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Ann Thorac Surg 2000;69:1006-1009
© 2000 The Society of Thoracic Surgeons
a Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Karl-Franzens University Medical School, Graz, Austria
b Department of Radiotherapy, Karl-Franzens University Medical School, Graz, Austria
c Division of Biomedical Engineering and Computing, Karl-Franzens University Medical School, Graz, Austria
d Department of Dermatology, Karl-Franzens University Medical School, Graz, Austria
Address reprint requests to Dr Maier, Department of Surgery, Division of Thoracic and Hyperbaric Surgery, Karl-Franzens University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria
Background. We wanted to determine the role of photodynamic therapy in a multimodal approach for the treatment of patients with advanced cancer of the esophagus.
Methods. We reviewed the cases of 119 patients with nonresectable esophageal carcinoma who underwent endoluminal palliation. Twenty-one patients required initial dilation and tumor obliteration with a neodymium:yttrium-aluminum-garnet laser prior to therapy. Forty-four patients received photodynamic therapy followed by brachyradiotherapy, and 75 patients were treated with brachyradiotherapy. In both groups, some patients also received external-beam irradiation.
Results. Photodynamic therapy produced a significant difference in relieving stenosis caused by tumor stenosis (mean, 6.6 mm; p = 0.0000). The dysphagia score improved by one to three levels in all patients, with a significant difference in favor of PDT (p = 0.0003). The mean number of overall treatment sessions was four (range, one to seven). The rate of major complications was 9.2%. Four esophageal perforations occurred, three after intervention and one spontaneously 5 months later. Four esophagorespiratory tract fistulas developed several months after combined PDT and irradiation. The mean overall survival was 7.7 months, and analysis of variance revealed a significant difference in favor of PDT and external-beam irradiation (p = 0.0129 and p = 0.0001, respectively).
Conclusions. Photodynamic therapy has been shown to be an effective palliative treatment of advanced esophageal cancer. However, proper patient selection is necessary to prevent serious complications.
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