Photodynamic therapy with curative intent for Barrett's esophagus with high grade dysplasia and superficial esophageal cancer.
BACKGROUND
Photodynamic therapy (PDT) has been used to palliate advanced, obstructing, or bleeding esophageal cancers (ECs) and Barrett's high-grade dysplasia (HGD). Few investigators, though, have described using PDT to cure either disease.


METHODS
We performed a retrospective review from 1997-2005 of 50 patients with HGD or EC. All patients refused surgical resection or were physiologically unfit. They were instead treated using PDT with curative intent. Clinical follow-up, long-term survival, complications, and recurrence were evaluated.


RESULTS
Thirteen patients (26%) had Barrett's HGD, 6 (12%) had small, intramural carcinomas, 16 (32%) had T1 N0 tumors, 14 (28%) had T2 N0 tumors, and 1 (2%) had a small, polypoid T3 lesion. The mean length of follow-up was 28.1 months. Sixteen patients (32%) are alive without recurrence, 15 (30%) are living with residual or recurrent disease and have received additional PDT, and the remainder (38%) died of recurrent EC or other causes and had known recurrence. Sixteen (32%) patients received adjuvant chemotherapy, radiation, or both. Esophageal stricture occurred in 21 (42%) patients. There was no procedure-related mortality.


CONCLUSIONS
PDT may represent a reasonable alternate to esophagectomy for high-risk patients with HGD or superficial esophageal cancer. Due to superior survival and local control, we still favor esophagectomy for patients without physiologic impairment. However, PDT appears to potentially cure approximately one-third of superficial esophageal cancers and provide local control of high-grade dysplasia in a similar subset of patients.
Keeley
Samuel B
SB
University of Pittsburgh Medical Center, Heart, Lung, and Esophageal Surgery Institute, Pittsburgh, PA, USA. keeleysb@upmc.edu
Pennathur
Arjun
A
Gooding
William
W
Landreneau
Rodney J
RJ
Christie
Neil A
NA
Luketich
James
J
D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use; D016145:Endoscopy, Digestive System; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017319:Photosensitizing Agents / Q000627:therapeutic use; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether