Photofrin PDT for early stage oesophageal cancer: Long term results in 40 patients and literature review

Summary 

Background

Yorkshire Laser Centre experience of PDT in early oesophageal cancer (EOCa) to determine long survival at 3 and 5 years (absolute) and factors which might influence outcome.

Material/Method

The records of patients who had PDT (1997–2009) for oesophageal cancer were reviewed and those with EOCa were studied and analysed. All patients had standard work up and staging. PDT was carried out using Photofrin 2mg/kwbw, iv followed 24–72h later by endoscopic illumination with 630nm laser light. Results were assessed based on pathological response to treatment and survival at 3 and 5 years post-PDT.

Results

There were 40 patients with EOCa amongst 144 who had PDT for oesophageal cancer. 30 male and 10 female (mean age 77, range 48–84). 35 had adenocarcinoma and 5 squamous cell carcinoma. 20 of the former had Barrett's mucosa. There was no operative or 30-day mortality and no serious complications. Adverse effects were noted in 10 patients including 2 with skin photosensitivity and 3 with mild stricture requiring one dilatation. The median follow up was 76.1 (range 36–150 months). In this period 24 patients have died between 2 and 150 months (median 41 months). 16 patients are alive in between 36 and 110 months. 3 and ≥5 years or more survival (absolute) were 72.5% and 53.8%, respectively.

Conclusion

Endoscopic PDT should be considered as the treatment of choice in patients with EOCa who are ineligible for surgical resection. We suggest that a carefully designed study of a cohort of patients with EOCa comparing surgical resection with endoscopic PDT is warranted.

Keyword: PDT for early oesophageal cancer