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Photodynamic Therapy (PDT): The Best-Validated Technique

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Endoscopic Therapy for Barrett's Esophagus

Part of the book series: Clinical Gastroenterology ((CG))

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Summary

Photodynamic therapy (PDT) has been used in medicine to ablate and destroy unwanted tissue for nearly 50 years. Its unique mechanism of action is non-thermal and utilizes the activation of a photosensitizer by local application of a specific wavelength of light and the subsequent generation of oxygen radicals by the “excited” photosensitizer. These oxygen radicals create localized cellular injury and necrosis in the region of photoactivation. While a variety of photosensitizers have been studied, only porfimer sodium is approved for use in the United States. Approved gastrointestinal applications include the treatment of both squamous cell cancer and adenocarcinoma of the esophagus in non-surgical candidates for the purposes of palliation of malignant dysphagia or tumor eradication. More recently, approval for the treatment of Barrett’s esophagus with high-grade dysplasia (HGD) has been granted. The technique achieves success rates of 70–100% for these indications, but residual Barrett’s epithelium usually remains. Due to its status as the most-widely used ablation technique with more than 15 years of clinical data, PDT is the only method of ablation that has currently been shown to be durable, reduce the risk of cancer recurrence, and achieve outcomes similar to esophagectomy for the treatment of Barrett’s with HGD. Despite its high cost and known complications (development of photosensitivity reactions and esophageal strictures in nearly a third of patients), PDT appears to meet established criteria for cost-effectiveness. While initial studies of newer ablative techniques offer promising efficacy results with the advantages of cost-reduction and decreased complications, it is uncertain if these methods are durable, reduce the risk of subsequent cancer, or achieve outcomes similar to surgical therapy. Until data regarding these issues are available, PDT remains the best-validated endoscopic treatment option to surgery for patients with Barrett’s esophagus with HGD and early-stage esophageal cancer.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Veterans Affairs Medical Center, Kansas City, MO

    V. Raman Muthusamy MD

  2. H.H. Chao Comprehensive Digestive Disease Center, School of Medicine, University of California, Irvine, Orange, CA

    Kenneth J. Chang MD

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  1. V. Raman Muthusamy MD
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  2. Kenneth J. Chang MD
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Editors and Affiliations

  1. College of Medicine, University of Arizona, Tucson, 85724-5028, U.S.A.

    Richard E. Sampliner

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© 2009 Humana Press, a part of Springer Science+Business Media, LLC

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Muthusamy, V.R., Chang, K.J. (2009). Photodynamic Therapy (PDT): The Best-Validated Technique. In: Sampliner, R. (eds) Endoscopic Therapy for Barrett's Esophagus. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60327-445-6_8

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  • DOI: https://doi.org/10.1007/978-1-60327-445-6_8

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