Long-Term Survival After Photodynamic Therapy for Early (T1N0M0) Adenocarcinoma of the Esophagus

Abstract

Background: The treatment of early adenocarcinoma of the esophagus has traditionally been surgical esophagectomy. Attractive less invasive endoscopic treatments with low morbidity and mortality have pushed for acceptance over recent years. The aim of this study was to access the feasibility of curative treatment of T1N0M0 adenocarcinoma of the esophagus with photodynamic therapy (PDT). Methods: From 1996 to 2003, PDT was used to treat 6 patients with adenocarcinoma of the esophagus. All 6 patients had T1N0M0 lesions as determined by endoscopic ultrasound staging. All 6 patients consulted with a thoracic surgeon and refused surgery or were considered non-surgical candidates because of other comorbid diseases. PHOTOFRIN 2 mg/kg was injected 48 hours before laser activation with 300 joules using a 630-nm dye laser. Surveillance endoscopy with random biospies were performed every 3 months for 2 yrs., then every 6 months thereafter. Results: Average follow up was 58 months (range 17 - 96). 4 patients had no reoccurrence. 2 patients developed a reoccurrence or second primary diagnosed on surveillance endoscopy within 12 months of treatment, both of which were completely ablated by repeat PDT. 4 patients developed PDT related esophageal strictures. 3 patients had successful endoscopic treatment of their strictures. One went for esophagectomy after developing pseudo-achalasia and wt loss. Surgical specimen revealed fibrotic stricture without any cancer reoccurrence. 5 out of these 6 patients received only PDT and were without dysphagia or reoccurrent cancer at the end of the follow up period. Conclusion: In patients with T1N0M0 adenocarcinomas of the esophagus PDT is a durable alternative to esophagectomy. It can be successfully repeated for reoccurrent disease. Complications of esophageal strictures can be endoscopically resolved. Close endoscopic surviellance is mandatory for the first 2 years. Background: The treatment of early adenocarcinoma of the esophagus has traditionally been surgical esophagectomy. Attractive less invasive endoscopic treatments with low morbidity and mortality have pushed for acceptance over recent years. The aim of this study was to access the feasibility of curative treatment of T1N0M0 adenocarcinoma of the esophagus with photodynamic therapy (PDT). Methods: From 1996 to 2003, PDT was used to treat 6 patients with adenocarcinoma of the esophagus. All 6 patients had T1N0M0 lesions as determined by endoscopic ultrasound staging. All 6 patients consulted with a thoracic surgeon and refused surgery or were considered non-surgical candidates because of other comorbid diseases. PHOTOFRIN 2 mg/kg was injected 48 hours before laser activation with 300 joules using a 630-nm dye laser. Surveillance endoscopy with random biospies were performed every 3 months for 2 yrs., then every 6 months thereafter. Results: Average follow up was 58 months (range 17 - 96). 4 patients had no reoccurrence. 2 patients developed a reoccurrence or second primary diagnosed on surveillance endoscopy within 12 months of treatment, both of which were completely ablated by repeat PDT. 4 patients developed PDT related esophageal strictures. 3 patients had successful endoscopic treatment of their strictures. One went for esophagectomy after developing pseudo-achalasia and wt loss. Surgical specimen revealed fibrotic stricture without any cancer reoccurrence. 5 out of these 6 patients received only PDT and were without dysphagia or reoccurrent cancer at the end of the follow up period. Conclusion: In patients with T1N0M0 adenocarcinomas of the esophagus PDT is a durable alternative to esophagectomy. It can be successfully repeated for reoccurrent disease. Complications of esophageal strictures can be endoscopically resolved. Close endoscopic surviellance is mandatory for the first 2 years.