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Photodynamic Therapy with Curative Intent for Barrett’s Esophagus with High Grade Dysplasia and Superficial Esophageal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Photodynamic therapy (PDT) has been used to palliate advanced, obstructing, or bleeding esophageal cancers (ECs) and Barrett’s high-grade dysplasia (HGD). Few investigators, though, have described using PDT to cure either disease.

Methods

We performed a retrospective review from 1997–2005 of 50 patients with HGD or EC. All patients refused surgical resection or were physiologically unfit. They were instead treated using PDT with curative intent. Clinical follow-up, long-term survival, complications, and recurrence were evaluated.

Results

Thirteen patients (26%) had Barrett’s HGD, 6 (12%) had small, intramural carcinomas, 16 (32%) had T1 N0 tumors, 14 (28%) had T2 N0 tumors, and 1 (2%) had a small, polypoid T3 lesion. The mean length of follow-up was 28.1 months. Sixteen patients (32%) are alive without recurrence, 15 (30%) are living with residual or recurrent disease and have received additional PDT, and the remainder (38%) died of recurrent EC or other causes and had known recurrence. Sixteen (32%) patients received adjuvant chemotherapy, radiation, or both. Esophageal stricture occurred in 21 (42%) patients. There was no procedure-related mortality.

Conclusions

PDT may represent a reasonable alternate to esophagectomy for high-risk patients with HGD or superficial esophageal cancer. Due to superior survival and local control, we still favor esophagectomy for patients without physiologic impairment. However, PDT appears to potentially cure approximately one-third of superficial esophageal cancers and provide local control of high-grade dysplasia in a similar subset of patients.

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Authors and Affiliations

  1. University of Pittsburgh Medical Center, Heart, Lung, and Esophageal Surgery Institute, Pittsburgh, PA, USA

    Samuel B. Keeley MD, Arjun Pennathur MD, Rodney J. Landreneau MD, Neil A. Christie MD & James Luketich MD

  2. University of Pittsburgh Cancer Institute, Biostatistics Facility, Pittsburgh, PA, USA

    William Gooding

Authors
  1. Samuel B. Keeley MD
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  2. Arjun Pennathur MD
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  3. William Gooding
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  4. Rodney J. Landreneau MD
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  5. Neil A. Christie MD
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  6. James Luketich MD
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Corresponding author

Correspondence to Samuel B. Keeley MD.

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Keeley, S.B., Pennathur, A., Gooding, W. et al. Photodynamic Therapy with Curative Intent for Barrett’s Esophagus with High Grade Dysplasia and Superficial Esophageal Cancer. Ann Surg Oncol 14, 2406–2410 (2007). https://doi.org/10.1245/s10434-007-9392-x

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  • DOI: https://doi.org/10.1245/s10434-007-9392-x

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