Abstract
Although chemoradiotherapy (CRT) is one curative treatment option for patients with esophageal squamous cell carcinoma (ESCC), local failure after CRT remains a major problem for patients’ curability. The aim of this study was to evaluate the efficacy and safety of photodynamic therapy (PDT) as a salvage treatment for local failure. From August 2007 to March 2012, 193 consecutive ESCC patients were treated with definitive CRT in Kyoto University Hospital. Eighteen of the patients with T2 or earlier T-stage local failure after CRT underwent salvage PDT. After the salvage PDT, 11 patients (61.1%) achieved a complete response at the primary site. Over a median follow-up period of 28.3 months, the 1-year survival and progression-free survival rates were 77.8% and 38.9%, respectively; and the 2-year survival and progression-free survival rates were 60.6% and 33.3%, respectively. Adverse events were mild esophageal stricture in seven (38.9%), esophageal obstruction because of necrotic tissue in nine (50.0%), and photosensitivity in three (16.7%) patients. There were no severe complications or treatment-related deaths. Salvage PDT may be a promising treatment option for the patients with a local residual or recurrent tumor after CRT for ESCC when the lesion is suspected to be in T2 or earlier.
Highlights
Definitive chemoradiotherapy (CRT) is one curative treatment for esophageal squamous cell carcinoma (ESCC)
Thirteen patients were confirmed histologically to have recurrent or residual ESCC before photodynamic therapy (PDT) and five patients were assessed as having local failure clinically by EGD and EUS
There are some reports of PDT as a first-line treatment for ESCC [6]; only a few studies have reported on the use of PDT for salvage treatment for failure of first-line CRT
Summary
Definitive chemoradiotherapy (CRT) is one curative treatment for esophageal squamous cell carcinoma (ESCC). Salvage surgery or second-line chemotherapy is generally indicated for local failure after CRT. The treatment outcome of second-line chemotherapy for patients with treatment failure after definitive CRT is poor and a cure could not be expected (i.e., median survival time; 8.1 months and 1-year survival rate; 34%) [2]. The establishment of minimally invasive and curative salvage treatment options for local failure is essential for improving the survival and quality of life of the patients treated with CRT. At present, salvage PDT is not recognized widely as a salvage treatment for local failure after CRT.
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