title: Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in barrett esophagus after endoscopic resection.
abstract: OBJECTIVE
  The aim of the study was to evaluate the efficacy of photodynamic therapy (PDT) in the treatment of residual high-grade dysplasia or early cancer (HGD/EC) after endoscopic resection in Barrett esophagus.
  
  
  METHODS
  Study patients were separated into group A, with proven residual HGD/EC, and group B with possible HGD/EC (positive lateral margins in the endoscopic resection specimen, without HGD/EC in the remaining Barrett esophagus). PDT treatment consisted of 5-aminolevulinic (5-ALA) photosensitization (40 mg/kg) followed by illumination of the Barrett esophagus with a total light dose of 100 J/cm (2). Complete remission was defined as the absence of HGD/EC in biopsies taken in two consecutive follow-up endoscopies. The percentage regression of Barrett esophagus, as well as the recurrence rate of HGD/EC, was calculated.
  
  
  RESULTS
  20 patients underwent PDT (group A, 11; group B, 9). Mild complications were seen in 4/26 procedures. The overall success rate was 15/20 (75 %). There was a significant difference in success rate between group A (55 %) and group B (100 %); P = 0.03. All patients had residual Barrett esophagus after PDT; the median regression percentage was 50 % (IQR 25 - 70 %). Recurrence of HGD/EC occurred in four patients (two each in groups A and B) after a median follow up of 30 months.
  
  
  CONCLUSIONS
  In this selected group of patients, the addition of 5-ALA-PDT after endoscopic resection for HGD/EC had a disappointing success rate in patients who had residual HGD/EC after endoscopic resection. Most patients undergoing 5-ALA-PDT have residual Barrett mucosa after PDT and 5-ALA-PDT does not seem to prevent recurrences during follow-up.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Peters
authors.forename: M
authors.initials: M
authors.lastname: Kara
authors.forename: W
authors.initials: W
authors.lastname: Rosmolen
authors.forename: M
authors.initials: M
authors.lastname: Aalders
authors.forename: F
authors.initials: F
authors.lastname: Ten Kate
authors.forename: K
authors.initials: K
authors.lastname: Krishnadath
authors.forename: J
authors.initials: J
authors.lastname: van Lanschot
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.forename: J
authors.initials: J
authors.lastname: Bergman
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012008:Recurrence; D017211:Treatment Failure
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid