Photodynamic therapy (PDT) in Barrett's esophagus with dysplasia or early cancer.
OBJECTIVE
Esophagectomy is the standard treatment for high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) arising within Barrett's esophagus. Results of photodynamic therapy (PDT) were retrospectively studied to evaluate the effectiveness of PDT in ablating HGD and/or IMC complicating Barrett's esophagus.


METHODS
Thirty-one patients unfit for or refusing esophagectomy (male: 20, mean age: 73.4+/-9.3 years) underwent Porfimer sodium PDT ablation of their HGD (15 patients), HGD plus IMC (10 patients) or submucosal/limited T2 adenocarcinoma (6 patients). The mean Barrett's length was 5.8+/-2.2 cm. Pre-PDT endoscopic mucosal resection or Nd:YAG laser ablation of mucosal nodularity within Barrett's segment was offered in six patients.


RESULTS
The main PDT complications were esophagitis (16.1%), photoreactions (12.9%) and stricture requiring dilatation (6.25%). The median post-PDT follow-up was 14 months. The long-term results were (a) for HGD/IMC: initial complete response (endoscopic and histologic absence of HGD-IMC) to PDT was observed in 80.95% of patients, partial response (no endoscopic abnormality, residual IMC-HGD on biopsy) in 9.52%, no response in 9.52% (the recurrence rate after an initial complete response was 17.64%) and (b) for T1b/limited T2 tumors: two patients died from cancer after 24 and 46 months, no evidence of tumor was found in two patients after 12 and 19 months and tumor recurrence was seen in two after 15 and 17 months. The mean survival was 22.1+/-12.3 months.


CONCLUSIONS
PDT is effective in ablating HGD/IMC complicating Barrett's esophagus in the majority of cases, while it also seems to be quite effective in treating T1b/limited T2 carcinomas.
Foroulis
Christophoros N
CN
The General Infirmary at Leeds, Thoracic Unit, Leeds LS9 3EX, UK.
Thorpe
James A C
JA
D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D017060:Patient Satisfaction; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether