Palliative Treatment of the Upper Gastrointestinal Tract Using a Combination of Laser Therapy and Intracavitary Radiation

  • M. Bader
  • H. J. Dittler
  • B. Ultsch
  • B. Ries
  • J. R. Siewert
Conference paper

Abstract

Palliative treatment of malignant stenoses of the upper gastrointestinal tract should be instituted only when, on the basis of previous staging and assessment of the risk involved, curative surgery is no longer possible. Resection of an esophageal carcinoma is contraindicated by infiltration of the growth into the trachea or other organs, as revealed by CT or magnetic resonance. Invasion of the bronchial system by the tumor can be detected with the aid of bronchoscopy. Distant metastasis, poor pulmonary function, and cirrhosis of the liver also militate against resection [13]. For this reason endoscopic implantation of an endoproth-esis should not be carried out without discussing the oncological situation with the surgeon. Since the implantation of a tube does not always satisfactorily improve the quality of the patient’s life [1, 3], in the past 18 months, as an alternative to endoscopic tube implantation, we have submitted 93 patients to intracavitary afterloading following prior laser therapy [2].

Keywords

Adenocarcinoma Perforation Dunham 

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References

  1. 1.
    Atkinson M, Ferguson R (1977) Fibreoptic endoscopic palliative intubation of inoperable esophagogastric neoplasms. Br Med J 1:266PubMedCrossRefGoogle Scholar
  2. 2.
    Bader M, Dittler HJ, Ultsch B, Ries G, Siewert JR (1986) Palliative treatment of malignant stenoses of the upper gastrointestinal tract using a combination of laser and afterloading therapy. Endoscopy 18 (Suppl 1):27–31PubMedCrossRefGoogle Scholar
  3. 3.
    Barbier P, Kappeler M, Teuscher H, Scheurer U (1984) Erfahrungen mit endoskopisch piazierten Endoprothesen bei stenosierenden Malignomen von Oesophagus und Cardia. Chirurg 55:593PubMedGoogle Scholar
  4. 4.
    Buset M, Dunham F, Baize M, Tocuf J de, Cremer M (1983) Nd: YAG laser, a new palliative alternative in the management of esophageal cancer. Endoscopy 15:535CrossRefGoogle Scholar
  5. 5.
    Fleischer D, Kessler F, Hage O (1982) Endoscopic Nd: YAG laser therapy for carcinoma of the esophagus: a new palliative approach. Am J Surg 143:280PubMedCrossRefGoogle Scholar
  6. 6.
    Fleischer D, Sivak M (1983) Endoscopic Nd: YAG laser palliation for obstructing esophagogastric carcinoma. Lasers Surg Med 3:172Google Scholar
  7. 7.
    Fleischer D, Sivak MV (1984) Endoscopic Nd: YAG laser therapy as palliative treatment for advanced adenocarcinoma of the gastric cardia. Gastroenterology 87:815PubMedGoogle Scholar
  8. 8.
    Kiefhaber P (1984) Indikationen für die endoskopische Verwendung des Lasers im Gastroin-testinaltrakt. Münch Med Wschr 126:103Google Scholar
  9. 9.
    Phillip J, Hagenmüller F, Manegold K, Szepesi S, Classen M (1984) Endoskopische, intraductale Strahlentherapie hochsitzender Gallengangscarcinoma. Dtsch Med Wschr 109:422PubMedCrossRefGoogle Scholar
  10. 10.
    Riemann JR, Ell Ch, Lux G, Demling L (1985) Combined therapy of malignant stenosis of the upper gastrointestinal tract by means of laser beam and bougienage. Endoscopy 17:43PubMedCrossRefGoogle Scholar
  11. 11.
    Sander R, Poesl H, Spuhler A (1984) Neodym- YAG-Laser in der Gastroenterologie: Palliative Therapie malignombedingter Stenosen im Gastrointestinaltrakt. Münch Med Wschr 126:1113Google Scholar
  12. 12.
    Schray MF, McDougall JC, Martinez A, Edmundson GK, Cortese DA (1985) Management of malignant airway obstruction: clinical and dosimetric considerations using an iridium-192 afterloading technique in conjunction with the neodymium-YAG-laser. Int J Radiation Oncology Biol Phys 11:403CrossRefGoogle Scholar
  13. 13.
    Siewert JR, Ries G, Fink U (1984) Palliative Behandlung des Oesophaguscarcinomas. Münch Med Wschr 126:438Google Scholar
  14. 14.
    Wain CP, Boen SG, Edwards DAW, Kirkham JS, Salmon PR, Clark CG (1984) Laser re-canalization of obstructing foregut cancer. Br J Surg 71:112CrossRefGoogle Scholar
  15. 15.
    Wara WM, et al. (1976) Palliation for carcinoma of the esophagus. Radiology 121:717PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • M. Bader
    • 1
  • H. J. Dittler
    • 1
  • B. Ultsch
    • 1
  • B. Ries
    • 1
  • J. R. Siewert
    • 1
  1. 1.Department of Surgery and Institute for Radiological Oncology and RadiotherapyTechnical University MunichMunichFederal Republic of Germany

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