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Eur J Cardiothorac Surg 2006;29:30-34
© 2006 Elsevier Science NL

Photodynamic therapy (PDT) in Barrett's esophagus with dysplasia or early cancer

The General Infirmary at Leeds, Thoracic Unit, Leeds LS9 3EX, UK

Received 14 June 2005; received in revised form 23 October 2005; accepted 24 October 2005.

^_* Corresponding author. Present address: Department of Thoracic Surgery, The General Infirmary at Leeds, D Floor, Jubilee Building, Great George Street, Leeds LS1 3EX, UK. Tel.: +44 113 2583250; fax: +44 113 3928436. (Email: THORPYAT{at}aol.com).

Objective: Esophagectomy is the standard treatment for high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) arising within Barrett's esophagus. Results of photodynamic therapy (PDT) were retrospectively studied to evaluate the effectiveness of PDT in ablating HGD and/or IMC complicating Barrett's esophagus. Methods: Thirty-one patients unfit for or refusing esophagectomy (male: 20, mean age: 73.4 ± 9.3 years) underwent Porfimer sodium PDT ablation of their HGD (15 patients), HGD plus IMC (10 patients) or submucosal/limited T2 adenocarcinoma (6 patients). The mean Barrett's length was 5.8 ± 2.2 cm. Pre-PDT endoscopic mucosal resection or Nd:YAG laser ablation of mucosal nodularity within Barrett's segment was offered in six patients. Results: The main PDT complications were esophagitis (16.1%), photoreactions (12.9%) and stricture requiring dilatation (6.25%). The median post-PDT follow-up was 14 months. The long-term results were (a) for HGD/IMC: initial complete response (endoscopic and histologic absence of HGD–IMC) to PDT was observed in 80.95% of patients, partial response (no endoscopic abnormality, residual IMC–HGD on biopsy) in 9.52%, no response in 9.52% (the recurrence rate after an initial complete response was 17.64%) and (b) for T1b/limited T2 tumors: two patients died from cancer after 24 and 46 months, no evidence of tumor was found in two patients after 12 and 19 months and tumor recurrence was seen in two after 15 and 17 months. The mean survival was 22.1 ± 12.3 months. Conclusions: PDT is effective in ablating HGD/IMC complicating Barrett's esophagus in the majority of cases, while it also seems to be quite effective in treating T1b/limited T2 carcinomas.

Key Words: Barrett's esophagus • High-grade dysplasia • Intramucosal esophageal adenocarcinoma • Porfimer sodium • Photodynamic therapy • Endoscopic ablative techniques