Outcome of patients receiving photodynamic therapy for early esophageal cancer

Purpose: Photodynamic therapy (PDT) has shown remarkable activity in a vari ety of human cancers. In the present study, we report the effects of PDT on inoperable early-stage esophageal cancer. Methods and Materials: Sixty-two patients were treated with an argon dye la ser (630 nm wavelength, 300-800 mW of power, energy dose of 200-300 J/cm) a fter intravenous injection of 5 mg/kg of hematoporphyrin derivative. Eighte en patients (29.5%) had in situ carcinoma (Tis), 30 (48.5%) had T1-stage ca ncer, 7 (11%) had T2-stage cancer, and 7 (11%) had recurrent disease in the anastomotic area after previous surgery without evidence of invasion outsi de the lumen. Patients with residual disease after two rounds of PDT receiv ed definitive radiotherapy. Patients were evaluated for response to therapy and survival. The follow-up time ranged from 3 to 90 months (median, 32 mo nths). Results: The complete response (CR) rate was 37% (23 of 62) in patients who received PDT alone and 82% (51 of 62) in those who also received radiother apy. The CR rate after PDT alone was statistically higher (p = 0.04) for pa tients who had Tis/T1 lesions (21 of 48; 44%) than for those with T2-stage disease (2 of 7; 28%) or recurrent tumors (0 of 7; 0%). Fifty-two percent o f patients who had CB following PDT alone did not suffer local tumor recurr ence. The median local progression-free survival times after PDT and additi onal radiotherapy (in cases with incomplete response) was 49 months for Tis - and T1-stage lesions, 30 months for those with T2-stage disease, and 14 m onths for patients with locally recurrent disease. Patients who completely responded to PDT had a median overall survival (OS) of 50 months, which was significantly longer (p < 0.003) than that of patients not responding to P DT. Toxicity was minimal; we recorded three cases of esophageal stenosis (7 %) and one case of tracheo-esophageal fistula (2.5%) after combined PDT and radiotherapy. Conclusion: PDT is an effective regimen for early esophageal cancer, giving a CR rate of about 40%, long-term local control and favorable overall surv ival. Additional radiotherapy in cases of incomplete response to PDT is eff ective and potentially curative in another 45% of cases. (C) 2000 Elsevier Science Inc.