Loizou, Louis; (1996) Palliative endoscopic Nd:YAG laser therapy for gastrointestinal cancers: A clinical perspective. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The aim of this thesis was to evaluate by means of clinical studies endoscopic Nd:YAG laser therapy (LT) for the palliation of gastrointestinal cancers in the context of alternative treatments. A prospective comparison of LT (n=43) and endoscopic intubation (EI, n=30) for malignant dysphagia demonstrated similar long-term efficacy for thoracic oesophageal cancers (77% vs 86%); for gastric cardia tumours, EI proved superior (50% vs 92%, p<0.001). Swallowing function was better and perforation rate lower after LT, but the lifetime cost was greater and more procedures and longer hospitalisation were required. Both techniques resulted in a significant improvement in quality of life. In a pilot study of LT plus external beam radiotherapy for malignant dysphagia, treatment was well tolerated and long-term palliation achieved in 81% (n=22). Combination therapy appeared to reduce the frequency of follow-up laser treatments (mean interval 32 weeks) and prolong survival. LT proved safe and effective for managing dysphagia due to tumour recurrence after surgery (n=10) or endoprosthesis tumour occlusion (n=14). A modified Celestin endoprosthesis was developed and successfully used to treat 8 patients with cervical oesophageal cancer unsuitable for other treatment. In a prospective audit of LT for advanced rectosigmoid cancer, symptomatic palliation until death was achieved in 74% (n=42); success depended on circumferential tumour extent. Bowel perforation occurred in 5% without mortality. Macroscopic eradication of small tumours was possible in 43% (n=7). A retrospective comparison of LT (n=35) and surgery (n=47) for incurable rectosigmoid cancer, showed similar long-term palliation rates (74% vs 85%) and survival. Morbidity and mortality were significantly greater and hospitalisation longer after surgery. Conclusion: LT is an effective and safe palliative treatment for gastrointestinal cancers; best results are likely to be achieved if it is used in a complementary fashion with other modalities in specialist centres.

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