Photodynamic therapy for treatment of malignant dysphagia

Photodynamic therapy (PDT) was recently approved by the Food and Drug Admin istration for palliating obstructing esophageal cancer. This report reviews our initial experience using PDT to treat malignant dysphagia. Patients wi th inoperable, obstructing esophageal cancer were considered for PDT. Photo frin was injected 48 hours before endoscopic laser activation. Dysphagia sc ore was assessed. Thirty patients underwent 53 PDT courses. Improvement in dysphagia occurred in 83%. Mean dysphagia score decreased from 2.8 to 1.8 ( p < 0.05). Complications included esophageal stricture (9.4%), candida esop hagitis (5.7%), symptomatic pleural effusion (5.7%), contained esophageal p erforation (1.9%), aspiration pneumonia (1.9%), and sunburn (13.2%). Sevent een patients (57%) required more than one PDT treatment, and in 10 an expan dable metal stent was used as an adjunct. The 30-day mortality rate was 7%. PDT is effective in palliating patients with malignant dysphagia. The idea l patient for PDT has an obstructing, primarily endoluminal esophageal tumo r with minimal extrinsic compression.