Cobalt-60* Teletherapy for Palliation of Carcinoma of the Thoracic Esophagus

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CARCINOMA OF THE ESOPHAGUS presents a distressing problem in management. Despite the improvement in surgical and radiologic technics, only 2 to 3 per cent of patients having this disease survive for five years after the diagnosis. Since most cases are diagnosed only after esophageal obstruction has developed and the tumor has spread to involve regional or distant lymph nodes, the primary objective of treatment usually is palliative—relief of the esophageal obstruction.

Surgical resection or a bypassing procedure frequently has been performed for the relief of obstruction even when the disease is uncontrollable and despite a significant operative mortality in patients in the older age group.1 The objective of treatment is to give the patients the satisfaction of being able to swallow during the remaining months of life. Without treatment these patients eventually may not be able to swallow even saliva. Other procedures have been employed with the hope of palliation — such as bougienage which temporarily dilates the obstruction but is painful and exposes the patient to the risk of perforation, and gastrostomy which permits nourishment of the patient but denies him the pleasure of eating—but they have been abandoned in most medical centers because of unsatisfactory results.

For the most part the results of palliative roentgen therapy heretofore have been disappointing. The inability to relieve the dysphagia may be attributable to many factors, physiologic, pathologic, and physical. The physiologic factors include the advanced age (average age, 62 years) and the poor nutritional status of the patient when he. . .



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