Electrochemical Therapy for Late

Electrochemical Therapy for Late Stage Esophageal Cancer
Patients with Serious Obstruction XIN Yu-Ling
China-Japan Friendship Hospital, Beijing 100029, China

From March of 1992 to December of 1993 we treated 102 late stage esophageal cancer patients with serious obstruction by using tube electrode developed in China. Among the group, 70 cases belonged to primary late stage esophageal cancer obstruction and 32 cases belonged to postoperative anastomotic stricture. All the strictures belonged to III or IV obstruction and die stricture degree was 1-3 mm according to esophagoscopy and the measurement on the barium radiography of esophagus. The patient could only take liquid food or live on intravenous infusion. Because they hadn‘t been able to take food for a long time, their constitution was very poor and they couldn‘t accept surgical treatment, radiotherapy, or chemotherapy. ECT method is simple, safe, and effective. As there is little harm done and patients recover quickly, it is accepted willingly by the old weak patients.

Among the group, there were 67 cases male and 35 case female. They ranged in age from 41 to 50 years (37 cases), 51 to 60 years(42 cases), and 61 to 78 years(23 cases).

Lesion sites: There were 21 cases with lesion in upper esophagus, 38 in the middle and 11 in lower esophagus, among the 70 cases with primary esophageal cancer. here were 27 cases with lesion in upper esophagus and 5 cases in the middle, among 32 cases with anastomotic stricture.

Pathological type: All cases were squamous cell carcinoma. Fifty-nine cases belonged to stenotic type, 32 cases belonged to medullary type and 11 cases belonged to fungoid type.

Stricture degree: There were no cases with J0 or 110 stricture, 42 cases(4 1.2%) with 11I~, and 60 cases (58.8%) with IV° stricture. Among 70 cases with primary esophageal cancer, there were 32 cases (45.7%) belonged to 1V⁰stricture and 38 cases (54.3%) belonged to III~. Among 32 cases with anastomotic stricture there were 28 cases (87.5%).with 1V⁰stricture and only 4 cases (12.5%) with 1110 stricture. lt is obvious that W° siricture was dominant among postoperative anastigmatic stricture. (Table1)

Among 70 cases with primary esophageal cancer 26 cases had been treated by means of radiotherapy and chemotherapy, and 31 cases took traditional Chinese medicine and they failed to respond to die treatment. Among 32 cases with postoperative anastomotic stricture, cancer relapse was confirmed in 27 cases by means of esophagoscopy and biopsy and 5 cases were circular cicatricial siricture and accepted dilating treatment.

(1) Instrument and tube electrode selection: We select BK 901 and ZAY-6B model instrument, which have die function of pre-determining voltage, current intensity, current quantity and treatment time and also have die monitoring and alarming device to guarantee die accuracy and safety of die therapy. We select appropriate tube electrode depending on die length of die lesion. Die tube electrode is 70 cm long

and its outer diameter is 0.5-0.8cm. Anodic and cathodic rings of platinum wire (diameter 0.3 mm) are wound on the tube end. The length of the treating end is 4 cm, 6 cm, and 8 cm.

(2) Preparations before treatment: Examinations include routine main organs‘ function testing, barium radiography of esophagus, and esophagoscopy in order to identify the pathological type, Length and extent of the lesion. The tube electrode is suitable to a circular esophageal cancer. When the cancer doesn‘t occupy the whole circular wall, we must protect the normal esophageal tissue by sealing the electrode which contacts the normal tissue.

(3) Operating methods: Patients take sitting position. Topical anaesthesia with decaine on mucosa of nasal cavity and pharyngeal site is given. We can place the tube electrode through nostril. While placing the electrode, we let the patient swallow to make it into esophagus easily. If it is difficult to place it through nostril, we can do it through oral cavity. We insert the tube electrode into the lesion of stricture. If the lesion is seriously obstructing and we can‘t insert the electrode into it, we can first expand it by using dilator under the monitoring of esophagoscope and insert the electrode into the lesion under the elastic wire guiding, then give the treatment.

We usually use the voltage of 4-8V, the current intensity of 50-1 OOmA, current quantity of 60-80 coulombs per cm length of the tumor and time of 1.5-2 hours. We can give the patient intramuscular injection of pethidine 5Omg. If we treat lower segment of esophageal cancer or cardiac cancer, we should monitor rhythm of heart, because the electrode is near the heart and can make its beat slow. If necessary, we can give the patient intramuscular injection of atropine and decrease the voltage below 4V and adjust the current intensity below 3OmA. lt still has the treating effectiveness, but the time required is prolonged.

To obtain effective result it needs several times of treatment for the longer lesion or seriously obstructing scar ofanastomosis. The interval is usually about two weeks.

ECT is very good at removing esophageal cancer obstruction. patients can drink in one day and take liquid food in three days, soft food in two weeks and ordinary food in three weeks after treatment.

We evaluate the effectiveness according to barium radiography of esophagus, esophagoscopy and the Four Scales Standard for Tumor Radiotherapy of WHO: CR: The tumor disappears totally, dysphagia is alleviated, patients can take ordinary food and their condition is stable Within 12 months. Twenty-three cases belonged to CR. PR: One-half of tumor disappears, dysphagia is alleviated, patients can take ordinary food and their condition is stable within 6 months. Fifty-three cases to PR. MX: Tumor reduces a quarter of its dimension, dysphagia is alleviated partly, patient can take soft or liquid food and have relapse within 3-5 months. Fifteen cases belonged to MX. PD: Tumor reduces a little of its dimension and dysphagia is not alleviated. Eleven cases belonged to PD.

Table 2: Treating Effectiveness of 102 cases with Serious Obstruction of Esophageal Cancer

	n	CR n %		PR_ n %		MR n %		PD n %		CR+PR n %
primary esophageal	70	14	20.4	35	50.0	12	17.1	9	12.8	49	70.0
cancer
Postoperative anastomotic	32	9	28.1	18	56.2	3	9.3	2	6.2	27	84.3
relapse
Total	102	23	22.5	53	5I.9	15	I4.7	11	10.8	76	74.5

lt indicates that the clinical effectiveness of postoperative anastomotic stricture group is better than that of primary esophageal cancer group. The difference two groups is significant (P<0.05) (Table 2)

After treatment esophageal cancer tissue becomes necrotic and drops off and dysphagia is alleviated soon. According to barium radiography of esophagus 57 cases with 1110 or IV° obstruction (l-4mm) became that with I or IIobstruction (5-lOmm), and even 19 cases became 0obstruction (lO-2Omm) among 102 cases (Table 3)

Obstruction Degree	Stricture Degree (mm)	Before Treatment n %		After Treatment n %
0				19	18.6
I				34	33.3
II				23	22.5
III	3-4	42	41.2	I6	15.7
IV	1-2	60	58.8	I0	9.8

After treatment the obstruction degree I, and II meant that the treatment had effectiveness and the effective rate was 74.5% (76/102). III and IV⁰indicated that the treatment was non-effective and die rate was 25.5% (26/102).

Months 15 cases with partial alleviation died within 6-12 months, 61 cases survived more than one year (59.8%), 21 cases survived more than two years (20.6%), and 6 cases survived more than three years (5.9%).

Late stage esophageal cancer patients with serious obstruction can‘t take food during a long period; They are very weak and can‘t accept surgical treatment. They usually fail to respond to radiotherapy an chemotherapy. lt is more difficult to treat postoperative anastomotic relapse and cicatricial stricture. Starving threatens die patients‘ lives seriously. lt has obtained better effectiveness to treat esophageal cancer obstruction by using ECT recently. lt is simple, safe, and effective. As there is little harm done and patients recover quickly, it is accepted willingly by die old and weak patients. lt provides us with effective method to treat late stage esophageal cancer obstruction.

Though ECT is effective to treat intraluminal esophageal obstruction, it is difficult to treat extraesophageal invasion because it is hard to deliver die current quantity exactly. Tumor tissue will remain if die quantity is not sufficient, but perforation of esophagus may occur if too much quantity is delivered. Now die method by which we resolve die problem may involve: (1) Treatment for several time. We let patients have esophagoscopy every time after treatment to observe the lesion‘s change and decide die treating current quantity and die accurate site for die next time.(2) After dysphagia is alleviated, patients can take food, and their constitution is improved and if there is still cancer tissue remained in esophageal wall, patients may accept surgical treatment or radiotherapy or chemotherapy to improve die treating effectiveness and prolong their lives.