Photodynamic therapy as salvage treatment for local failures after definitive chemoradiotherapy for esophageal cancer.
BACKGROUND
Although definitive chemoradiotherapy for esophageal cancer shows a high response rate, persistent or recurrent locoregional disease remains a major problem. Salvage esophagectomy is the only curative intent treatment option; however, it carries higher morbidity and mortality rates than primary esophagectomy. Response to second-line chemotherapy is quite dismal.


METHODS
From December 2002 to November 2003, we applied salvage photodynamic therapy to 13 patients with local failures after completion of chemoradiotherapy, 4 patients had local recurrence after achieving a complete response, and 9 had a persistent tumor after chemoradiotherapy. The decision to treat was based on patients' refusal of salvage surgery or chemotherapy. After the intravenous administration of 2 mg/kg of Photofrin, photoradiation treatment with an excimer dye laser was performed for 48 hours and 72 hours after the injection. Written informed consent was obtained from all patients.


RESULTS
Eight patients (62%) achieved a complete response. After a median follow-up period of 12 months after photodynamic therapy, 6 patients were still free of disease, and the overall survival rate at 1 year was 68.4%. There were no treatment-related deaths.


CONCLUSIONS
Our results show that salvage photodynamic therapy could be a promising curative intent treatment option with low morbidity and mortality rates.
Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan.
Tomonori
T
Yano
Manabu
M
Muto
Keiko
K
Minashi
Atsushi
A
Ohtsu
Shigeaki
S
Yoshida
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D017323:Dihematoporphyrin Ether / Q000008:administration & dosage / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D017211:Treatment Failure
D000970:Antineoplastic Agents; D017323:Dihematoporphyrin Ether