Palliation of advanced esophageal carcinoma by photodynamic therapy and irradiation

Background. We wanted to determine the role of photodynamic therapy in a mu ltimodal approach for the treatment of patients with advanced cancer of the esophagus. Methods. We reviewed the cases of 119 patients with nonresectable esophagea l carcinoma who underwent endoluminal palliation. Twenty-one patients requi red initial dilation and tumor obliteration with a neodymium: yttrium-alumi num-garnet laser prior to therapy. Forty-four patients received photodynami c therapy followed by brachyradiotherapy, and 75 patients were treated with brachyradiotherapy. In both groups, some patients also received external-b eam irradiation. Results. Photodynamic therapy produced a significant difference in relievin g stenosis caused by tumor stenosis (mean, 6.6 mm; p = 0.0000). The dysphag ia score improved by one to three levels in all patients, with a significan t difference in favor of PDT (p = 0.0003). The mean number of overall treat ment sessions was four (range, one to seven). The rate of major complicatio ns was 9.2%. Four esophageal perforations occurred, three after interventio n and one spontaneously 5 months later. Four esophagorespiratory tract fist ulas developed several months after combined PDT and irradiation. The mean overall survival was 7.7 months, and analysis of variance revealed a signif icant difference in favor of PDT and external-beam irradiation (p = 0.0129 and p = 0.0001, respectively). Conclusions. Photodynamic therapy has been shown to be an effective palliat ive treatment of advanced esophageal cancer. However, proper patient select ion is necessary to prevent serious complications. (C) 2000 by The Society of Thoracic Surgeons.