ABSTRACT
BACKGROUND: Photodynamic therapy (PDT) has been used to palliate advanced, obstructing, or bleeding esophageal cancers (ECs) and Barrett's high-grade dysplasia (HGD). Few investigators, though, have described using PDT to cure either disease. METHODS: We performed a retrospective review from 1997-2005 of 50 patients with HGD or EC. All patients refused surgical resection or were physiologically unfit. They were instead treated using PDT with curative intent. Clinical follow-up, long-term survival, complications, and recurrence were evaluated. RESULTS: Thirteen patients (26%) had Barrett's HGD, 6 (12%) had small, intramural carcinomas, 16 (32%) had T1 N0 tumors, 14 (28%) had T2 N0 tumors, and 1 (2%) had a small, polypoid T3 lesion. The mean length of follow-up was 28.1 months. Sixteen patients (32%) are alive without recurrence, 15 (30%) are living with residual or recurrent disease and have received additional PDT, and the remainder (38%) died of recurrent EC or other causes and had known recurrence. Sixteen (32%) patients received adjuvant chemotherapy, radiation, or both. Esophageal stricture occurred in 21 (42%) patients. There was no procedure-related mortality. CONCLUSIONS: PDT may represent a reasonable alternate to esophagectomy for high-risk patients with HGD or superficial esophageal cancer. Due to superior survival and local control, we still favor esophagectomy for patients without physiologic impairment. However, PDT appears to potentially cure approximately one-third of superficial esophageal cancers and provide local control of high-grade dysplasia in a similar subset of patients.
Subject(s)
Adenocarcinoma/drug therapy , Barrett Esophagus/complications , Barrett Esophagus/drug therapy , Esophageal Neoplasms/drug therapy , Photochemotherapy/methods , Adenocarcinoma/complications , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Barrett Esophagus/diagnostic imaging , Barrett Esophagus/mortality , Barrett Esophagus/pathology , Dihematoporphyrin Ether/therapeutic use , Endoscopy, Digestive System , Endosonography , Esophageal Neoplasms/complications , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Photochemotherapy/adverse effects , Photochemotherapy/mortality , Photosensitizing Agents/therapeutic use , Survival Rate , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The metaplastic change of the normal squamous epithelium of the distal esophagus into a specialized columnar epithelium is known as Barrett's esophagus (BE) and is associated with an increased risk of adenocarcinoma of the esophagus. It is a frequent complication of gastroesophageal reflux disease (GERD) and up to 10% of patients with GERD suffer from BE. The progression to dysplasia increases the risk of cancer development and the annual risk of developing cancer in Barrett's esophagus is estimated to be 0.5% per year. The management of BE with high grade dysplasia (HGD) is controversial. Recent innovations in endoscopic therapy have allowed for the development of multiple endoscopic techniques, such as photodynamic therapy (PDT), argon plasma coagulation (APC), and endoscopic mucosal resection. In this article, we will discuss primarily photodynamic therapy, and other ablative technologies such as argon plasma coagulation in the treatment of BE.
