Sargeant, Ian Robert; (1994) Combined Nd YAG laser and external beam radiotherapy for palliation in gastrointestinal cancer. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The Nd YAG laser offers rapid relief of symptoms advanced gastrointestinal cancers but deep tumour is inaccessible. External beam radiotherapy alone can be effectively used to treat all local tumour but its effect is delayed and effective recanalisation is often not achieved. There is very little data on how these treatments can best be combined to achieve the optimum clinical result. This thesis reports a series of studies which focus on the combination of endoscopic laser therapy and external beam radiotherapy for palliation of GI cancers. Laser is effective in palliation of dysphagia in oesophageal cancer but regular repeat treatments are required to maintain symptomatic relief. We have studied the additional use of external beam radiotherapy to reduce frequency of follow up treatments in this group and have identified patients most likely to benefit. We have also studied the effect on quality of life and cost of the additional radiotherapy in patients undergoing laser treatment. The use of external beam radiotherapy in patients with rectal cancer undergoing laser has been studied. This approach reduces the need for follow up procedures more dramatically than with oesophageal cancers. The role of endoprostheses in combination with laser and radiotherapy for oesophageal cancer is assessed. Patients with late complications such as fistulae and perforation are probably seen more commonly after laser/radiotherapy combinations. The use of cuffed tubes in this group is described. Standard oesophageal prostheses are useful later in palliation when laser is no longer effective. Tube overgrowth can subsequently present a problem in such patients, but is usually controllable with laser recanalisation. Conclusion: Laser has an important role in endoscopic palliation of advanced gastrointestinal cancers which is complementary to radiotherapy and intubation.

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