Photodynamic therapy for Barrett's esophagus: does light still have a role?
Photodynamic therapy was the first treatment to have been shown to significantly decrease high-grade dysplasia and cancer in patients with Barrett's esophagus. However, its use has been limited, primarily because of the side effects, which include esophageal strictures, cutaneous photosensitivity, chest pain, and nausea and vomiting. The tolerability aspects of photodynamic therapy, as well as the dosimetry, though, can be improved with existing technologies to further develop this therapy into truly a widely applicable therapy. Studies have recently been done to help identify patients more likely to suffer stricture after photodynamic therapy. In addition there has been evidence to suggest that the efficacy of photodynamic therapy also can be limited by genetic abnormalities in the mucosa. By combining knowledge of tissue biology, optical properties of the tissue, and dosimetry issues with ablation, photodynamic therapy can still have a potentially bright future.
Wang
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Mayo Clinic and Foundation, Mayo College of Medicine, Rochester, Minnesota 55905, USA. wang.kenneth@mayo.edu
Lutzke
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Borkenhagen
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Westra
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Song
M W K
MW
Prasad
G
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Buttar
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NS
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D001706:Biopsy; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D020701:Esophagoscopes; D004947:Esophagus / Q000187:drug effects / Q000473:pathology; D005500:Follow-Up Studies; D006414:Hematoporphyrin Photoradiation / Q000295:instrumentation; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D010778:Photochemotherapy / Q000295:instrumentation*; D011230:Precancerous Conditions / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate