Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Surg Endosc. 2020 Feb;34(2):899-906. doi: 10.1007/s00464-019-06846-3. Epub 2019 May 28.
Photodynamic therapy (PDT) is a salvage treatment for local failure following chemoradiotherapy (CRT) for esophageal cancer. This study aimed to evaluate the efficacy and safety of salvage PDT using the second-generation photosensitizer, talaporfin sodium (L-PDT), and compare L-PDT to PDT using porfimer sodium (P-PDT).
We retrospectively analyzed clinical outcomes of patients treated with L-PDT and P-PDT. Patients with histologically proven local failure limited to the shallow muscularis propria layer (T2) after CRT or radiotherapy (RT) for esophageal cancer were enrolled.
A total of 121 patients were enrolled in this study. L-PDT and P-PDT groups consisted of 44 and 77 patients, respectively. The overall local complete response (L-CR) rate was 62.1% (95% confidence interval [CI], 52.6-70.9), and the L-PDT group showed a better L-CR rate than did the P-PDT group (69.0% [95% CI 52.9-82.4] vs. 58.1% [95% CI 46.1-69.5]). The common complications of skin phototoxicity, esophageal stricture, and esophageal fistula were all less frequent in the L-PDT group than in the P-PDT group. The only treatment-related death in this study was in the P-PDT group. With a median follow-up period of 15.8 months (interquartile range 7.1-37.4) in all 121 patients, overall survival rate at 1 year was significantly higher among patients who achieved L-CR (91.2% [95% CI 80.2-96.3]) than among those who could not achieve L-CR with PDT (50.8% [95% CI 33.6-65.6]).
L-PDT represented better short-term outcomes than P-PDT as a salvage treatment for local failure following CRT or RT for esophageal cancer.
光动力疗法（PDT）是放化疗（CRT）治疗食管癌后局部复发的挽救性治疗方法。本研究旨在评估第二代光敏剂替泊芬钠（L-PDT） salvage PDT 的疗效和安全性，并将 L-PDT 与 PDT 用卟吩姆钠（P-PDT）进行比较。
我们回顾性分析了接受 L-PDT 和 P-PDT 治疗的患者的临床结果。入组标准为 CRT 或放疗（RT）后病理证实的局限于浅肌层（T2）的局部复发食管癌患者。
本研究共纳入 121 例患者。L-PDT 和 P-PDT 组分别有 44 例和 77 例患者。总的局部完全缓解（L-CR）率为 62.1%（95%可信区间[CI]：52.6-70.9），L-PDT 组的 L-CR 率优于 P-PDT 组（69.0% [95% CI：52.9-82.4] vs. 58.1% [95% CI：46.1-69.5]）。皮肤光毒性、食管狭窄和食管瘘等常见并发症在 L-PDT 组均少于 P-PDT 组。本研究中唯一的治疗相关死亡发生在 P-PDT 组。在所有 121 例患者中，中位随访时间为 15.8 个月（四分位间距 7.1-37.4），在 L-CR 患者中，1 年总生存率显著高于 PDT 未能达到 L-CR 的患者（91.2% [95% CI：80.2-96.3] vs. 50.8% [95% CI：33.6-65.6]）。
L-PDT 作为 CRT 或 RT 治疗食管癌后局部复发的挽救性治疗，其短期疗效优于 P-PDT。
