Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Gastrointestinal Surgery, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Esophagus. 2021 Jul;18(3):645-654. doi: 10.1007/s10388-020-00799-6. Epub 2020 Nov 17.
Salvage photodynamic therapy with talaporfin sodium has a high local control rate for esophageal cancer after definitive chemoradiotherapy. The eligibility criteria for photodynamic therapy include the absence of invasion to the cervical esophagus and a 3 cm maximum longitudinal lesion length. There is little evidence regarding the efficacy and safety of lesions outside the eligibility criteria. This retrospective cohort study evaluated the efficacy and safety of photodynamic therapy of such lesions.
Patients with consecutive lesions between February 2016 and May 2020 (n = 36) were enrolled. The local complete response rates and adverse events were compared between patients with cervical and non-cervical lesions and those with lesions larger and smaller than 3 cm.
The local complete response rate was 77.8% and was significantly lower in cervical than in non-cervical lesions (20.0% vs 80.6%, p = 0.005). Esophageal stricture, laryngeal pain, and fever were significantly higher in the cervical than in the non-cervical lesion group; however, the detected adverse events were up to grade 2. Laser exposure dose was high in lesions larger than 3 cm (median, 650 vs 400 J; p < 0.001). No significant differences in local complete response rates and adverse effects were noted. One case involving a lesion larger than 3 cm needed balloon dilations for esophageal stricture.
Although salvage esophageal photodynamic therapy was effective for local control with acceptable safety after definitive chemoradiotherapy failure, photodynamic therapy toward cervical lesions had a statistically lower local complete response rate. Lesions larger than 3 cm may be considered treatable.
对于接受根治性放化疗后食管癌患者，采用替拉泊芬钠进行挽救性光动力疗法（PDT），其局部控制率较高。PDT 的纳入标准包括无颈段食管侵犯和最长径不超过 3cm 的纵向病变。对于超出纳入标准的病变，PDT 的疗效和安全性证据有限。本回顾性队列研究评估了 PDT 治疗此类病变的疗效和安全性。
连续纳入 2016 年 2 月至 2020 年 5 月间的连续病变患者（n=36）。比较颈段与非颈段病变、病变长度大于 3cm 与小于 3cm 患者的局部完全缓解率和不良事件。
局部完全缓解率为 77.8%，颈段病变显著低于非颈段病变（20.0% vs. 80.6%，p=0.005）。颈段病变的食管狭窄、喉痛和发热发生率显著高于非颈段病变组；然而，检测到的不良事件最高为 2 级。病变长度大于 3cm 的激光暴露剂量较高（中位数，650 与 400J；p<0.001）。病变长度大于 3cm 与局部完全缓解率和不良事件无显著相关性。1 例病变长度大于 3cm 的患者因食管狭窄需要球囊扩张。
尽管根治性放化疗失败后，挽救性食管 PDT 对局部控制有效且安全性可接受，但颈段病变的 PDT 局部完全缓解率统计学上较低。病变长度大于 3cm 可能可以考虑进行治疗。
