Toxicity of photodynamic therapy after combined external beam radiotherapyand intraluminal brachytherapy for carcinoma of the upper aerodigestive tract

Background and Objective: To describe the toxicity of photodynamic therapy (PDT) in patients with carcinoma of the upper aerodigestive tract who recei ved prior treatment with external beam irradiation and intraluminal brachyt herapy (IB). Study Design/Materials and Methods: Hospital records of PDT patients were r eviewed. Three patients who received prior treatment with external beam irr adiation and IB were identified. Two patients had esophageal carcinoma trea ted with combined chemotherapy and external beam irradiation (55.8 and 50.4 Gy) followed by LB (12 Gy and 35 Gy at 1 cm). These patients then received PDT for treatment of recurrence (2 mg/kg Photofrin injection and 2 light a pplications: 630 nm, 150-200 J/cm, 200-400 mW/cm). One patient had non-smal l. cell lung cancer treated with external beam irradiation (60 Gy) followed by IB (36.1 Gy at 1 cm) and then received PDT for recurrence (1 mg/kg Phot ofrin injection and one light application: 630 nm, 150 J/cm, 200 mW/cm). Results: One patient with esophagus cancer had formation of a tracheoesopha geal fistula, which required stent placement. The other esophageal cancer p atient developed quadriplegia due to an epidural abscess arising from a fis tula with the diseased portion of the esophagus. The lung cancer patient ha d massive hemoptysis after the procedure and died 2 days later. Autopsy sho wed necrotizing arteritis of the right pulmonary artery. Conclusion: Patients with upper aerodigestive tract carcinoma who have rece ived treatment with both external beam irradiation and IB seem to be at hig her risk for complications when treated with PDT. (C) 2001 Wiley-Liss, Inc.