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Palliation of advanced esophageal carcinoma by photodynamic therapy and irradiation.

AbstractBACKGROUND:
We wanted to determine the role of photodynamic therapy in a multimodal approach for the treatment of patients with advanced cancer of the esophagus.
METHODS:
We reviewed the cases of 119 patients with nonresectable esophageal carcinoma who underwent endoluminal palliation. Twenty-one patients required initial dilation and tumor obliteration with a neodymium: yttrium-aluminum-garnet laser prior to therapy. Forty-four patients received photodynamic therapy followed by brachyradiotherapy, and 75 patients were treated with brachyradiotherapy. In both groups, some patients also received external-beam irradiation.
RESULTS:
Photodynamic therapy produced a significant difference in relieving stenosis caused by tumor stenosis (mean, 6.6 mm; p = 0.0000). The dysphagia score improved by one to three levels in all patients, with a significant difference in favor of PDT (p = 0.0003). The mean number of overall treatment sessions was four (range, one to seven). The rate of major complications was 9.2%. Four esophageal perforations occurred, three after intervention and one spontaneously 5 months later. Four esophagorespiratory tract fistulas developed several months after combined PDT and irradiation. The mean overall survival was 7.7 months, and analysis of variance revealed a significant difference in favor of PDT and external-beam irradiation (p = 0.0129 and p = 0.0001, respectively).
CONCLUSIONS:
Photodynamic therapy has been shown to be an effective palliative treatment of advanced esophageal cancer. However, proper patient selection is necessary to prevent serious complications.
AuthorsA Maier, F Tomaselli, F Gebhard, P Rehak, J Smolle, F M Smolle-Jüttner
JournalThe Annals of thoracic surgery (Ann Thorac Surg) Vol. 69 Issue 4 Pg. 1006-9 (Apr 2000) ISSN: 0003-4975 [Print] Netherlands
PMID10800784 (Publication Type: Journal Article)
Topics
  • Adenocarcinoma (drug therapy, radiotherapy)
  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy
  • Carcinoma, Squamous Cell (drug therapy, radiotherapy)
  • Combined Modality Therapy
  • Esophageal Neoplasms (drug therapy, radiotherapy)
  • Female
  • Humans
  • Male
  • Middle Aged
  • Palliative Care

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