Surgical treatment of esophageal carcinoma

Inverse expression of dihydrodiol dehydrogenase and glutathione-S-transferase in patients with esophageal squamous cell carcinoma

We investigated the significances of the expressions of dihydrodiol dehydrogenase (DDH) and glutathione-S-transferase (GST) in patients with esophageal squamous cell carcinoma (ESCC). By using immunohistochemistry, we measured expressions of DDH, GST, COX-2, nm23-H1, HER-2/neu and mdr-1 in 145 patients with ESCC. Expression of DDH was confirmed by immunoblotting and reverse transcription-polymerase chain reaction. Relation between DDH expression and clinicopathological parameters was analyzed by statistical analysis. Difference of survivals between different groups was compared by a log rank test. DDH overexpression was detected in 66.9% of pathological sections (97/145) and in 41.6% of metastatic lymph nodes (37/89). The nucleotide sequencing of DNA fragments from 16 tumorous specimens showed that the major isoform was DDH2 for ESCC. GST expression, however, was only detected weakly in 24 patients (16.6%). For patients with ESCC, DDH overexpression was positively correlated with smoking habit, tumor stage, number of metastatic lymph nodes, lymphovascular invasion and COX-2 expression, and inversely correlated with GST and nm23-H1 expressions, but not related to mdr-1 or HER-2/neu expressions. As compared to DDH overexpressed group, patients with low DDH expression had significantly lower incidence of tumor recurrences and better survival (p = 0.026). Using univariate analysis, prognostic factors included tumor stage, number of metastatic lymph nodes, cell differentiation, lymphovascular invasion and expressions of DDH and nm23-H1. Multivariate analysis showed significant correlation of tumor stage, number of metastatic lymph nodes and nm23-H1 expression with patient's survival. In conclusion, inverse expressions of DDH and GST may be associated with carcinogenesis and disease progression for ESCC patients, but their biological function and pathophysiological regulation in tumors require additional studies.

Detection of Epstein-Barr virus in esophageal squamous cell carcinoma in Taiwan

OBJECTIVE

Recently, an association between viral infection and the development of esophageal carcinoma has been reported, particularly the human papilloma virus (HPV) and Esptein-Bar virus (EBV). However, geographic variation in carcinogenesis is realized. In this study, we investigate the viral carcinogenesis and the biologic effect of viral infection on esophageal squamous cell carcinoma (ESCC) in Taiwan.

METHODS

To determine the association of viral infection (EBV and HPV) with ESCC, we applied polymerase chain reaction (PCR), immunohistochemistry, and in situ hybridization (ISH) to examine 119 surgical specimens from different sites of esophagus in 31 ESCC patients. Additionally, an immunoperoxidase method was used to detect EBV latent membrane protein-1 (LMP-1), p53, CD45RO (UCHL-1), Fas ligand (Fas L), and RNA ISH with oligonucleotide sequences was used to detected interleukin-6 (IL-6) mRNA.

RESULTS

By PCR, EBV DNA was detected in 11 cases (35.5%). Expression of EBERs in ESCC was further confirmed with ISH. Nonetheless, no LMP-1 expression was detected. On the other hand, human papillomavirus (HPV) was identified in only one case (3.2%) of ESCC. Furthermore, HPV was located by ISH in the distant normal region rather than in tumor cells. In EBV-positive cases, accumulation of p53 protein was detected in 10 lesions (91%); CD45RO+ lymphocytes together with expressions of FasL and IL-6 were respectively identified in 100%, 63.6%, and 54.5% of 11 EBV-positive lesions. Interestingly, in the EBV-negative cases (n = 20), p53 protein was detected in 40% of lesions; CD45RO 30%; FasL 50%, and IL-6 10%.

CONCLUSIONS

In this study, no correlation was found between the presence of EBV in ESCC and the patients' age, sex, as well as survival. Although our results indicate that EBV could be associated with ESCC, the clinical role of EBV in ESCC remains to be determined.

Expression and up-regulation of interleukin-6 in oesophageal carcinoma cells by n-sodium butyrate

Recently, the serum level of interleukin (IL)-6 has been shown to correlate with disease progression and prognosis of cancer patients. However, the available information about the source and the pathophysiological regulation of IL-6 in cancer cells is limited. Thus, in this study, we tried to identify the source and the clinical roles of serum IL-6 in patients with oesophageal squamous cell carcinoma (ESCC), and then further to characterize the biological regulation of IL-6 in ESCC cell lines. Sera and tissue specimens from 80 consecutive patients with ESCC were collected between 1993 and 1997. Additionally, three ESCC cell lines were used for in vitro study. The concentration of serum IL-6 was measured by enzyme-linked immunosorbent assay (ELISA), and correlated the survival time with measured IL-6 level. Expressions of IL-6, IL-6R alpha (IL-6 receptor alpha) and gp130 in pathological sections and cell lines were characterized by immunological staining. Detection of IL-6 mRNA was determined by in situ hybridization (ISH) and reverse transcription-polymerase chain reaction (RT-PCR). Up-regulation of IL-6 by n-sodium butyrate (n-BT) was studied in ESCC cell lines. The levels of serum IL-6 in patients with ESCC were significantly higher than those in the healthy controls. Serum levels of IL-6 were also shown to correlate with disease progression and survival. However, sCD8 levels and lymphocyte counts in the peripheral blood were not parallel to the changed pattern of serum IL-6. In pathological sections and ESCC cell lines, message of IL-6 was identified by ISH in cancer cells. Expression of IL-6 mRNA was further confirmed with RT-PCR in ESCC cell lines. Although IL-6 was detected in some ESCC cell lines, IL-6 gene expression and protein production could be induced or enhanced by n-BT treatment in all three cell lines. The serum levels of IL-6 are frequently elevated at diagnosis of ESCC, and are associated with poor prognosis. IL-6 that could be produced by cancer cells is up-regulated by n-BT.

Prognosis of esophageal squamous cell carcinoma: analysis of clinicopathological and biological factors

OBJECTIVE

Esophageal squamous cell carcinoma (ESCC) is rather common among the Chinese, but the therapeutic outcome is dismal. Knowledge of the prognostic factors in cancerous patients may influence therapeutic strategy. However, systemic analyses of clinicopathological and biological factors for patients with ESCC are few, and the results are controversial.

METHODS

Between 1985 and 1996, 117 patients undergoing en bloc esophagectomy and gastric substitution were enrolled. None had neoadjuvant treatment. Postoperative adjuvant therapy was provided for patients at and beyond stages IIa. Clinical responses were followed routinely. Flow cytometry was used to measure DNA ploidy and synthesis-phase fraction (SPF) of the resected esophageal tissues from all patients. Immunohistochemistry was also used to examine the expression of proliferating cell nuclear antigen (PCNA), epidermoid growth factor receptor (EGFR), HER-2/neu, and p53 in the pathological sections. Clinical correlation was evaluated by chi2 with Fisher's exact test, and survival by log-rank test.

RESULTS

The overall survival rates were 74% for 1 yr, 48% for 3 yr, and 38% for 5 yr. TNM tumor staging, the number of diseased lymph nodes (N < or = 3 or N > 3), degree of cell differentiation, DNA ploidy, SPF, and lymphovascular invasion were more useful than biological markers, such as PCNA, EGFR, HER-2/neu, and p53, for the prognosis of ESCC. Multivariate analysis revealed significant correlation of tumor staging and number of diseased lymph nodes with patient survival after surgery.

CONCLUSIONS

En bloc esophagectomy may provide a rather satisfactory survival rate for patients with early stage ESCC. However, for patients with distant lymph node metastasis and those with more than three lymph nodes involved, radical surgical resection, even combined with postoperative chemoradiotherapy, cannot improve survival. The prognostic value of biological markers, including PCNA, EGFR, HER-2/neu, and p53, however, is limited.

Management for patients with advanced T4 epidermoid carcinoma of the esophagus

Available data concerning the treatment of patients with advanced T4 esophageal carcinoma are limited. A consecutive series of 42 patients with advanced T4M0 epidermoid carcinoma of the esophagus were studied from June 1987 to July 1992. The aim of this study was to evaluate the efficacy of various therapeutic modalities, and further evaluate the therapeutic options. The various therapeutic modalities included the following: Group I, feeding jejunostomy or endoesophageal intubation, 6 patients; Group II, palliative subtotal esophagectomy only, 8 patients; Group III, bypass procedures without tumor resection, 9 patients; Group IV, nutritional support and then treatment with irradiation (n=8) or concurrent radio-chemotherapy (n=4), 12 patients; Group V, subtotal esophagectomy, followed by aggressive concurrent radiochemotherapy, 7 patients. The total prescribed irradiation dose was 60 Gy (10 Gy/5 fractions/week). A combination regimen of chemotherapy consisted of cisplatin, 5-fluorouracil, and leucovorin (PFL regimen). For the patients undergoing esophagectomy or bypass procedures (n=24), the rates of operative complication and mortality were 45.8% and 25%, respectively. Side effects of adjuvant therapy (n=24) consisted of main airway irritation (100%), mucositis or gastrointestinal symptoms (83.3%), hematologic toxicity (79.2%), esophagitis or gastric ulcer (62.5%), alopecia (37.5%), and pneumonia (20.8%). The mortality due to toxicity of adjuvant therapy was 21.1% (4/19 patients). The mean survival times for each of the different groups was 1.9+/-0.5 months for Group I, 4.8+/-1.6 months for Group II, 5.2+/-1.2 months for Group III, 7.3+/-2.0 months for Group IV, and 20.3+/-2.5 months for Group V, respectively. Compared with patients of Groups I--IV, the Group V patients had a significantly superior one-year survival rate (P<0.01). Our results demonstrated that esophagectomy followed by concurrent irradiation and PFL combination chemotherapy may provide a significant improvement in the quality of life and survival for appropriate patients with advanced T4M0 epidermoid carcinoma of the esophagus. Furthermore, more than one cycle of PFL regimen chemotherapy may result in a better prognosis. During the performance of such an aggressive treatment, the utmost care must be taken with the patient's nutrition and to prevent pulmonary complications.

Palliative intubation for dysphagia in patients with carcinoma of the esophagus

One hundred seven consecutive patients seen over a 6-year period with dysphagia secondary to advanced primary carcinoma of the esophagus underwent intubation. One hundred five patients underwent pulsion intubation. In 2 patients pulsion intubation was not possible, and laparotomy and traction intubation was performed. For the intubated group there were 65 men and 40 women (ratio, 1.6:1), with a mean age of 71.3 +/- 10.5 years (range, 36 to 92 years). Of the 105 patients who had pulsion intubation, a perforation developed in 11 (10.5%), which was responsible for the death of 4 patients (3.8%). A further 3 patients died of malignant cachexia, which resulted in an overall mortality of 6.7%. Late complications included tube displacement (4 patients; 3.8%) and tube obstruction (32 patients; 30.5%). Tube obstruction was due to advancement of malignant disease in 26 patients (81.2%) and food bolus impaction in the remaining 6 patients (18.8%). Pulsion intubation for advanced carcinoma of the esophagus can be performed with a low morbidity and early mortality. However, there is a substantial long-term morbidity of tube obstruction in almost a third of survivors.

Gastric substitution for resectable carcinoma of the esophagus: an analysis of 368 cases

Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6%. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2%), posteromediastinal (7.1%), and intrathoracic (15.7%). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3% and 6.5%, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5%. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4% and 7.6%, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1%; postprandial fullness of abdomen, 38.2%; dumping syndrome, 13.2%; distended stomach with dyspnea, 11.8%; aspiration pneumonia, 6.6%; and gastric ulcer, 6.6%. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5% versus 8.6%), dumping syndrome (33.3% versus 6.9%), aspiration pneumonia (16.7% versus 3.4%), and gastric ulcer (22.2% versus 1.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective study on radiotherapy and radiochemotherapy in esophageal cancer

One hundred nineteen patients with inoperable esophageal cancer who had been treated with radiotherapy and/or chemotherapy from Jan. 1982 to Dec. 1986 at the Korea Cancer Center Hospital were retrospectively analyzed. Of 119 patients, 111 were male, and eight were female. Ten (8%) had a lesion in the cervical esophagus; 71 (60%), in the upper and midthoracic esophagus; and 38 (32%), in the lower esophagus. One hundred ten (92%) patients had squamous cell carcinoma, and nine (8%) had adenocarcinoma. In 40 patients receiving radiotherapy alone, the response rate was 50% (complete response, 10%; partial response, 40%) with a median survival of 9 months. The 1-, 2-, and 3-year survival rates were 35%, 10%, and 5%, respectively. In 36 patients receiving radiochemotherapy, the response rate was 61% (complete response. 20%; partial response, 41%) with a median survival of 15 months. The 1-, 2-, and 3-year survival rates were 45%, 31%, and 12%, respectively. Six patients who had received chemotherapy alone had no objective response and died within one year. None of the 37 patients who had not received a specific treatment for underlying cancer survived two years. T1 stage, a lesion in the cervical esophagus, and good performance status (0–2) were considered to be favorable prognostic factors. There was no significant difference in the response rate and the actuarial survival between the radiotherapy and radiochemotherapy groups. These results suggest that both radiotherapy and radiochemotherapy are effective treatment modalities for inoperable esophageal cancer.

Palliative laser therapy for malignant dysphagia

Seventy six patients with dysphagia caused by malignant tumours of the oesophagus or gastric cardia have been treated using the Neodymium Yttrium Aluminium Garnet (NdYag) laser. The laser was set to deliver 80-100 watts of power for 0.5-1 second pulses. To obtain improvement, patients on average needed four treatment sessions with a mean energy per treatment of 3586 joules. Follow up endoscopy and laser treatment was at four week intervals, unless the clinical or endoscopic results indicated otherwise. The immediate result was to allow 32% of patients to swallow anything they liked, a further 54% were able to take most solids and 9% were improved, or maintained on liquids only. The mortality of laser recanalisation and associated treatment was 5%. The improvement in swallowing was maintained until death in all but 15% of these patients, some of the 15% needed intubation to allow adequate swallowing. Endoscopic, or surgical intubation was required immediately in five patients after an initial laser course failed to provide improvement. The mean survival of the whole group was 19 weeks (range one to 112 weeks).

Cancer of esophagus and esophagogastric junction: analysis of results of 1,025 resections after 5 to 20 years

Resection was carried out in 1,025 of 1,654 patients with cancer of the esophagus or esophagogastric junction at the Peking Medical College Hospitals in China from 1953 through 1973. All cancers of the esophagus were squamous cell carcinomas except for five adenocarcinomas. A lesion localized within the esophageal wall was found in 55% and lymph node metastasis in 41.3% of the patients undergoing resection. All cancers of the esophagogastric junction were adenocarcinomas. The tumor had invaded beyond the boundaries of the stomach in 76.7% of these patients, and positive nodes were found in 61% of the patients. The rate of resectability was 81.2% for esophageal cancer and 74% for cancer of the esophagogastric junction. Surgical mortality after resection was 4.9% (50/1,025). The 5-year survival after resection was 20.9% (214/1,025). Better results were found following complete resection: 24% (210/875) for all patients, 28.2% (162/575) for patients with cancer of the esophagus, and 16% (48/300) for patients with cancer of the esophagogastric junction. Late survival at 10, 15, and 20 years after resection of esophageal cancer was 20%, 12%, and 7.4%, respectively. The favorable prognostic factors after resection of esophageal cancer were tumor of the lower third of the esophagus, the absence of lymph node involvement, and the presence of a localized lesion. The 5-year survival for patients with cancer of the lower third of the esophagus was 32.7%. It was 64.2% for patients with a localized lesion with negative nodes in this subgroup.

Aortic rupture in manual dissection of the esophagus: a rare complication during palliative esophagectomy performed on account of radiated esophageal cancer. A pathologic-anatomic view

The report concerns the rare complication of a rupture of the aorta thoracica descendens during a palliative esophagectomy without thoracotomy performed on account of radiated carcinoma of the esophagus. The pathologic-anatomic findings are discussed and the literature is indicated.

Esophageal carcinoma metastatic to the stomach. A clinicopathologic study of 35 cases

Esophageal carcinoma metastatic to the stomach was analyzed in 35 patients. Ten were discovered in surgical specimens and 25 at autopsy. All patients were men with a mean age of 62 years. Primary lesions were most frequently located in the middle of thoracic esophagus and were larger than 7 cm. Undifferentiated carcinoma was found in 29% of the patients. Local spread of the primary lesions to neighboring structures was seen in 34%. Lymphatic invasion, and intramural metastases within the esophagus, as well as lymph node metastases, were predominant. Metastatic lesions within the stomach were mostly located in the gastric cardia, were less than 2 cm or more than 4 cm in size, and resembled submucosal tumors. Gastric metastases occasionally spread from the submucosa to neighboring structures. In spite of aggressive treatment, the prognosis was extremely poor because of multiple spread of carcinoma to local regions, lymph nodes, and distant organs. The clinicopathologic characteristics of this disease and possible treatment are discussed.

Esophageal carcinoma metastatic to the stomach. A clinicopathologic study of 35 cases

Esophageal carcinoma metastatic to the stomach was analyzed in 35 patients. Ten were discovered in surgical specimens and 25 at autopsy. All patients were men with a mean age of 62 years. Primary lesions were most frequently located in the middle of thoracic esophagus and were larger than 7 cm. Undifferentiated carcinoma was found in 29% of the patients. Local spread of the primary lesions to neighboring structures was seen in 34%. Lymphatic invasion, and intramural metastases within the esophagus, as well as lymph node metastases, were predominant. Metastatic lesions within the stomach were mostly located in the gastric cardia, were less than 2 cm or more than 4 cm in size, and resembled submucosal tumors. Gastric metastases occasionally spread from the submucosa to neighboring structures. In spite of aggressive treatment, the prognosis was extremely poor because of multiple spread of carcinoma to local regions, lymph nodes, and distant organs. The clinicopathologic characteristics of this disease and possible treatment are discussed.

Surgery of esophageal carcinoma

The experience of surgical treatment in 1,874 patients with carcinoma of the esophagus seen at the Cancer Institute and Hospital of the Chinese Academy of Medical Sciences, Beijing, People's Republic of China, between 1958 and 1982, is reported. Despite the prevalence of this malignancy in this part of China, only 3% of the patients in this series had stage I disease, while 80% of the patients had either stage III or stage IV disease with extraesophageal tumor invasion and regional or distant metastases. Of the entire series there was an overall resectability rate of 83.9%, being 77.6% between 1958 and 1969 and 89.0% between 1970 and 1982. Among the 1,572 resections of the entire series, there were 66 deaths within 30 days of operation, for a resection mortality rate of 4.2%, being 4.9% between 1958 and 1969 and 3.7% between 1970 and 1982. Anastomotic leakage occurred in 67 cases of the 1,572 resections, for an incidence of 4.3%. Of the 67 cases with anastomotic leaks, 38 recovered after intensive treatment; the remaining 29 died eventually of the complication, giving a death rate of 43.3%. Pathologic studies of the 1,572 specimens showed lymph node metastasis in 46.1% of the cases. It is obvious that practically all the unresectable cases showed more extensive lymph node involvement at operation, although fixation of the tumor with severe invasion to the surrounding organs usually constituted the chief cause of unresectability. The postresection long-term survivals as calculated by the number of resections at 5, 10, and 15 years were 30.2% (390/1293), 22.4% (196/876), and 18.9% (112/594), respectively. Over one-third, or 36.8%, of the 1,874 patients in the present series were treated with a combination therapy of preoperative irradiation and surgery. The results in the group of 408 selective patients and those in the group of 83 randomized patients with midthoracic esophageal carcinomas were gratifying. In the latter group there was a resectability rate of 95.2%, a resection mortality rate of 3.8%, an incidence of intrathoracic anastomotic leakage of 0%, and a 5-year survival rate of 45.5%, as compared to 89.6%, 4.3%, 1.7%, and 25%, respectively, in the control group treated by surgery alone. From these findings it is concluded that preoperative irradiation as an adjunct can promote both the immediate and long-term results of surgery for carcinoma of the esophagus. Recent advances in the surgical treatment of carcinoma of the esophagus may change the pessimistic philosophy for this malignancy.(ABSTRACT TRUNCATED AT 400 WORDS)

Esophagogastrectomy as palliative treatment for esophageal carcinoma: results obtained in the setting of a thoracic surgery residency program

The palliative treatment of esophageal carcinoma has included intubation, bypass, dilation, irradiation, and esophagogastrectomy. The last has been criticized by some on the basis of high operative morbidity and mortality. To assess the success of this method at our institution, we reviewed the 60 consecutive resections performed for carcinoma of the esophagus from January, 1972, through June, 1983. Forty-six patients had squamous cell tumors and 14, adenocarcinomas. There were 47 men and 13 women, and the mean age was 59.9 years (range, 38.5 to 78.9 years). The most frequent preoperative findings included dysphagia (55), weight loss (34), chest pain (22), and vomiting (49). Fifty (83%) out of the 60 resections were performed by the resident staff under the supervision of an attending surgeon. Four patients died within 30 days of operation, an operative mortality of 6.7%. Immediate causes of death included respiratory failure, myocardial infarction, hemorrhage, and renal failure. One of the patients who died and 3 of the survivors had an anastomotic leak. There were 27 additional complications in 24 patients: respiratory problems (8), arrhythmias (5), pleural effusion (4), gastric outlet obstruction (2), wound infection (2), and 1 each of pulmonary embolus, acute brain syndrome, congestive heart failure, myocardial infarction, chylothorax, and empyema. The one-, two-, three-, and five-year actuarial survival rates were 46%, 27%, 10%, and 5%, respectively. Mean survival for the 46 patients dead at the time of this study was 13.5 months. Outpatient follow-up data were available on 53 (95%) of the operative survivors and showed an absence of dysphagia in 87.5% during most of the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcome of thoracic esophageal carcinoma in blacks in the inner city

This report is based on 45 cases of cancer of the thoracic esophagus in blacks residing in a socioeconomically depressed area of the inner city of South-Central Los Angeles. There were 30 men and 15 women, ranging in age from 26 to 89 years. Preoperative management, contraindications of surgery, and overall results are specified. The operative mortality rate was 14%. As a means of restoring continuity of the alimentary tract after resection of esophageal carcinoma, the stomach was preferred, although the colon was used in two instances. Five-year survival in this series was 14% in the operative group and 13% in the radiotherapy group; one of the surgical patients is still alive, and another one survived for 72 months. In the radiation group, no such incidence occurred. It is therefore concluded that surgery is the optimal palliation if there is an acceptable risk of mortality. When operative risks are unacceptable radiation therapy is used.

Surgical therapy of advanced esophageal cancer. A critical appraisal

Thirty-five patients with advanced esophageal carcinoma underwent esophagogastrectomy. Of these, 13 patients underwent esophagogastrectomy through midline celiotomy and right thoracotomy incisions (Group 1), and 20 patients underwent extrathoracic esophagectomy with either reversed gastric tube (Group 2) or isoperistaltic tube reconstruction (Group 3). Morbidity was significantly greater in patients who underwent extrathoracic esophagectomy due to more severe pulmonary complications and anastomotic fistulas. Because of these complications, a longer interval to solid food ingestion occurred in the extrathoracic esophagectomy group. Long-term survival was not affected by the operative procedure utilized. Extrathoracic esophagectomy with cervical anastomosis is associated with more complications than an intrathoracic anastomosis, resulting in inferior palliation for patients with advanced esophageal carcinoma.

The consequences and effectiveness of intubation in the palliation of dysphagia due to benign and malignant strictures affecting the oesophagus

In a study of 66 patients intubated to relieve dysphagia, 52 (79 per cent) survived the procedure and were discharged home. Of these, 23 (44 per cent) developed further dysphagia due to tube dysfunction, and 19 patients (37 per cent) were readmitted for further procedures to restore swallowing. With early intervention, the periods of dysphagia were short and the palliation so achieved was effective. Overall, intubation proved to be an effective method of relieving dysphagia in patients unsuitable for curative treatment.