Nonoperable patients with superficial esophageal cancer treated by photodynamic therapy after chemoradiotherapy have more severe complications than patients treated in primary intent.
BACKGROUND
Photodynamic therapy (PDT) is a therapeutic option in patients with a superficial esophageal cancer. Recently, PDT was shown to be effective as a salvage therapy for a local recurrence after chemoradiotherapy (CRT).


OBJECTIVE
To compare retrospectively the results and the complications rate of PDT between consecutive patients treated in primary intent for a superficial esophageal cancer versus patients treated by PDT for a local recurrence after CRT.


METHODS
Between 1999 and 2007 in a single center, 40 consecutive patients were treated by PDT for a superficial esophageal cancer, 25 (group 1) in primary intent and 15 (group 2) for a local recurrence after CRT. Two days after intravenous (IV) Photofrin (2 mg/kg), the phototherapy was performed with a dye laser. The treatment response and severe complications, defined as perforation and stricture requiring endoscopic dilation, were compared between the two groups.


RESULTS
The patient and tumor characteristics were not different between the two groups. In group 1, 19 out of 25 patients (76%) were successfully treated versus 8 out of 15 patients (53%) in group 2 (P= 0.17). Severe complications occurred more frequently in patients with a prior CRT (8%vs 46.7%, P= 0.008) and included two perforations and five strictures requiring endoscopic dilation, while only two strictures occurred in group 1. A prior CRT was an independent risk factor of severe complications (odds ratio [OR] 8.05; 95% confidence interval [CI]1.22-43.0).


CONCLUSIONS
Severe complications were significantly more frequent in patients treated after a prior CRT. PDT as a salvage therapy in patients with a local recurrence after CRT for esophageal cancer tended to be less efficient than in first-line treatment.
Department of Hepato-Gastroenterology and Nutrition and Appareil Digestif et Nutrition Equipe d'Accueil 3234, Rouen University Hospital, Rouen, France.
Stéphane
S
Lecleire
Frédéric
F
Di Fiore
Michel
M
Antonietti
Emmanuel
E
Ben-Soussan
Patrick
P
Hochain
Eric
E
Lerebours
Pierre
P
Michel
Philippe
P
Ducrotté
D000368:Aged; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D017323:Dihematoporphyrin Ether / Q000009:adverse effects / Q000627:therapeutic use; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009367:Neoplasm Staging; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether