4911 Argon plasma coagulation plus photodynamic therapy vs. argon plasma coagulation plus brachytherapy in palliation of malignant dysphagia: a prospective and randomized study.

Abstract

Background: Argon plasma coagulation [APC], high-dose-rate brachytherapy [HDR], and photodynamic therapy [PDT] have been used in palliative treatment of malignant dysphagia. However, these methods as a monotherapy result in a relatively short period of good swallowing. The aim of this study is to evaluate whether an additional HDR or PDT after APC recanalization of malignant stenosis may prolong dysphagia-free period [DFP] in patients [pts] with non-operable esophageal or cardia cancer. Material:We considered for inclusion 72 pts (median age 70 yrs, range: 39-90) with malignant dysphagia who were not suitable for or did not accept radical treatment. However, 24 of them were excluded due to: bronchial involvement on EUS (n=9), esophago-bronchial fistula (n=4), perforation (n=1), lack of pts consent (n=7), death before randomization (n=3). The remaining 48 pts compromise study material. Methods: The stenosis was treated with APC until the patient could eat solid foods. After recanalization, pts were randomized to one of three groups: 1.additional HDR (n=16), 2.additional PDT (n=16), 3.observation without additional treatment (n=16). HDR was performed using 10-14 mm wide “bougie” applicator. Single dose of 12 Gy was given, specified 0.5 cm from the surface of the applicator. PDT was performed using Photosan-3 (dose 2.5 mg/kg) and low power laser irradiation (630 nm) to a dose of 250 J/cm of tumor. After the treatment pts were followed until death. Kaplan-Meier survival analysis of DFP was calculated for each group compared (fig). Results: The median DFP in HDR, PDT, and control group was 87 (range 16-219), 52.2 (16-303), and 27 (11-66) days respectively. The difference between HDR and control group and between PDT and control group were significant (log rank test, p=0.002and p=0.013 respectively). There was no significant difference between HDR and PDT group. Conclusions: These results show significant prolongation of DFP in pts who underwent additional HDR or PDT after recanalization with APC as compared to recanalization only. Background: Argon plasma coagulation [APC], high-dose-rate brachytherapy [HDR], and photodynamic therapy [PDT] have been used in palliative treatment of malignant dysphagia. However, these methods as a monotherapy result in a relatively short period of good swallowing. The aim of this study is to evaluate whether an additional HDR or PDT after APC recanalization of malignant stenosis may prolong dysphagia-free period [DFP] in patients [pts] with non-operable esophageal or cardia cancer. Material:We considered for inclusion 72 pts (median age 70 yrs, range: 39-90) with malignant dysphagia who were not suitable for or did not accept radical treatment. However, 24 of them were excluded due to: bronchial involvement on EUS (n=9), esophago-bronchial fistula (n=4), perforation (n=1), lack of pts consent (n=7), death before randomization (n=3). The remaining 48 pts compromise study material. Methods: The stenosis was treated with APC until the patient could eat solid foods. After recanalization, pts were randomized to one of three groups: 1.additional HDR (n=16), 2.additional PDT (n=16), 3.observation without additional treatment (n=16). HDR was performed using 10-14 mm wide “bougie” applicator. Single dose of 12 Gy was given, specified 0.5 cm from the surface of the applicator. PDT was performed using Photosan-3 (dose 2.5 mg/kg) and low power laser irradiation (630 nm) to a dose of 250 J/cm of tumor. After the treatment pts were followed until death. Kaplan-Meier survival analysis of DFP was calculated for each group compared (fig). Results: The median DFP in HDR, PDT, and control group was 87 (range 16-219), 52.2 (16-303), and 27 (11-66) days respectively. The difference between HDR and control group and between PDT and control group were significant (log rank test, p=0.002and p=0.013 respectively). There was no significant difference between HDR and PDT group. Conclusions: These results show significant prolongation of DFP in pts who underwent additional HDR or PDT after recanalization with APC as compared to recanalization only.