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Ann Thorac Surg 1999;68:1763-1769
© 1999 The Society of Thoracic Surgeons

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Original Articles

Photodynamic therapy for esophageal lesions: selectivity depends on wavelength, power, and light dose

^a Laboratory for Experimental Surgery, Erasmus University, Rotterdam, The Netherlands

Address reprint requests to Dr van den Boogert, Laboratory for Experimental Surgery, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands
e-mail: vandenboogert{at}heel.fgg.eur.nl

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, January 25–27, 1999.

Background. Photodynamic therapy with 5-aminolevulinic acid–induced photosensitization could selectively eliminate esophageal epithelial lesions. This study aimed at optimizing laser parameters for 5-aminolevulinic acid photodynamic therapy of the normal rat esophagus.

Methods. Sixty rats received 200 mg/kg 5-aminolevulinic acid orally and were illuminated 3 hours later with either 633 or 532 nm light (n = 30 for each group) through an endoesophageal balloon catheter. Rats received either 8.3 or 25 J/cm diffuser, applied with a 33, 100, or 300 mW/cm diffuser. During illumination, tissue fluorescence measurements and light dosimetry were done. Rats were sacrificed at 48 hours after photodynamic therapy.

Results. During illumination, protoporphyrin IX fluorescence declined faster when a higher power output was used. Fluence rate at the esophageal surface was highest for 633-nm light. At 532 nm, light caused less damage to the epithelium and muscle than 633-nm light. Illumination with 33 mW resulted in selective epithelial ablation, whereas illumination with 300 mW caused muscle damage with minor epithelial damage.

Conclusions. The assumed selective epithelial damage of 5-aminolevulinic acid photodynamic therapy in the esophagus largely depends on the combination of wavelength, power, and light dose applied. Most selective epithelial damage was found when low-power 633-nm light was used.