title: Salvage photodynamic therapy for local failure after chemoradiotherapy for esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  Photodynamic therapy (PDT) is a less-invasive salvage treatment option for local failure at the primary site after chemoradiotherapy (CRT) for esophageal squamous cell carcinoma. The objective of this study was to clarify the long-term outcomes and prognostic factors of salvage PDT.
  
  
  METHODS
  One hundred thirteen consecutive patients treated in our institution with PDT for local failure limited to within T2 without any metastases after definitive CRT performed between 1998 and 2008 were retrospectively enrolled. The complete response rate, adverse events, and survival outcomes were assessed and prognostic factors were investigated using a multivariate analysis.
  
  
  RESULTS
  The complete response rate was 58.4% (95% confidence interval [CI], 49.3%-67.5%). The progression-free survival (PFS) and the overall survival (OS) rates at 5 years after salvage PDT were 22.1% (95% CI, 14.3%-30.0%) and 35.9% (95% CI, 26.7%-45.1%). N0 before CRT was significantly associated with OS (hazard ratio [HR], 0.54; 95% CI, 0.33-0.91, P = .020), whereas the impact of T1 or T2 before CRT on PFS (HR, 0.63; 95% CI, 0.38-1.04, P = .068) and that of a longer period between CRT and PDT on OS (HR, 0.64; 95% CI, 0.39-1.05, P = .078) were marginal. The treatment-related death rate was 1.8%.
  
  
  CONCLUSIONS
  Salvage PDT was found to have a superior outcome and a satisfactory safety profile. An earlier clinical stage before CRT and a longer interval between CRT and PDT may be associated with a longer survival period.
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Gastroenterology, Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Hatogai
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.affiliation: Department of Gastroenterology, Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Onozawa
authors.affiliation: Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daiko
authors.affiliation: Department of Biostatistics, National Cancer Center, Kashiwa, Chiba, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Nomura
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yoda
authors.affiliation: Department of Gastroenterology, Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: Department of Gastroenterology, Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ohtsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology; D059248:Chemoradiotherapy; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether