Endoscopic Nd.:YAG laser debulking of esophageal squamous cell carcinoma (ESCCA) prior to treatment with chemotherapy and radiotherapy (Ch/XRT): A prospective study

Background: ESCCA carries a poor prognosis. Most patients have advanced disease at initial presentation. Current treatment regimens with combination Ch/XRT have limited efficacy and only have survival rates of 20%. Laser therapy has been used for palliation but rarely for tumor debulking prior to chemotherapy or radiation therapy. Aim: For 2 yrs we have treated patients with nonmetastatic (stage 1-3) ESCCA with initial laser debulking, followed by 5-florouracil (5-FU) and radiotherapy with a goal of complete response (CR). Methods: 11 pts. with exophytic ESCCA were treated with endoscopic Neodynium:YAG laser at 2-4 day intervals to achieve major reduction of intraluminal tumor bulk. Laser therapy was followed by 5-FU (400-500mg/m²/d) for 45 days and XRT (total dose 5000 cGy). Each patient required 1-6 sessions of laser therapy (mean 2.4). Total dose ranged from 3.104J - 15.309J/ endoscopy session (mean 8,842J). Cumulative dose/pt. was 6,328J - 67.443J (mean 23.046J). Restaging to assess response rate was done by endoscopic biopsies and /or esophagectomy specimens at the end of Ch/XRT. CR: No tumor seen in multiple biopsies. Partial response (PR): Regression of tumor size but positive pathology. Results: Of the 11 patients, CR was achieved in 5 (45.4%), PR in 3 (27%). Death occured during treatment before restaging in 2 pts (18%). The duration of CR was 1-22 months (mean 9 months). Conclusion: Laser debulking of intraluminal limited stage ESCCA appears to enhance the response of the remaining tumor to Ch/XRT by decreasing the tumor burden. Further studies are needed to determine whether this therapy truly increases the complete response rate and survival.