Combination Of Laser Therapy Research Articles

Combination of Laser Therapy and Oral Propranolol Therapy for Infantile Hemangioma

Combination of Laser Therapy and Oral Propranolol Therapy for Infantile Hemangioma

Two-year Follow-up of Avulsed Teeth Submittted to Laser Therapies: A Case Report

Background: Replanted teeth can lead to critical biological conditions involving ankylosis and external root resorption. To prevent these occurrences, antimicrobial Photodynamic Therapy (aPDT) and Photobiomodulation Therapy (PBMT) can be used during the postoperative phase. Case Report: The present report described the clinical case of a patient, an adult male with the avulsion of teeth #11 and #21. Teeth were stored under dry conditions and replanted 18h after trauma. The pulp was removed before replantation and aPDT was performed using a low power laser (660 nm,100 mW, 9 J) in direct irradiation of the root canal. A passive flexible splint was fixed in place from tooth #13 to #23 for 4 weeks. The PBMT was applied three times a week, for the first 2 months, using the same laser device but with an infrared wavelength (808 nm, 100 mW, 3J). Clinical and radiographic examination supported the assessment of inflammatory/infectious resorption. Conclusion: The combination of laser therapy with endodontic procedures for treating traumatized teeth ensured successful clinical and radiographic outcomes at a 2-year follow-up examination.

New evidence of photobiomodulation and ozone therapy combined in the treatment of Bell's palsy

Bell's palsy is the most common cause of unilateral facial palsy reported in the literature. This condition consists of causing rapid onset and unilateral peripheral paresis/paraesthesia of the seventh cranial nerve. Despite being well documented, its etiology is still uncertain, imposing difficulty in immediate treatment. The combination of laser therapy and ozone therapy was proposed as a new treatment method for Bell's palsy, as it combines the efficacy and response of a therapy with the benefits of a minimally invasive approach. In the present study, we describe the first treatment protocol combining laser therapy and ozone therapy in Brazil, as well as details of the technique for the treatment of Bell's palsy. Case Report: A 59-year-old female with paralysis and paresthesia in the right hemiface, diagnosed for Bell's palsy, underwent a combined treatment of laser therapy and ozone therapy (VK OzonTherapy). After the fourth treatment session, a great clinical response was observed, and another session of the VK OzonTherapy protocol was performed. The patient evolved with significant improvement in the sequelae of right hemifacial paralysis, oro-ocular and eye closure, with rapid recovery of muscle tone and correction of asymmetries. Conclusions: This Report shows that the VK OzonTherapy protocol is an adjunct tool for clinical practice capable of improving the aesthetic-functional quality of life in patients with recent unilateral facial palsy.

Еndothelial dysfunction in patients with chronic obstructive pulmonary disease: feasibility of non-medicamental treatment (literature review and personal experience)

The aim of the work was to study the feasibility of the use of non-medicamental factors for the correction of endothelial dysfunction in patients with chronic obstructive pulmonary disease. Results. Chronic obstructive pulmonary disease (COPD) is considered as a systemic disease, one of the pathogenetic components of which is endothelial dysfunction (ED), which contributes to the development of comorbid cardiovascular pathology. At the same time, the basic treatment of patients with COPD includes drugs that may adversely influence it, and some medicines for the cardiac pathology treatment can increase the bronchial obstruction. Therefore, a question of non-medicamental methods of ED correction is actual, especially beyond the acute period of the disease. Methods of hardware physiotherapy, including ozone therapy, singlet oxygen therapy and its combination with magnetic therapy, low-intensity laser radiation, ultrasound therapy, a combination of laser therapy with balneotherapy, are widely employed. These methods have antioxidant, bronchodilating and anti-inflammatory effects, promote improvement of hemodynamics, as well as rheological properties of blood and microcirculation. Interval hypoxic therapy is also used, because in response to the hypoxic stimulation, the mechanisms of the respiratory system regulation, gas exchange and blood circulation are activated. It is also promising to use haloaerosoltherapy (HAT), which due to the increase of bronchs drainage function and sanitizing effect leads to the inhibition of local inflammation, improves ventilation and gas exchange, and reduces the intensity of oxidative stress, which promotes decrease of systemic inflammation and ED, associated with it. Particularly, this effect is manifested by lowering of edothelin-1 level and the expression of adhesion molecules by lymphocytes (CD54+). Conclusions. The analysis shows that the inclusion of methods with non-medicamental influence on the endothelium can significantly increase the effectiveness of complex treatment of patients with COPD, without increasing the medicinal load on the organism, which helps to avoid undesirable side effects. The use of HAT in the rehabilitation treatment of COPD patients contributes not only to decreasing the activity of local and systemic inflammatory processes, but also is accompanied by a certain correction of ED. However, specific recommendations for the use of certain non-medicamental effects in the complex rehabilitation treatment of patients with COPD, taking into account the presence of ED, have not been developed.

Treatment patterns and outcomes in children with infantile hemangiomas: A retrospective observational analysis.

Objective:This study aimed to make use of real-world medical records to explore the clinical characteristics, treatments, and outcomes of infantile hemangiomas in southeastern China.Methods:This study applied a retrospective observational method using real-world data derived from the electronic medical records of the Foshan Women and Children Hospital, southeastern China dated between June 2014 and June 2019.Results:A total of 2427 patients with infantile hemangiomas were recruited in this study, including 942 (38.8%) males and 1485 (61.2%) females. Among the participants, 620 (25.5%) were high-risk infantile hemangioma, 449 (18.5%) were medium risk, and 1358 (56.0%) were low risk. A total of 14 treatment patterns in clinical practice were identified. The top 3 treatment patterns in each group of risk levels were the same: laser therapy, a combination of laser therapy and topical timolol maleate, and topical timolol maleate. The outcomes of the top 3 treatment patterns were significantly (P < 0.05) different in each risk group.Conclusion:Among the top 3 treatment patterns, laser therapy or a combination of laser therapy and topical timolol maleate were more likely to have an “Excellent” outcome.

The effect of a combination of laser therapy and handling of medical gymnastics on the indices of hemodynamics with dilated cardiomyopathy

The aim of the study: Combined use of kineso- and laser therapy to correct regional hemodynamic disorders in patients with dilated cardiomyopathy (DCMP). Material and methods: The study included 100 patients diagnosed with DCMP. The diagnosis "DCMP" was established for patients with dilatation of the heart cavity of non-coronatural origin, increased heart size (final diastolic size of the left ventricle - LV CDR &gt; 6.0 cm). The determination of the CHF FC was made according to the Russian National Recommendations of the RSCS (2018) and OSSN on the diagnosis and treatment of CHF. All patients took differentiated medication-assisted therapy according to indications during 3 months. Patients were divided into 2 comparable groups by sex, age, disease course, severity of the condition, and specifics of medication therapy. Patients of the 1st group were treated with intravenous laser irradiation of blood (ILIB) and selection of unloading therapeutic gymnastics against the background of supporting differentiated medication therapy. Patients of the 2nd group (control) received only differentiated medication therapy. The main method of investigation was venous occlusal plethysmography to evaluate regional hemodynamics with the determination of blood flow (Qr) and regional vascular resistance (Rr) at rest, venous tone (Vt), reserve blood flow (QH) and regional vascular resistance (RH) on the background of a functional load test. РResults: The data obtained during the dynamic observation (in 1, 3, 6 and 12 months) in the main group showed a reliable increase in the volume velocity of the blood flow at rest (Qr) and the reserve blood flow (QH), a decrease in the regional vascular resistance at rest (Rr) and under functional load (RH), venous tone (Vt), respectively. In the control group there was no reliable positive dynamics, after 12 months of observation indicators of regional hemodynamics significantly deteriorated. Conclusion: In patients with DCMP, according to venous occlusal plethysmography, the use of relieving therapeutic gymnastics in combination with ILIB on the background of medication therapy has significantly improved the indices of regional hemodynamics. The developed method of non-drug therapy can be used by cardiologists, general practitioners, therapists, doctors of physical and rehabilitation medicine to optimize treatment of patients with DCMP.

Effects of Low-Level Laser Therapy and Chiropractic Care on Back Pain in Quarter Horses

Low-level laser therapy has been used clinically to treat musculoskeletal pain; however, there is limited evidence available to support its use in treating back pain in horses. The objective of this study was to evaluate the clinical effectiveness of low-level laser therapy and chiropractic care in treating thoracolumbar pain in competitive western performance horses. The subjects included 61 Quarter Horses actively involved in national western performance competitions judged to have back pain. A randomized, clinical trial was conducted by assigning affected horses to either laser therapy, chiropractic, or combined laser and chiropractic treatment groups. Outcome parameters included a visual analog scale (VAS) of perceived back pain and dysfunction and detailed spinal examinations evaluating pain, muscle tone, and stiffness. Mechanical nociceptive thresholds were measured along the dorsal trunk and values were compared before and after treatment. Repeated measures with post-hoc analysis were used to assess treatment group differences. Low-level laser therapy, as applied in this study, produced significant reductions in back pain, epaxial muscle hypertonicity, and trunk stiffness. Combined laser therapy and chiropractic care produced similar reductions, with additional significant decreases in the severity of epaxial muscle hypertonicity and trunk stiffness. Chiropractic treatment by itself did not produce any significant changes in back pain, muscle hypertonicity, or trunk stiffness; however, there were improvements in trunk and pelvic flexion reflexes. The combination of laser therapy and chiropractic care seemed to provide additive effects in treating back pain and trunk stiffness that were not present with chiropractic treatment alone. The results of this study support the concept that a multimodal approach of laser therapy and chiropractic care is beneficial in treating back pain in horses involved in active competition.

Refractive outcomes following the treatment of retinopathy of prematurity in the anti-VEGF era: a literature review

A growing body of evidence indicates that antivascular endothelial growth factor (VEGF) therapy is effective in the treatment of retinopathy of prematurity (ROP). We conducted a comprehensive literature review on refractive outcomes of anti-VEGF treatments compared to laser treatment or a combination of laser therapy and anti-VEGF injections. Of the 9 studies analyzed, the final mean refractive error was myopic in 3 studies (37%) with IVB monotherapy, 7 studies (87.5%) with laser photocoagulation, and 1 study (50%) with combined therapy. In comparing IVB with laser monotherapy, 6 of 7 studies (86%) reported that final refractive error was significantly more myopic (>1 D) after laser treatment. No study was graded as high quality, and only a single article provided moderate quality of evidence.

The Combination of Laser Therapy and Metal Nanoparticles in Cancer Treatment Originated From Epithelial Tissues: A Literature Review.

Several methods have been employed for cancer treatment including surgery, chemotherapy and radiation therapy. Today, recent advances in medical science and development of new technologies, have led to the introduction of new methods such as hormone therapy, Photodynamic therapy (PDT), treatments using nanoparticles and eventually combinations of lasers and nanoparticles. The unique features of LASERs such as photo-thermal properties and the particular characteristics of nanoparticles, given their extremely small size, may provide an interesting combined therapeutic effect. The purpose of this study was to review the simultaneous application of lasers and metal nanoparticles for the treatment of cancers with epithelial origin. A comprehensive search in electronic sources including PubMed, Google Scholar and Science Direct was carried out between 2000 and 2013. Among the initial 400 articles, 250 articles applied nanoparticles and lasers in combination, in which more than 50 articles covered the treatment of cancer with epithelial origin. In the future, the combination of laser and nanoparticles may be used as a new or an alternative method for cancer therapy or diagnosis. Obviously, to exclude the effect of laser's wavelength and nanoparticle's properties more animal studies and clinical trials are required as a lack of perfect studies.

Transcutaneous laser treatment of leg veins

Leg telangiectasias and reticular veins are a common complaint affecting more than 80% of the population to some extent. To date, the gold standard remains sclerotherapy for most patients. However, there may be some specific situations, where sclerotherapy is contraindicated such as needle phobia, allergy to certain sclerosing agents, and the presence of vessels smaller than the diameter of a 30-gauge needle (including telangiectatic matting). In these cases, transcutaneous laser therapy is a valuable alternative. Currently, different laser modalities have been proposed for the management of leg veins. The aim of this article is to present an overview of the basic principles of transcutaneous laser therapy of leg veins and to review the existing literature on this subject, including the most recent developments. The 532-nm potassium titanyl phosphate (KTP) laser, the 585-600-nm pulsed dye laser, the 755-nm alexandrite laser, various 800-983-nm diode lasers, and the 1,064-nm neodymium yttrium-aluminum-garnet (Nd:YAG) laser and various intense pulsed light sources have been investigated for this indication. The KTP and pulsed dye laser are an effective treatment option for small vessels (<1 mm). The side effect profile is usually favorable to that of longer wavelength modalities. For larger veins, the use of a longer wavelength is required. According to the scarce evidence available, the Nd:YAG laser produces better clinical results than the alexandrite and diode laser. Penetration depth is high, whereas absorption by melanin is low, making the Nd:YAG laser suitable for the treatment of larger and deeply located veins and for the treatment of patients with dark skin types. Clinical outcome of Nd:YAG laser therapy approximates that of sclerotherapy, although the latter is associated with less pain. New developments include (1) the use of a nonuniform pulse sequence or a dual-wavelength modality, inducing methemoglobin formation and enhancing the optical absorption properties of the target structure, (2) pulse stacking and multiple pass laser treatment, (3) combination of laser therapy with sclerotherapy or radiofrequency, and (4) indocyanin green enhanced laser therapy. Future studies will have to confirm the role of these developments in the treatment of leg veins. The literature still lacks double-blind controlled clinical trials comparing the different laser modalities with each other and with sclerotherapy. Such trials should be the focus of future research.

Effectiveness of lasers in the treatment of dentin hypersensitivity.

Dentin hypersensitivity (DH) is a relatively common painful condition among dental problems. Although many studies have been performed regarding the diagnosis and treatment of DH, dental practitioners are still confused about the definite diagnosis and treatment.The use of lasers as a treatment for dentin hypersensitivity was first introduced in 1985.Laser treatment in dentin hypersensitivity is an interesting and controversial issue and many investigations have been done on its mechanism of action, advantages, and unclear points.The present literature review tries to go over the definition, diagnosis, etiology , predisposing factors, various laser types in the treatment of DH alone or in combination with topical desensitizing agents. Since a certain treatment has not yet introduced for dentin hypersensitivity, a combination of laser therapy and topical desensitizing factors ,can increase the success of the treatment compared with either treatments alone.

Laser thermal therapy of benign skin tumours: Review and update

The goal of this review is to provide an overview on laser treatment of benign skin tumours and recent developments in this field. Ablational laser systems are established treatment devices for benign skin tumours. They obtain good cosmetic results with mostly minimal side-effects. Recently, fractional laser devices or combination of laser therapy with photodynamic therapy has gained attention in this field. However, there is a lack of randomised, controlled trials for laser treatment of benign skin tumours.

Anti‐VEGF for the treatment of diabetic macular edema

AbstractPurpose To assess efficacy and safety of intraocular injections of anti‐VEGF in patients with diabetic macular edemaMethods The gold standard for treatment has been laser coagulation. Limitations of this therapy are refractive DME, ischemic diabetic maculopathy and complications after laser application. The need for a non‐destructive and effective strategy has led to investigations regarding VEGF inhibitors for reduction of vessel leakage and oedema formation. Trials for different anti‐VEGF compounds are nearing completion or are completed. Data regarding dose, injection scheme and practicable application form are reviewed. Combination of laser therapy and anti‐VEGF will be reported.Results For diabetic macular edema, trials of intravitreal pegaptanib and intravitreal ranibizumab have shown short‐term benefit in visual acuity. Intravitreal bevacizumab also has been shown to have beneficial short‐term effects on both visual acuity and retinal thickness. Furthermore, combined therapies shows promising results. Despite promising early reports on the safety of these medications, the results of large, controlled trials are still expected in order to substantiate the safety and efficacy of anti‐VEGF drugs for diabetic retinopathy.Conclusion New therapeutic approaches based on intravitreal injections of anti‐VEGF molecules offer new hope for the management of diabetic macular edema. However, randomized studies are needed in order to attest longterm safety and efficacy profiles.

Improvement of dermal burn healing by combining sodium alginate/chitosan-based films and low level laser therapy

This paper aimed to evaluate the improvement of burn wounds healing by sodium alginate/chitosan-based films and laser therapy. Natural polymers with different biological activities are widely used as film dressings to improve wound healing. Lasers arrays accelerate the healing repair of soft tissue injuries. Burn procedures were performed on the backs of 60 male rats assigned into six groups: untreated (CTR), dressed with cellulose films (CL), dressed with sodium alginate/chitosan-based films (SC), laser-irradiated undressed wounds (LT), laser-irradiated wounds with cellulose (CLLT) and sodium alginate/chitosan-based films (SCLT). Laser therapy was applied for 7 days. Animals of each group were euthanised 8 and 14 days after the burn procedures. The inflammatory reaction was significantly more intense in the CTR group than in the irradiated groups after 8 and 14 days. Laser therapy stimulated myofibroblastic differentiation in 8 days, with or without dressing films. Combined laser therapy and both dressings improved epithelisation, blood vessels formation and collagenization, promoted rapid replacement of type III for type I collagen and favored the better arrangement of the newly formed collagen fibres. The combination of laser therapy and sodium alginate/chitosan-based dressing improves burn healing, apparently by modulating the epithelisation, blood vessels formation and collagenization processes.

Diagnosis and management of pediatric cervicofacial venous malformations: Retrospective review from a vascular anomalies center

Venous malformations are rare congenital aberrations of vein development frequently presenting in the head and neck. Without treatment, venous malformations cause progressive disfigurement, dysfunction, and bleeding. In this study, we analyzed a cohort of pediatric patients with cervicofacial venous malformations (CFVM), with the goal of developing a treatment algorithm for these complex lesions. Eleven-year retrospective chart review. The setting was a vascular anomalies center at a pediatric tertiary hospital. Nineteen patients (10 male, 9 female), aged 11 months to 17 years, presented with CFVM. Patient charts were reviewed for demographics, signs and symptoms, timing of first and subsequent interventions, total number and type of interventions performed, and procedural complications. A family questionnaire supplemented outcome measures by determining the perception of disease control. Presenting symptoms for CFVM include growth (100%), disfigurement (63%), pain (58%), respiratory compromise (42%), and dysphagia (32%). A mean of 6.7 interventions were performed per patient (median, 6; range, 2-12), requiring a mean of 0.8 excisions, 4.6 laser treatments, and 1.3 sclerotherapy injections. Average age at first procedure was 8.5 years. Time between treatments averaged 8.9 months. Four complications occurred in 127 procedures (3.1%). Questionnaire responses indicated subjective improvement following therapy. A management algorithm could be developed from therapeutic outcomes. Treatment of CFVM can be safely and successfully performed with a combination of laser therapy, sclerotherapy, and surgical excision. A treatment algorithm involving multiple procedures during childhood can lead to successful management of CFVM.

Palliative Treatment of Esophageal Cancer.

Palliative interventions for advanced esophageal cancer include surgery, radiation therapy, chemotherapy, chemoradiation, endoscopic procedures, and combinations of the above. Palliative esophagectomy or bypass procedures are difficult to justify in these patients because their life expectancy is so short. Palliative external beam radiation to doses of 50 to 60 Gy is successful in 50% to 70% of patients. The addition of brachytherapy may improve these results. One third to one half of patients treated with radiation develop benign or maglinant stricture. Although response rates to combination chemotherapy are only 50% at best, the majority of patients do have improvement of dysphagia. These regimens are commonly used as part of a multidisciplinary approach with radiation andøor surgery, rather than as a sole modality of treatment. Chemoradiation regimens results in better survival than treatment with radiation alone, and provide palliation of dysphagia in up to 90% of patients. Although acute toxicity of chemoradiation is more severe than radiation alone, this is of limited duration. Chemoradiation may be the treatment of choice for the majority of patients with locally advanced esophageal cancer. Endoscopic techniques are available that provide palliation of dysphagia. The most commonly used technique is esophageal dilatation, either alone or before performing other palliative procedures such as laser therapy or stent placement. The most significant limitation of dilatation alone is that palliation is short-lived and most patients require repeat dilatations. Esophageal stents offer a high degree of palliation, but procedure-related morbidity and mortality rates are not insignificant. Expandable metal stents are associated with few complications but tumor ingrowth through the metallic mesh is frequent. Conventional plastic stents are not affected by tumor ingrowth but can migrate. Endoscopic laser therapy also provides symptoms relief and complication rates are relatively low. It is possible that a combination of laser therapy and external beam or intraluminal radiation will provide more durable palliation than laser treatment alone. BICAP tumor probes, (Circon-ACMI, Stamford, CT), which provide direct application of electrical current, are limited to treatment of tumors that are circumferential. Photodynamic therapy (PDT), which applies laser light along with a photosensitizing agent, has resulted in a high rate of palliation. Limitations of PDT include skin photosensitization requiring patients to stay out of the sun for at least 1 month following treatment, high cost of required equipment, and limited efficacy because of the shallow depth of light penetration. A variety of treatment options exist for the management of tracheoesophageal fistulae (TEF), but only radiation therapy or bypass surgeyr appear to prolong survival. Radiation therapy does not appear to worsen the TEF as was commonly thought in the past, and it is likely applicable in more patients than is surgery. The challenge for the physician in palliating patients with esophageal cancer is to select therapy appropriate for a given patient, taking into account the patient's disease, coexisting medical problems, performance status, and the patient's desires.

Laser combined medical technologies from Russia

This article reflects the latest achievements of Russian science in the field of creating laser combined technologies for medicine. Lasers and several other therapeutic technologies are shown to supplement each other beneficially and in combination they can provide a significant increase in treatment effectiveness. This review deals with various types of such combinations, i.e., conjunction of laser and ultrasound for treatment of soft and hard tissues; application of acoustic effects for destruction of gall and kidney stones; combination of laser therapy and electrostimulation for treatment of chronic prostatitis; utilization of laser-induced optoacoustic, vacuum, and hydrodynamic effects for transcutaneous drug delivery enhancement; unification of photo- and drug therapy for treatment of inflammatory processes and festering wounds. Experimental and clinical results on combined laser technologies as well as the principles of feedback in complex therapeutic devices which involve optical, thermal, acoustic, and hemodynamic effects are considered. Multifunctional therapeutic micromodules which employ laser combined technologies with both autonomous control and remote feeding are presented.

LASER PHARMACOLOGY AND ACHILLES TENDINOPATHY

The Achilles tendon, although the largest and strongest tendon in the human body, has been recognized as a weak point since classical times. In the case of Achilles, an arrow severed the tendon, but repetitive body load is what causes this problem for athletes. The whip effect of pronation in the running gait and potential intrinsic weakness or collagen deterioration with age makes the Achilles tendon very vulnerable. Poor results with conservative therapy and laser therapy (LT) prompted us to use a combination of LT and local infiltration with concomitant medication. The subjects were 100 successive athletes with chronic Achilles tendinopathy who had undergone conservative treatment for six months without positive results. This study used a combination of Photodynamic Therapy with Plenosol® intradermal and 660nm LT, followed by a cooling down treatment using Ubiquinon, Ferrum and Cu+ + subcutaneous infiltration, LT with 660nm, 830nm and 904nm. After an average of 4 treatments in 14 days, healing was achieved in 16 days and training was resumed in 90% of the patients. With these results, it was concluded that a good knowledge of the interaction between laser and pharmacology could reduce treatment time, even for chronic cases of Achilles tendinopathy.

Palliation of malignant dysphagia by laser therapy.

The outcome of 211 patients undergoing laser therapy as palliation for inoperable carcinoma of the esophagus is presented. The median age was 73 (range 44-97). The histology was adenocarcinoma for 127 patients and squamous-cell carcinoma for 84 patients. For 133 patients, laser was the only therapy while 56 patients had a combination of laser therapy and radiotherapy/chemotherapy. One patient underwent laser recanalization prior to resection while four patients had recurrence after resection treated by laser. Eleven patients underwent laser therapy for recurrent dysphagia after placement of an esophageal endoprosthesis. Eighteen patients died of procedure-related complications (i.e. 9% of patients and 2% of procedures). Of 32 procedures which perforated the tumour, 10 ended in death and the remaining patients were successfully treated conservatively. Good palliation was achieved for 170 patients (80%), while 19 patients underwent intubation after failure of laser therapy. Laser therapy failed to relieve dysphagia for 22 patients. The median survival was 20 weeks with the 1-year survival 12% and 2-year survival 4%; there were no significant differences in survival dependent on histology or administration of adjuvant radiotherapy or chemotherapy. Laser therapy provides a practical alternative to intubation in the treatment of malignant dysphagia for patients with unresectable esophageal carcinoma.

Palliative treatment of esophageal cancer

Palliative interventions for advanced esophageal cancer include surgery, radiation therapy, chemotherapy, chemoradiation, endoscopic procedures, and combinations of the above. Palliative esophagectomy or bypass procedures are difficult to justify in these patients because their life expectancy is so short. Palliative external beam radiation to doses of 50 to 60 Gy is successful in 50% to 70% of patients. The addition of brachytherapy may improve these results. One third to one half of patients treated with radiation develop benign or malignant stricture. Although response rates to combination chemotherapy are only 50% at best, the majority of patients do have improvement of dysphagia. These regimens are commonly used as part of a multidisciplinary approach with radiation and/or surgery, rather than as a sole modality of treatment. Chemoradiation regimens result in better survival than treatment with radiation alone, and provide palliation of dysphagia in up to 90% of patients. Although acute toxicity of chemoradiation is more severe than radiation alone, this is of limited duration. Chemoradiation may be the treatment of choice for the majority of patients with locally advanced esophageal cancer. Endoscopic techniques are available that provide palliation of dysphagia. The most commonly used technique is esophageal dilatation, either alone or before performing other palliative procedures such as laser therapy or stent placement. The most significant limitation of dilatation alone is that palliation is short-lived and most patients require repeat dilatations. Esophageal stents offer a high degree of palliation, but procedure-related morbidity and mortality rates are not insignificant. Expandable metal stents are associated with few complications but tumor ingrowth through the metallic mesh is frequent. Conventional plastic stents are not affected by tumor ingrowth but can migrate. Endoscopic laser therapy also provides symptom relief and complication rates are relatively low. It is possible that a combination of laser therapy and external beam or intraluminal radiation will provide more durable palliation than laser treatment alone. BICAP tumor probes, (Circon-ACMI, Stamford, CT), which provide direct application of electrical current, are limited to treatment of tumors that are circumferential. Photodynamic therapy (PDT), which applies laser light along with a photosensitizing agent, has resulted in a high rate of palliation. Limitations of PDT include skin photosensitization requiring patients to stay out of the sun for at least 1 month following treatment, high cost of required equipment, and limited efficacy because of the shallow depth of light penetration. A variety of treatment options exist for the management of tracheo-esophageal fistulae (TEF), but only radiation therapy or bypass surgery appear to prolong survival. Radiation therapy does not appear to worsen the TEF as was commonly thought in the past, and it is likely applicable in more patients than is surgery. The challenge for the physician in palliating patients with esophageal cancer is to select therapy appropriate for a given patient, taking into account the patient's disease, coexisting medical problems, performance status, and the patient's desires.