Sa1248 EFFICACY OF PHOTODYNAMIC THERAPY USING TALAPORFIN SODIUM AND A DIODE LASER AS SALVAGE TREATMENT FOR LOCAL FAILURE AFTER RADIOTHERAPY OR CHEMO RADIOTHERAPY FOR ESOPHAGEAL CANCER

Abstract

Local failure at the primary site is a major problem after radiotherapy (RT) or chemoradiotherapy (CRT) in patients with esophageal cancer (EC). The indication of endoscopic resection (ER) is restricted to mucosal residue due to curability. Surgery is a first choice for deeper local residue invaded into submucosal or muscular layer. However, surgery is associated with a high complication and mortality rate. We had reported that photodynamic therapy (PDT) using talaporfin sodium and a diode laser had the high Complete Response (CR) rate (88.5%) for local failure after RT or CRT in patients with EC. However, few studies have reported on PDT using talaporfin sodium. This study aims to evaluate the efficacy and safety of PDT as a salvage treatment after RT or CRT in patients with EC. This study subjects were recruited from a database of patients treated by PDT using talaporfin at Hyogo Cancer Center. The eligibility criteria of PDT were as follows: 1) local failure after RT or CRT for EC without distant metastasis; 2) esophageal squamous cell carcinoma (ESCC) or esophageal adenocarcinoma (EAC) were histologically proven; 3) salvage ER not indicated due to incurability; 4) salvage surgery not indicated due to intolerable or patient’s wishes; 5) lesions limited to within the muscularis propria; 6) longitudinal lesion length of 3 cm or shorter and 1/2 the circumference of the lumen or less. PDT was applied with intravenous administration of 40 mg/m2 dose of talaporfin sodium followed by a diode laser irradiation of 100J/cm2 4-6 hours later after administration. The Local (L)-CR rate, the times of PDT session required to achieve L-CR, adverse events, clinical course after PDT and overall survival were assessed in this study. Between April 2013 and September 2019, 33 patients with 37 lesions were treated with PDT at Hyogo Cancer Center. ESCC or EAC were histologically proven in 31 patients, in 2 patients, respectively. The L-CR rate per patients was 81.8% (95% CI: 65.6%-91.4%) (T1: 88.9%, T2: 50.0%) (ESCC: 80.6%, EAC: 100%). The times of PDT session required to achieve L-CR was 3 in one patient, 2 in one patient, 1 in 31 patients, respectively. No grade 3 or worse non-hematological toxicities related to PDT were observed. The median follow up period was 12 months (range: 3-72). Two patients received salvage surgery for progressive disease (PD) at 3 months and 16 months after PDT. Three patients died from esophageal cancer progression at 558 days, 686 days and 878 days after PDT. One patient died with pneumonia at 81 days after PDT, and another patient died with pulmonary embolism at 403 days after PDT. Twenty-eight patients are alive. DT using talaporfin sodium and a diode laser is a safe and potentially curative salvage treatment for local failure after RT or CRT for patients with EC.