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Photodynamic Therapy with Curative Intent for Barrett’s Esophagus with High Grade Dysplasia and Superficial Esophageal Cancer

Abstract

Background

Photodynamic therapy (PDT) has been used to palliate advanced, obstructing, or bleeding esophageal cancers (ECs) and Barrett’s high-grade dysplasia (HGD). Few investigators, though, have described using PDT to cure either disease.

Methods

We performed a retrospective review from 1997–2005 of 50 patients with HGD or EC. All patients refused surgical resection or were physiologically unfit. They were instead treated using PDT with curative intent. Clinical follow-up, long-term survival, complications, and recurrence were evaluated.

Results

Thirteen patients (26%) had Barrett’s HGD, 6 (12%) had small, intramural carcinomas, 16 (32%) had T1 N0 tumors, 14 (28%) had T2 N0 tumors, and 1 (2%) had a small, polypoid T3 lesion. The mean length of follow-up was 28.1 months. Sixteen patients (32%) are alive without recurrence, 15 (30%) are living with residual or recurrent disease and have received additional PDT, and the remainder (38%) died of recurrent EC or other causes and had known recurrence. Sixteen (32%) patients received adjuvant chemotherapy, radiation, or both. Esophageal stricture occurred in 21 (42%) patients. There was no procedure-related mortality.

Conclusions

PDT may represent a reasonable alternate to esophagectomy for high-risk patients with HGD or superficial esophageal cancer. Due to superior survival and local control, we still favor esophagectomy for patients without physiologic impairment. However, PDT appears to potentially cure approximately one-third of superficial esophageal cancers and provide local control of high-grade dysplasia in a similar subset of patients.

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References

  1. Cancer Facts and Figures 2005, Surveillance Research. American Cancer Society, Atlanta, GA, 2005

    Google Scholar 

  2. McCaughan JS Jr., Guy JT, Hawley P, Hicks W, et al. Hematoporphyrin—derivative and photoablation therapy of malignant tumors. Lasers Surg Med 1983; 3(3):199–209

    PubMed  Article  Google Scholar 

  3. Dougherty TJ, Kaufman JE, Goldfarb A, Weishaupt KR, et al. Photoradiation therapy for the treatment of malignant tumors. Cancer Res 1978; 38(8):2628–35

    PubMed  CAS  Google Scholar 

  4. Wolfsen HC. Photodynamic therapy for mucosal esophageal adenocarcinoma and dysplastic Barrett’s esophagus. Dig Dis 2002; 20:5–17

    PubMed  Article  Google Scholar 

  5. Cameron AJ, Ott BJ, Payne WS. The incidence of adenocarcinoma in columnar-lined [Barrett’s] esophagus. N Engl J Med 1985; 13:857–9

    Article  Google Scholar 

  6. Wolfsen HC. Present status of photodynamic therapy for high-grade dysplasia in Barrett’s esophagus. J Clin Gastroenterol 2005; 39(3):189–202

    PubMed  Article  Google Scholar 

  7. Rice TW, Falk GW, Achkar E, Petras RE. Surgical management of high-grade dysplasia in Barrett’s esophagus. Am J Gastroenterol 1993; 88:1832–6

    PubMed  CAS  Google Scholar 

  8. Schnell TG, Sontag SJ, Chejfec G, Aranha G, Metz A, O’Connell S, Seidel UJ, et al. Long-term nonsurgical management of Barrett’s esophagus with high-grade dysplasia. Gastroenterology 2001; 120 (7):1607–19

    PubMed  Article  CAS  Google Scholar 

  9. Gerson LB, Groeneveld PW, Triadafilopoulos G. Cost-effectiveness model of endoscopic screening and surveillance in patients with gastroesophageal reflux disease. Gastrohepatol 2004; 2(10):868–79

    Google Scholar 

  10. Shahee NJ, Inadomi JM, Overholt BF, Sharma P. What is the best management strategy for high grade dysplasia in Barrett’s esophagus? A cost effective analysis. Gut 2004; 53(12):1736–44

    Article  Google Scholar 

  11. Chang LC, Oelschlager BK, Quiroga E, Parra JD, Mulligan M, Wood DE, et al. Long-term outcome of esophagectomy for high-grade dysplasia or cancer found during surveillance for Barrett’s esophagus. J Gastrointest Surg 2006; 10(3):341–6

    PubMed  Article  Google Scholar 

  12. Swanstrom SJ, Batirel HF, Bueno R, et al. Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection for esophageal carcinoma. Ann Thorac Surg 2001; 72:1918–24

    Article  Google Scholar 

  13. Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, et al. Minimally invasive esophagectomy outcomes in 222 patients. Ann Surg 2003; 238:486–95

    PubMed  Google Scholar 

  14. Overholt BF, Lightdale DJ, Wang KK, Canto MI, Burdick S. Haggit RC, et al. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized Phase III trial. Gastrointest Endosc 2005; 62(4):488–98

    PubMed  Article  Google Scholar 

  15. Moraca RJ, Low DE. Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramural cancer. Arch Surg 2006; 141(6):545–9

    PubMed  Article  Google Scholar 

  16. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista L, Welch HG, Wennberg DE Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346(15):1128–37

    PubMed  Article  Google Scholar 

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Correspondence to Samuel B. Keeley MD.

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Keeley, S.B., Pennathur, A., Gooding, W. et al. Photodynamic Therapy with Curative Intent for Barrett’s Esophagus with High Grade Dysplasia and Superficial Esophageal Cancer. Ann Surg Oncol 14, 2406–2410 (2007). https://doi.org/10.1245/s10434-007-9392-x

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  • DOI: https://doi.org/10.1245/s10434-007-9392-x

Keywords

  • Photodynamic therapy
  • High-grade dysplasia
  • Barrett’s esophagus
  • Esophageal cancer