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Eur J Cardiothorac Surg 2000;18:649-655
© 2000 Elsevier Science NL

Combined photodynamic therapy and hyperbaric oxygenation in carcinoma of the esophagus and the esophago-gastric junction

^a Department of Surgery, Division of Thoracic and Hyperbaric Surgery, University Medical School, Auenbruggerplatz 29, A-8036 Graz, Austria
^b Division of Biomedical Engineering and Computing, University Medical School, Auenbruggerplatz 29, A-8036 Graz, Austria

Received 29 February 2000; received in revised form 25 September 2000; accepted 25 September 2000.

Corresponding author. Tel.: +43-316-385-3302; fax: +43-316-385-4679
e-mail: alfred.maier{at}klinikum-graz.at

Objectives: The photochemical reaction of photodynamic therapy (PDT) depends on the presence of molecular oxygen. Due to anoxic regions in tumor tissue and vascular shutdown during PDT the efficiency is limited. Therefore, the use of hyperbaric oxygen which increases the oxygen in tumor tissue, as well as the amount of singlet oxygen, may enhance the efficiency of PDT. Patients and methods: After diagnostic work-up, photosensitization was carried out with a hematoporphyrin-derivate 2 mg/kg BW 48 h prior to PDT. The light dose was calculated as 300 J/cm fiber tip. Thirty-one patients were treated by PDT alone and 44 patients received PDT under hyperbaric oxygen at a level of two absolute atmospheric pressure. Results: Improvement regarding stenosis-diameter could be obtained in both treatment arms with no significant difference (P=0.82). The dysphagia-score and tumor-length also decreased in both groups and showed a significant difference in favour of the PDT/HBO-group (P=0.0064 and P=0.0002, respectively). The median overall survival for the PDT-group was 7 months and for the PDT/HBO-group 12 months (P=0.0098). Conclusion: According to this prospective non-randomized study, combined PDT/HBO represents a new approach in the treatment of esophageal and cardia cancer which appears to have enhanced the efficiency of PDT.

Key Words: Photodynamic therapy • Hyperbaric oxygenation • Esophageal carcinoma • Cardia carcinoma

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