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Endoscopic photodynamic therapy for obstructing esophageal cancer: 77 cases over a 2-year period
J D Luketich1, N A Christie, P O Buenaventura
1Section of Thoracic Surgery and Minimally Invasive Surgery Center, University of Pittsburgh Medical Center, Presbyterian Hospital, PA 15213, USA.
Background:
Photodynamic therapy (PDT) is an alternative treatment option for the palliation of obstructive esophageal cancer. We report our experience with PDT for patients presenting with inoperable, obstructing, or bleeding esophageal cancer.
Methods:
Seventy-seven patients with inoperable, obstructing esophageal cancer were treated with PDT from November 1996 to July 1998. Photofrin (1.5-2.0 mg/kg) was administered, followed by endoscopic light treatment (630 nm red dye laser) at 48 h. Dysphagia score (1 for no dysphagia to 5 for complete obstruction), dysphagia-free interval, and patient survival were assessed.
Results:
Seventy-seven patients underwent 125 PDT courses. The mean dysphagia score at 4 weeks after PDT in 90.8% of the patients improved from 3.2 +/- 0.7 to 1.9 +/- 0.8 (p < 0.05). PDT adequately controlled bleeding in all six patients who had bleeding. The most common complications after the 125 PDT courses were esophageal stricture (4.8%), Candida esophagitis (3.2%), symptomatic pleural effusion (3.2%), and sunburn (10.0%). Twenty-nine patients (38%) required more than one PDT course, and seven patients required placement of an expandable metal stent for recurrent dysphagia. The mean dysphagia-free interval was 80.3 +/- 58.2 days. The median survival was 5.9 months.
Conclusions:
Photodynamic therapy is a safe and effective treatment for the palliation of obstructing and bleeding esophagus cancer.