Jamieson, N.F.; Thorpe, S.; Mosse, A.; Brown, S.G.; Lovat, L.B.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA46
Academic Journal
Background: Oesophageal adenocarcinoma is rising in incidence and is strongly associated with Barrett's oesophagus. Oesophagectomy is the standard treatment for early carcinoma but has considerable morbidity and mortality. Photodynamic therapy (PDT) is a non-thermal minimally invasive technique for mucosal ablation. Meso-tetrahydroxy-phenylchlorin (mTHPC, Foscan) is a potent photosensitiser which has been used with PDT in small series with squamous-cell oesophogeal cancer. Aims: To assess efficacy and safety of ablating high-grade dysplasia (HGD) or early oesophageal adenocarcinoma by PDT using mTHPC. Methods: 5 patients with dysplasia (Vienna 4) within nodules and 11 with early adenocarcinoma (Vienna 5) staged by CT and EUS as T2NO or less were included: T1(6), T1/2(3), T2(2). Oesophagectomy was inappropriate because of patient refusal or co-morbid pathology. Patients were photosensitised intravenously with mTHPC (0.15mg/ kg). Three days later, at endoscopy, red light (wavelength 652nm) was delivered to the tumour by bare-tipped fibre or diffuser fibre within a windowed silicone bolster. Further PDT was given within 48 hours if needed. Patients were followed up by endoscopy and multiple biopsies (1,3,6,9,12 months) and EUS (3 monthly). Results: 16 patients have been treated since Sept 1995. One patient died before initial follow-up unrelated to PDT and is excluded from analysis. At a median follow up of 17 months (range 9-73 months) 8/11 (72.7%) cancer patients are clear of carcinoma. All 4 patients with HGD are clear of dysplasia (median 13 months). There were 2 serious complicationsσan aorto-oesophageal fistula from which the patient died (an early case, later recognised as due to excessive light dose), and a tracheo-oesophageal fistula, successfully treated by covered oesophageal stent. Of 3 carcinomas not responding to PDT, there is no evidence of residual carcinoma after subsequent chemoradiotherapy (2) or surgery (1). Conclusions: PDT with mTHPC...


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