Long-term results of salvage photodynamic therapy for patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma.

Abstract

BACKGROUND AND STUDY AIMS:

Local failure after chemoradiotherapy (CRT) remains a major problem for patients with esophageal squamous cell carcinoma (ESCC). The aim of this study was to clarify the long-term results of salvage photodynamic therapy (PDT) for local failure.

PATIENTS AND METHODS:

Patients were treated with CRT, consisting of more than 50 Gy irradiation and concurrent chemotherapy. The indications for salvage PDT were as follows: 1) absence of lymph-node or distant metastasis after CRT; 2) failure lesion limited to T2; 3) refusal by patient to undergo salvage esophagectomy; 4) written informed consent. PDT was performed using an excimer dye laser at 48 and 72 hours after administration of Photofrin.

RESULTS:

A total of 37 consecutive patients underwent salvage PDT. The baseline stage before CRT was as follows: T1/T2/T3/T4 in 3/4/24/6 and N0/1 in 13/24 patients, respectively. Prior to PDT, 20 patients had a uT1 lesion, and 17 had a uT2 lesion; 24 patients had histologically proven local failure. A complete response was achieved in 22 patients (59.5%) following PDT. Esophageal fistulae, stenosis, and phototoxicity occurred in 4 (10.8%), 20 (54.1%), and 2 (5.4%) patients, respectively. Over a median follow-up period of 55 months, the 5-year progression-free (PFS) and overall survival rates of 37 patients following PDT were 20.7% and 36.1%, respectively. The 5-year PFS and overall survival of 24 patients with proven local failure were 17.6% and 34.6%, respectively.

CONCLUSION:

Salvage PDT is a curative treatment option for patients with local failure after CRT for ESCC.

• Authors: T Yano, M Muto, K Minashi, M Onozawa, K Nihei, S Ishikura, K Kaneko, A Ohtsu
• Journal: Endoscopy (Endoscopy) Vol. 43 Issue 8 Pg. 657-63 (Aug 2011) ISSN: 1438-8812 [Electronic] Germany
• PMID: 21623555 (Publication Type: Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Photosensitizing Agents
• Dihematoporphyrin Ether

Topics

• Aged
• Carcinoma, Squamous Cell (pathology, therapy)
• Chemoradiotherapy
• Dihematoporphyrin Ether (therapeutic use)
• Disease-Free Survival
• Esophageal Neoplasms (pathology, therapy)
• Female
• Humans
• Kaplan-Meier Estimate
• Lasers, Dye (therapeutic use)
• Male
• Middle Aged
• Photochemotherapy
• Photosensitizing Agents (therapeutic use)
• Retrospective Studies
• Salvage Therapy
• Time Factors
• Treatment Failure
• Treatment Outcome