Effect of photodynamic therapy in a multimodal approach for advanced carcinoma of the gastro-esophageal junction

Background and Objective: We wanted to determine the role of additional pho todynamic therapy in a multimodal approach for the treatment of patients wi th advanced cancer of the gastro-esophageal junction. Study Design/Materials and Methods: We reviewed 53 patients, after endolumi nal palliation, with advanced cancer of the gastro-esophageal junction. Com bined dilatation and retrograde tumor disobliteration with Nd-YAG) laser be fore photodynamic therapy (PDT), brachyradio-therapy, or both, became neces sary in 12 patients. Brachyradiotherapy was carried out in all patients. PD T before brachyradiotherapy was performed in 25 patients. The endoluminal t reatment was completed by external beam irradiation in 30 patients (15 case s with PDT and 15 without PDT) with an at least fair performance status. Results: Photodynamic therapy showed a significant difference regarding the mean opening of the tumor stenosis (mean, 6.4 mm; P = 0.0002), the mean de crease in tumor length (3.1 cm; P = 0.00001) and the increase in median sur vival (13.8 months; P = 0.001). The combined multimodal approach by using P DT, brachyradiotherapy and external beam irradiation showed a median surviv al of 16.8 months. However, additional external beam irradiation showed no significant difference (P = 0.11). The rate of severe complications was 5.7 %. The mortality rate was 1.9%. Conclusion: Photodynamic therapy has been shown to be an effective treatmen t for palliation of advanced cancer at the gastro-esophageal junction. The use of PDT combined with irradiation was associated with an acceptable surv ival rate, low rates of complications and reasonable quality of life. (C) 2 000 Wiley-Liss, Inc.