Role of photodynamic therapy in the treatment of esophageal cancer

Abstract

Photodynamic therapy (PDT), a treatment of choice for cancer, induces a photochemical reaction, thereby eradicating tumor cells. This is achieved through the administration of a photosensitizer drug, which is activated with a laser after localization to the tumor mass, and is an approved curative endoscopic ablative treatment for superficial esophageal squamous cell carcinoma (ESCC) in Japan. PDT has been approved for dysplastic Barrett's esophagus and as a palliative treatment for patients with symptomatic obstructive esophageal cancer in US. However, its adverse events and complicated procedure and the development of alternative endoscopic procedures such as endoscopic submucosal dissection, radiofrequency ablation and cryotherapy, have largely limited the practice of PDT in esophageal cancer worldwide. Recently, owing to the invention of second‐generation PDT using talaporfin sodium and diode laser, PDT can be performed with less phototoxicity and therefore has regained popularity in the treatment of ESCC. As a salvage treatment for patients with local failure after chemoradiotherapy (CRT), PDT has shown promising complete response with less phototoxicity and shorter sun shade period. In addition, the efficacy and safety of PDT in patients with local failure of ESCC after CRT were shown in several clinical trials. The direction of the study interest of the next‐generation PDT is the safety and potential expansion of the indications for its application in the future. This review covers the PDT for the treatment of ESCC and dysplastic Barrett's esophagus, with special focus on the role of PDT in practice for esophageal cancer.

Photodynamic therapy for solid tumors: A review of the literature

“…37 The largest study of palliative PDT for 215 affected patients reported improved dysphagia in 85%, achieving an average of 4.8 months of overall survival and a median of 2 months of dysphagia relief. 37,38 PDT using talaporfin sodium and diode laser has also been successfully used as a salvage treatment for local failure after chemotherapy or radiation therapy (CRT) for esophageal carcinoma. A prospective study found that complete remission was obtained in 19/25 patients (76%, 95% CI 55%-91%), with local failure limited to the submucosal layer.…”

“…As palliative treatment, stenting is still more commonly used for treatment of dysphagia in end‐stage esophageal cancer; however, PDT plays a large role in patients who cannot tolerate stents due to severe pain or post‐radiotherapy and has been shown to have a favorable survival outcome compared to other interventions when used initially . The largest study of palliative PDT for 215 affected patients reported improved dysphagia in 85%, achieving an average of 4.8 months of overall survival and a median of 2 months of dysphagia relief …”

“…Compared to porfimer solution, talaporfin sodium has the advantage of more rapid clearance from skin and requirement of a shorter sunshade period (2 weeks compared to 4‐6 weeks). The diode laser has a longer excitation wavelength, is smaller, and less expensive—this likely leads to deeper penetration to the muscularis propria, less tissue damage, and more accessibility for patients explaining the success of the aforementioned studies …”

“…The diode laser has a longer excitation wavelength, is smaller, and less expensive-this likely leads to deeper penetration to the muscularis propria, less tissue damage, and more accessibility for patients explaining the success of the aforementioned studies. 37 While chemotherapy with gemcitabine and cisplatin is current standard of care for patients with advanced cholangiocarcinoma, a recent study of 96 patients with advanced unresectable cholangiocarcinoma suggests combination of PDT with CRT improves overall survival (median 20 months, 95% CI 16.38-23.62) compared to PDT alone (15 months, 95% CI 10.02-19.98) and chemotherapy alone (10 months, 95% CI 8. 45-11.55).…”

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

“…86 In addition, when recurrence was found after CRT, morbidity and mortality rates of patients who underwent salvage esophagectomy after CRT increased because of the effects of the radiation given to the mediastinum and the tissues used as conduits. 92,93 However, other recent studies have suggested a promising degree of efficacy of photodynamic therapy, 94 a much-less-invasive treatment option in Figure 1 Curability criteria for endoscopic resection (ER) and the rate of lymph node metastasis (LNM) in superficial esophageal squamous cell carcinoma (SESCC). ¶No additional treatment is recommended in the white area, no definite recommendation is proposed in the gray area, and additional treatment is recommended in the black area.…”