Nonoperable patients with superficial esophageal cancer treated by photodynamic therapy after chemoradiotherapy have more severe complications than patients treated in primary intent

Am J Gastroenterol. 2008 Sep;103(9):2215-9. doi: 10.1111/j.1572-0241.2008.02042.x.


Introduction: Photodynamic therapy (PDT) is a therapeutic option in patients with a superficial esophageal cancer. Recently, PDT was shown to be effective as a salvage therapy for a local recurrence after chemoradiotherapy (CRT).

Aim: To compare retrospectively the results and the complications rate of PDT between consecutive patients treated in primary intent for a superficial esophageal cancer versus patients treated by PDT for a local recurrence after CRT.

Methods: Between 1999 and 2007 in a single center, 40 consecutive patients were treated by PDT for a superficial esophageal cancer, 25 (group 1) in primary intent and 15 (group 2) for a local recurrence after CRT. Two days after intravenous (IV) Photofrin (2 mg/kg), the phototherapy was performed with a dye laser. The treatment response and severe complications, defined as perforation and stricture requiring endoscopic dilation, were compared between the two groups.

Results: The patient and tumor characteristics were not different between the two groups. In group 1, 19 out of 25 patients (76%) were successfully treated versus 8 out of 15 patients (53%) in group 2 (P= 0.17). Severe complications occurred more frequently in patients with a prior CRT (8%vs 46.7%, P= 0.008) and included two perforations and five strictures requiring endoscopic dilation, while only two strictures occurred in group 1. A prior CRT was an independent risk factor of severe complications (odds ratio [OR] 8.05; 95% confidence interval [CI]1.22-43.0).

Conclusions: Severe complications were significantly more frequent in patients treated after a prior CRT. PDT as a salvage therapy in patients with a local recurrence after CRT for esophageal cancer tended to be less efficient than in first-line treatment.

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Combined Modality Therapy
  • Dihematoporphyrin Ether / adverse effects
  • Dihematoporphyrin Ether / therapeutic use
  • Esophageal Neoplasms / drug therapy
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / radiotherapy
  • Esophageal Neoplasms / therapy*
  • Esophagoscopy
  • Female
  • Humans
  • Logistic Models
  • Male
  • Neoplasm Staging
  • Photochemotherapy / adverse effects*
  • Photosensitizing Agents / adverse effects
  • Photosensitizing Agents / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Salvage Therapy
  • Statistics, Nonparametric
  • Treatment Outcome


  • Photosensitizing Agents
  • Dihematoporphyrin Ether