Photodynamic therapy for large superficial squamous cell carcinoma of the esophagus

Background: Photodynamic therapy (PDT) has been found to be safe and effective in patients with small early esophageal squamous cell carcinoma (SCC). However, its efficacy for widespread superficial SCC has not yet been confirmed. Objective: To assess the long-term survival, complications, and recurrence of PDT for large superficial esophageal SCC. Design: Retrospective study. Setting: Tertiary referral center. Patients: A total of 38 patients with superficial SCC of the esophagus. All patients had a large unifocal lesion or multifocal lesions that were too large to be resected endoscopically. In addition, all patients were physiologically unfit for esophagectomy or had refused surgery. Interventions: PDT with porfimer sodium. Main Outcome Measurements: Clinical follow-up, long-term survival, complications, and recurrence were evaluated. Results: Thirty-one patients (82%) had mucosal cancer (T1m), and 7 (18%) had submucosal cancer (T1sm). No patient had lymph node involvement. Nineteen patients had other primary malignancies. Complete remission was achieved in 33 (87%). At the time of writing, 28 patients (74%) were alive without recurrence. After a median follow-up period of 64 months (range, 7-125 months) after PDT, the overall 5-year survival rate was 76%. There was no treatment-related mortality. Limitations: Retrospective study with a small number of patients. Conclusions: This long-term follow-up study revealed that PDT was a potentially curative treatment for large superficial esophageal SCC. PDT might be a reasonable alternative to esophagectomy or to endoscopic resection for patients with superficial SOC of the esophagus without lymph node metastasis. (Gastrointest Endosc 2011;73:1-6.)