The aim of this paper is to present the updated experience of the Yorkshire
Laser Centre in
PDT for
esophageal cancer and to identify its role in specific subsets of patients. Also, in the light of this experience, to compare and contrast the results of
PDT with appropriate subsets of patients treated in my esophageal surgery practice. 102 consecutive patients; 84 with advanced (Group A) and 18 with early (Group E) stage
esophageal cancer undergoing endoscopic
PDT were entered into a prospective study. Every patient had standard work up including clinical staging.
PDT protocol was
intravenous administration of
Photofrin 2mg/kg
body weight followed 24-72 hours later by endoscopic illumination using 630 nm
laser light. Assessment of results was made on the basis of mortality, morbidity, patient satisfaction to treatment, symptom relief and survival. For comparison of
PDT role with non
PDT treated patients, reference is made to 3 previous publications comprising over 1100 patients [Moghissi, K., Br. J. Surg. 79, 935-937 (1992) (ref. 1); Sawant, D., Moghissi, K. Eur. J. Cardio-Thorac. Surg. 8, 113-117 (1994) (ref. 2); Sharpe, D. A. C., Moghissi, K. Eur. J. Cardiothorac. Surg. 10, 359-364 (1996) (ref. 3)]. There was no mortality associated with
PDT. All patients expressed satisfaction to treatment. Post
PDT complications consisted of photosensitivity skin reaction (
sunburn) in 5 patients (5%) and
esophageal stricture in 8 (8%) patients. Group A: There was significant symptom and
dysphagia grade improvement. Mean survival was 9.5 months. Group E: There were no significant symptoms pre or post
PDT and mean survival was 60.5 months. Comparison of
PDT results in Group A with results of other
palliative treatment methods, indicates that palliation can be achieved in all intraluminal
cancer using
PDT which is at least as good as other treatments. There is, in addition, advantage over other methods in patients with cervical
esophageal cancer and in cases with re-growth of
tumor obstructing previously placed
stents. In early cases
PDT appears capable of replicating surgical results in selected cases.
PDT is an effective and safe treatment method in
esophageal cancer. In advance disease it improves swallowing. In early stage disease it offers long survival and the prospect of cure in some patients. At present the role of
PDT in early stage
cancer should be limited to patients who are unsuitable for surgical resection. Therefore,
PDT should be considered as a valid oncological option to be applied in selected cases.