title: Effect of photodynamic therapy in a multimodal approach for advanced carcinoma of the gastro-esophageal junction.
abstract: Background and Objective We wanted to determine the role of additional photodynamic therapy in a multimodal approach for the treatment of patients with advanced cancer of the gastro-esophageal junction. Study Design/Materials and Methods We reviewed 53 patients, after endoluminal palliation, with advanced cancer of the gastro-esophageal junction. Combined dilatation and retrograde tumor disobliteration with Nd-YAG laser before photodynamic therapy (PDT), brachyradiotherapy, or both, became necessary in 12 patients. Brachyradiotherapy was carried out in all patients. PDT before brachyradiotherapy was performed in 25 patients. The endoluminal treatment was completed by external beam irradiation in 30 patients (15 cases with PDT and 15 without PDT) with an at least fair performance status.
  
  
  RESULTS
  Photodynamic therapy showed a significant difference regarding the mean opening of the tumor stenosis (mean, 6.4 mm; P = 0.0002), the mean decrease in tumor length (3.1 cm; P = 0.00001) and the increase in median survival (13. 8 months; P = 0.001). The combined multimodal approach by using PDT, brachyradiotherapy and external beam irradiation showed a median survival of 16.8 months. However, additional external beam irradiation showed no significant difference (P = 0.11). The rate of severe complications was 5.7%. The mortality rate was 1.9%.
  
  
  CONCLUSIONS
  Photodynamic therapy has been shown to be an effective treatment for palliation of advanced cancer at the gastro-esophageal junction. The use of PDT combined with irradiation was associated with an acceptable survival rate, low rates of complications and reasonable quality of life.
authors.affiliation: Department of Surgery, Division of Thoracic and Hyperbaric Surgery, K.F. University Medical School, Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Maier
authors.forename: U
authors.initials: U
authors.lastname: Anegg
authors.forename: B
authors.initials: B
authors.lastname: Fell
authors.forename: F
authors.initials: F
authors.lastname: Tomaselli
authors.forename: O
authors.initials: O
authors.lastname: Sankin
authors.forename: U
authors.initials: U
authors.lastname: Prettenhofer
authors.forename: H
authors.initials: H
authors.lastname: Pinter
authors.forename: P
authors.initials: P
authors.lastname: Rehak
authors.forename: G B
authors.initials: GB
authors.lastname: Friehs
authors.forename: F M
authors.initials: FM
authors.lastname: Smolle-Jüttner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001918:Brachytherapy / Q000379:methods; D002277:Carcinoma / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010778:Photochemotherapy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome