Photodynamic therapy for treatment of early adenocarcinoma in Barrett's esophagus.

Abstract

Barrett's esophagusl,2 is characterized by replacement over time of normal esophageal squamous epithelium with specialized columnar epithelium in some patients with hiatal hernia and esophagitis. The incidence of carcinoma in Barrett's esophagus patients is estimated to be 30 to 40 times that in the normal population,3-5 occurring in approximately 10% of cases.6-B Annual or semiannual screening endoscopy with multiple biopsy specimens is recommended for detection of high-grade dysplasia or early adenocarcinoma. Esophagectomy is recommended for cases of Barrett's adenocarcinoma and for selected cases involving severe dysplasia.9 Reid,lO however, recommends repeat biopsies and individualized treatment programs for those patients with negative endoscopy results and severe dysplasia found on biopsy. An alternative to surgery is desirable because of the morbidity and mortality associated with esophagectomy.lO Although combined chemotherapy and radiation or trimodality therapy with radiation, hyperthermia, and chemotherapy have been reported to produce promising results in some cases with stage I esophageal cancer,n·l4 no information exists about the possible use of these modalities for Barrett's early adenocarcinoma or for high-grade dysplasia. Photodynamic therapy (PDT)l5 has been used for treatment of superficial esophageal cancerl6-24 and represents a possible alternative to esophagectomy. This report describes two patients treated with PDT for three areas of superficial adenocarcinoma associated with Barrett's esophagus and discusses the potential role of PDT in the treatment of superficial esophageal cancer in Barrett's esophagus.