Endoscopic therapy for esophageal carcinoma with Nd:YAG laser: prospective evaluation of efficacy, complications, and survival.

Eleven consecutive patients who underwent endoscopic Nd: YAG laser therapy for palliation of esophageal carcinoma were prospectively evaluated between July 1, 1982, and December 31, 1982. All patients with tumor recurrence after radiotherapy or surgery (eight patients) or whose medical condition precluded surgery or full-course radiotherapy (three patients) underwent treatment. Mean tumor length was 8.1 cm and most had almost complete luminal occlusion. Survival was compared with patients with esophageal cancer treated at our institution during the 3 years prior to initiation of laser therapy (1978-1981). Treatment was completed in a mean of 3.3 sessions (range, 2 to 6). Dysphagia improved in all and performance status improved in eight patients, some markedly. Five patients with tumor re-occlusion were retreated at a mean of 10 weeks after initial therapy. No concurrent dilations were employed. Compared with our institution's historical controls, laser-treated patients' survival was significantly increased, whether measured from time of onset of radiotherapy (36 vs. 17 weeks, p = 0.02) or from time of recurrent symptoms after radiotherapy (25 vs. 8 weeks, p less than 0.05).