title: Individualized, multimodal palliative treatment of inoperable esophageal cancer: clinical impact of photodynamic therapy resulting in prolonged survival.
abstract: OBJECTIVE
  In esophageal carcinoma palliative treatment is often required due to advanced tumor stage or patient-related factors. The main goal of our retrospective single center study was to evaluate the effect of an individualized multimodal palliative treatment, focusing on the efficacy of different treatment options.
  
  
  METHODS
  Between 1999 and 2009, 640 patients suffering from esophageal carcinoma were referred to our division. Two hundred fifty out of those (39.1%) were treated with palliative intention by using a individualized, multimodal concept including endoscopic dilatation, photodynamic therapy (PDT), endoluminal brachytherapy, external radiation, chemotherapy, stenting, feeding tube, and palliative resection.
  
  
  RESULTS
  There were 37 women (14.9%) and 211 men (85.1%). The treatment included PDT in 171 cases (in 118 as first measure), stenting in 124 (38), dilatation in 83 (24), endoluminal brachytherapy in 92 (20), feeding enterostomy in 40 (14), external radiation in 67 (23), chemotherapy in 57 (29), and palliative resection in 3 patients. The mean number of palliative treatments per patient was 2.6. Mean survival time for the collective was 34 months. Distant metastases and nodal positivity were connected with a significantly reduced survival. If PDT was used in the first place, median survival was 50.9 months compared to 17.3 months if other options were used as initial modality (P = 0.012).
  
  
  CONCLUSIONS
  By using an individualized multimodal approach, an acceptable mean survival time can be achieved in advanced esophageal cancer treated with palliative intention. PDT, if used as initial endoluminal treatment in patients without gross tumor infiltration into the mediastinum, the great vessels or the tracheo-bronchial tree, enables a considerable beneficial effect in the palliative setting.
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University Graz, Graz, Austria. jo.lindenmann@medunigraz.at
authors.forename: Joerg
authors.initials: J
authors.lastname: Lindenmann
authors.forename: Veronika
authors.initials: V
authors.lastname: Matzi
authors.forename: Nicole
authors.initials: N
authors.lastname: Neuboeck
authors.forename: Udo
authors.initials: U
authors.lastname: Anegg
authors.forename: Eva
authors.initials: E
authors.lastname: Baumgartner
authors.forename: Alfred
authors.initials: A
authors.lastname: Maier
authors.forename: Josef
authors.initials: J
authors.lastname: Smolle
authors.forename: Freyja Maria
authors.initials: FM
authors.lastname: Smolle-Juettner
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D010778:Photochemotherapy; D057285:Precision Medicine; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D055815:Young Adult