title: Long-term results of salvage photodynamic therapy for patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  Local failure after chemoradiotherapy (CRT) remains a major problem for patients with esophageal squamous cell carcinoma (ESCC). The aim of this study was to clarify the long-term results of salvage photodynamic therapy (PDT) for local failure.
  
  
  METHODS
  Patients were treated with CRT, consisting of more than 50 Gy irradiation and concurrent chemotherapy. The indications for salvage PDT were as follows: 1) absence of lymph-node or distant metastasis after CRT; 2) failure lesion limited to T2; 3) refusal by patient to undergo salvage esophagectomy; 4) written informed consent. PDT was performed using an excimer dye laser at 48 and 72 hours after administration of Photofrin.
  
  
  RESULTS
  A total of 37 consecutive patients underwent salvage PDT. The baseline stage before CRT was as follows: T1/T2/T3/T4 in 3/4/24/6 and N0/1 in 13/24 patients, respectively. Prior to PDT, 20 patients had a uT1 lesion, and 17 had a uT2 lesion; 24 patients had histologically proven local failure. A complete response was achieved in 22 patients (59.5%) following PDT. Esophageal fistulae, stenosis, and phototoxicity occurred in 4 (10.8%), 20 (54.1%), and 2 (5.4%) patients, respectively. Over a median follow-up period of 55 months, the 5-year progression-free (PFS) and overall survival rates of 37 patients following PDT were 20.7% and 36.1%, respectively. The 5-year PFS and overall survival of 24 patients with proven local failure were 17.6% and 34.6%, respectively.
  
  
  CONCLUSIONS
  Salvage PDT is a curative treatment option for patients with local failure after CRT for ESCC.
authors.affiliation: Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan. toyano@east.ncc.go.jp
authors.forename: T
authors.initials: T
authors.lastname: Yano
authors.forename: M
authors.initials: M
authors.lastname: Muto
authors.forename: K
authors.initials: K
authors.lastname: Minashi
authors.forename: M
authors.initials: M
authors.lastname: Onozawa
authors.forename: K
authors.initials: K
authors.lastname: Nihei
authors.forename: S
authors.initials: S
authors.lastname: Ishikura
authors.forename: K
authors.initials: K
authors.lastname: Kaneko
authors.forename: A
authors.initials: A
authors.lastname: Ohtsu
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D054025:Lasers, Dye / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D016879:Salvage Therapy; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether