Combined photodynamic therapy and hyperbaric oxygenation in carcinoma of the esophagus and the esophago-gastric junction

Objectives: The photochemical reaction of photodynamic therapy (PDT) depend s on the presence of molecular oxygen. Due to anoxic regions in tumor tissu e and vascular shutdown during PDT the efficiency is limited. Therefore, th e use of hyperbaric oxygen which increases the oxygen in turner tissue, as well as the amount of singlet oxygen, may enhance the efficiency of PDT. Pa tients and methods: After diagnostic work-up, photosensitization was carrie d out with a hematoporphyrin-derivate 2 mg/kg BW 48 h prior to PDT. The lig ht dose was calculated as 300 J/cm fiber tip. Thirty-one patients were trea ted by PDT alone and 44 patients received PDT under hyperbaric oxygen at a level of two absolute atmospheric pressure. Results: Improvement regarding stenosis-diameter could be obtained in both treatment arms with no signific ant difference (P = 0.82). The dysphagia-score and tumor-length also decrea sed in both groups and showed a significant difference in favour of the PDT /HBO-group (P = 0.0064 and P = 0.0002, respectively). The median overall su rvival for the PDT-group was 7 months and for the PDT/HBO-group 12 months ( P = 0.0098). Conclusion: According to this prospective non-randomized study , combined PDT/HBO represents a new approach in the treatment of esophageal and cardia cancer which appears to have enhanced the efficiency of PDT. (C ) 2000 Elsevier Science B.V. All rights reserved.