Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: a multicenter randomized trial.
BACKGROUND
Photodynamic therapy (PDT) is a different type of laser treatment from Nd:YAG thermal ablation for palliation of dysphagia from esophageal cancer.


METHODS
In this prospective, multicenter study, patients with advanced esophageal cancer were randomized to receive PDT with porfimer sodium and argon-pumped dye laser or Nd:YAG laser therapy.


RESULTS
Two hundred thirty-six patients were randomized and 218 treated (PDT 110, Nd:YAG 108) at 24 centers. Improvement in dysphagia was equivalent between the two treatment groups. Objective tumor response was also equivalent at week 1, but at month 1 was 32% after PDT and 20% after Nd:YAG (p < 0.05). Nine complete tumor responses occurred after PDT and two after Nd:YAG. Trends for improved responses for PDT were seen in tumors located in the upper and lower third of the esophagus, in long tumors, and in patients who had prior therapy. More mild to moderate complications followed PDT, including sunburn in 19% of patients. Perforations from laser treatments or associated dilations occurred after PDT in 1%, Nd:YAG 7% (p < 0.05). Termination of laser sessions due to adverse events occurred in 3% with PDT and in 19% with Nd:YAG (p < 0.05).


CONCLUSIONS
Photodynamic therapy with porfimer sodium has overall equal efficacy to Nd:YAG laser thermal ablation for palliation of dysphagia in esophageal cancer, and equal or better objective tumor response rate. Temporary photosensitivity is a limitation, but PDT is carried out with greater ease and is associated with fewer acute perforations than Nd:YAG laser therapy.
Lightdale
C J
CJ
Columbia University College of Physicians and Surgeons, New York 10032, USA.
Heier
S K
SK
Marcon
N E
NE
McCaughan
J S
JS
Gerdes
H
H
Overholt
B F
BF
Sivak
M V
MV
Stiegmann
G V
GV
Nava
H R
HR
D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006414:Hematoporphyrin Photoradiation / Q000009:adverse effects; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome