PHOTODYNAMIC THERAPY WITH PORFIMER SODIUM VERSUS THERMAL ABLATION THERAPY WITH ND-YAG LASER FOR PALLIATION OF ESOPHAGEAL CANCER - A MULTICENTER RANDOMIZED TRIAL

Background: Photodynamic therapy (PDT) is a different type of laser tr eatment from Nd:YAG thermal ablation for palliation of dysphagia from esophageal cancer. Methods: In this prospective, multicenter study, pa tients with advanced esophageal cancer were randomized to receive PDT with porfimer sodium and argon-pumped dye laser or Nd:YAG laser therap y. Results: Two hundred thirty-six patients were randomized and 218 tr eated (PDT 110, Nd:YAG 108) at 24 centers. Improvement in dysphagia wa s equivalent between the two treatment groups. Objective tumor respons e was also equivalent at week 1, but at month 1 was 32% after PDT and 20% after Nd:YAG (p < 0.05). Nine complete tumor responses occurred af ter PDT and two after Nd:YAG. Trends for improved responses for PDT we re seen in tumors located in the upper and lower third of the esophagu s, in long tumors, and in patients who had prior therapy. More mild to moderate complications followed PDT, including sunburn in 19% of pati ents. Perforations from laser treatments or associated dilations occur red after PDT in 1%, Nd:YAG 7% (p < 0.05). Termination of laser sessio ns due to adverse events occurred in 3% with PDT and in 19% with Nd:YA G (p < 0.05). Conclusions: Photodynamic therapy with porfimer sodium h as overall equal efficacy to Nd:YAG laser thermal ablation for palliat ion of dysphagia in esophageal cancer, and equal or better objective t umor response rate. Temporary photosensitivity is a limitation, but PD T is carried out with greater ease and is associated with fewer acute perforations than Nd:YAG laser therapy.