PHOTODYNAMIC THERAPY IN THE TREATMENT OF ESOPHAGEAL CANCER

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Aims Esophageal cancer is characterized by poor prognosis. In the majority of cases radical operation cannot be performed due to tumor spread and concomitant diseases of age. Only 10% of patients receive surgical resection, providing 5-year survival only in 25%. Dysphagia is the main symptom of esophageal obstruction, which leads to poor quality and shortage of patients’ life. Photodynamic therapy (PDT) is a new technique, providing tumor destruction with minimal damage to surrounding tissue. Application of PDT to esophageal carcinomas is rarely reported. The aim of this study was the development of PDT technique for the treatment of obstructive esophageal cancer in inoperable patients for improvement of their quality of life and increase of their survival time. Methods PDT has been performed in 52 inoperable patients with advanced esophageal cancer and high grade dysphagia (43 primary, 9 recurrent after surgery or chemo-radiotherapy). Tumors were located in the cervical (23), middle and lower thoracic (27) parts of esophagus and esophago-gastric anastomosis (2). Photoditazine (chlorin-e6 derivative) was used as photosensitizer. Diode laser and fibers with diffusing tip were used for irradiation via endoscope. Results The treatment was well-tolerated by all patients, including those with severe concomitant diseases. There were no lethal outcomes or severe complications. Recanalisation effect of PDT with recovery of dysphagia was observed in all cases and lasted for 6-7 months. Fourth part of patients survived 2 years. Dysphagia-free period after PDT was longer than after other palliative modalities (radio-frequency or Nd-YAG laser ablation). Conclusions PDT is a safe and effective technique for obstructive esophageal cancer. Recovery of dysphagia and longer survival period in patients with obstructive esophageal cancer after PDT treatment are determined by vascular mechanisms produced by PDT which lead to vascular thrombosis and impaired tumor blood supply, these factors provide long-term process stabilization with significant improvement of patients’ quality of life.

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