Photodynamic therapy in the correction of disphagia in patients with esophagus cancer

Abstract

Relevance. In spite of successes in diagnostic and treatment of cancer, malignant neoplasm of the esophagus remain an acute problem. Cancer of the esophagus and gastroesophageal zone are the most prognostically unfavorable disease of the digestive tract. At the time of treatment, more than 70% of patients with esophageal cancer suffer from grade II – IV dysphagia, which significantly impairs the functional state and quality of life. Dysphagia indicates that 70% of the lumen of the esophagus is filled with a tumor.Purpose. Improve the results of treatment of patients with esophageal cancer with dysphagia through the use of fluorescent diagnostics and photodynamic therapy. Materials and methods. The study group included 49 patients with a diagnosis of esophageal cancer, where the disease was complicated by tumor obturation. Patients received photodynamic therapy with the use of the photogem sensitizer of hemato-porphyrin series. The comparison group included 32 patients complicated by dysphagia who received a course of radiation therapy. All patients underwent treatment and further examination at the Samara Regional Clinical Oncology Center from 2015 to 2017.Results and their discussion: In study group in 13 (26.5%) cases an increase in the lumen of the esophagus to 1 sm or more was recorded. In this case, the patient could take any food. A decrease in the degree of dysphagia was observed in 21 cases (42.8%). In 6 cases (12.2%), the tumor visually decreased in volume, but clinical improvement wasn’t observed. Positive functional results with decrease in dysphagia grade were obtained in 72 % of patients. Complete dysphagia resolution was achieved in 28 % of cases. The median survival rate was 24 weeks. In comparison group full restoration of patency was obtained in 8 cases (25%), partial - in 10 (28%). No effect was observed in 14 (43.7%) cases. Only in 8 (25%) cases an increase in the lumen of the esophagus to 1 sm or more was recorded. The median survival rate was 21 weeks.Conclusion. The result suggests a significant efficacy of photodynamic therapy compared with the results of radiation therapy. The use of photodynamic therapy allows to achieve a high degree of functional rehabilitation in patients with esophageal cancer complicated by dysphagia in the absence of serious complications.