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Ann Thorac Surg 1996;62:1009-1010
© 1996 The Society of Thoracic Surgeons
DR CAROLYN E. REED (Charleston, SC): Doctor McCaughan, would you comment on the cost of photodynamic therapy (PDT)?
DR McCAUGHAN: It is pretty hard to estimate the cost because PDT has been experimental to date. The cost of the drug has not been a problem for us. I do not know what the charge will be for it. Nor have the fibers been a problem for us. Some surgeons are doing PDT on an outpatient basis, but I usually do it in the operating room. I would think the cost is probably less than that of an esophagogastrectomy. The patients are in the hospital usually 3 or 4 days at most.
DR KAMAL G. KHALIL (Houston, TX): I have two questions. For patients in stage I, was this the only treatment given? Also, was the staging clinical or surgical, or how was it done?
DR McCAUGHAN: Staging was clinical, and as you know, it is very hard to stage patients. You have ±15% on the staging, and that is the problem.
The patients did not have any other treatment. All had been refused or turned down for surgical intervention.
DR LEWIS WETSTEIN (Freehold, NJ): This is interesting work, and I congratulate you, Dr McCaughan, for attempting to treat an extremely difficult clinical problem. My impression, however, is that this is only topical treatment. My first question is, once the patient undergoes fluorescent therapy, what is the depth of penetration?
DR McCAUGHAN: Light will penetrate only a quarter of an inch, and that is the problem.
DR WETSTEIN: So, although you are treating the dysphagia and allowing the patient to swallow, the disease grows not only intrinsically but extrinsically and continues to metastasize.
DR McCAUGHAN: That is correct.
DR WETSTEIN: Rather than the expense of PDT plus the need to go back however many times, why not just place a stent and allow the patient to eat and die of the disease?
DR McCAUGHAN: The new stents that have been developed are a lot better than the old ones. However, a stent does not kill the tumor at all. This way, you can kill at least part of the tumor. Lots of times, the tumors are very hard. If you do PDT, the tumor gets soft, and you can dilate it easily. Tumors have been retreated. When a tumor grows around the stent, it can be treated through the stent.
DR JOSEPH LoCICERO III (Boston, MA): Some comments need to be read into the minutes, as they are not going to appear in the article. This therapy has finally been approved by the Food and Drug Administration because of the perseverance of people like Dr McCaughan who held out over the years when companies in the United States abandoned this technique, and it went to Canada. I applaud Dr McCaughan and his colleagues for having done such a good job.
The technique of PDT is approved for esophageal use only. If a person wants to get into this area, a special new laser costing $200,000 is necessary. The drug is nowhere near that expensive. There are going to be new fibers, and I wonder, Dr McCaughan, if you have used any of the new diffusion fibers with the distention balloons. What are your thoughts about that?
DR McCAUGHAN: We tried many years ago to make balloons with a cylindrical fiber in them. We took a regular balloon dilator and put a fiber in it, but I could not get any company to do this commercially because it wanted to know first how great the market would be. At present, we do not use balloons. If a company could make a balloon that goes down the esophagoscope and you could then blow up the balloon with the fiber inside and turn the light on, that would be the best of all worlds. The balloon you are talking about is one that has to be placed down outside the scope, and I have not had experience with that. I have used the other type a couple of times. Right now, we simply put the fiber in and turn the light on.
Related Article
Ann. Thorac. Surg. 1996 62: 1005-1009.
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