Endoscopic photodynamic therapy for obstructing esophageal cancer: 77 cases over a 2-year period

Background: Photodynamic therapy (PDT) is an alternative treatment option f or the palliation of obstructive esophageal cancer. We report our experienc e with PDT for patients presenting with inoperable, obstructing, or bleedin g esophageal cancer. Methods: Seventy-seven patients with inoperable, obstructing esophageal can cer were treated with PDT from November 1996 to July 1998. Photofrin (1.5-2 .0 mg/kg) was administered, followed by endoscopic light treatment (630 nm red dye laser) at 48 h. Dysphagia score (1 for no dysphagia to 5 for comple te obstruction), dysphagia-free interval, and patient survival were assesse d. Results: Seventy-seven patients underwent 125 PDT courses. The mean dysphag ia score at 4 weeks after PDT in 90.8% of the patients improved from 3.2 +/ - 0.7 to 1.9 +/- 0.8 (p < 0.05). PDT adequately controlled bleeding in all six patients who had bleeding. The most common complications after the 125 PDT courses were esophageal stricture (4.8%), Candida esophagitis (3.2%), s ymptomatic pleural effusion (3.2%), and sunburn(10.0%). Twenty-nine patient s (38%) required more than one PDT course, and seven patients required plac ement of an expandable metal stent for recurrent dysphagia. The mean dyspha gia-free interval was 80.3 +/- 58.2 days. The median survival was 5.9 month s. Conclusions: Photodynamic therapy is a safe and effective treatment for the palliation of obstructing and bleeding esophagus cancer.