PHOTODYNAMIC THERAPY FOR ESOPHAGEAL MALIGNANCY - A PROSPECTIVE 12-YEAR STUDY

Background. We wanted to determine factors affecting survival rates of benefits to, and complications in patients with esophageal cancer tre ated with photodynamic therapy. Methods. From 1982 to January 1994, we used photodynamic therapy to treat 77 patients with esophageal carcin oma and evaluated survival to July 1994. All patients had failed, refu sed, or were ineligible for surgical intervention, ionizing radiation therapy, or chemotherapy. Results. The only significant variable affec ting survival was clinical stage. Median survival after photodynamic t herapy was as follows: all patients, 6.3 months (mean survival, 9.2 mo nths); stage I, not reached; stage II, 12 months; stage III, 6.2 month s; and stage IV, 3.5 months. For stages III and IV, a Karnofsky perfor mance status of 70 or higher had a significant effect. For stage III, the median survival was 6.3 months when the Karnofsky performance stat us was equal to or greater than 70 and 3.5 months when it was less tha n 70. For stage IV, the median survival was 5.5 months when the Karnof sky performance status was equal to or greater than 70 and 2.5 months when it was lower than 70. Seven stage I patients with no treatment pr ior to photodynamic therapy had an estimated 5-year survival rate of 6 2%. Three patients with stage I invasive adenocarcinoma and Barrett's mucosa diagnosed when they underwent endoscopy for dysphagia were aliv e with no evidence of disease 17, 44, and 59 months after photodynamic therapy. Conclusions. Photodynamic therapy for esophageal carcinoma c aused minimal complications and no procedure-related deaths. Photodyna mic therapy can be considered an alternative treatment for patients wi th Barrett's esophagus with severe dysplasia or patients with stage I carcinoma who are under consideration for operation but are high surgi cal risks. The length of palliation for patients having ''noncurative' ' treatment was equal to or better than that reported historically for most other treatment regimens.