision. Using a 192Iridium radiation source, 7 Gy were applied at a distance from the tube of 1 cm. Dysphagia was permanently relieved in 77%, while re-stenosis occurred in 23%. The mean survival time was 5.9 months. This procedure is associated with a low incidence of complications, and can be employed on an outpatient basis, and in combination with percutaneous radiotherapy given as boost radiation.