Yamashita Hiroki, Kadota Tomohiro, Minamide Tatsunori, Sunakawa Hironori, Sato Daiki, Takashima Kenji, Nakajo Keiichiro, Murano Tatsuro, Shinmura Kensuke, Yoda Yusuke, Ikematsu Hiroaki, Yano Tomonori
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan.
Dig Endosc. 2022 Mar;34(3):488-496. doi: 10.1111/den.14072. Epub 2021 Jul 21.
Photodynamic therapy (PDT) is an optional salvage treatment for local failure of esophageal squamous cell carcinoma (ESCC) after chemoradiotherapy; however, local failure after PDT sometimes occurs. In such cases, second PDT is sometimes attempted, but its outcomes remain unclear. This study aimed to evaluate the efficacy and safety of second PDT.
We enrolled patients who underwent PDT for local failure of ESCC after chemoradiotherapy. We retrospectively evaluated local-complete response (L-CR) rate and clinical outcomes of first and second PDT. The indications for PDT were lesions within the muscle layer, <3 cm in size, and <3/4 of the esophageal circumference; not suitable for salvage surgery; and absence of metastasis. Second PDT was avoided when lesions were apparently refractory to first PDT, e.g. persistence of submucosal tumor-like protruded component or rapid regrowth of tumor at the ulceration after first PDT. L-CR was defined as endoscopic disappearance of tumor and post-PDT ulcer and absence of cancer cells histologically.
Among 82 patients who underwent first PDT, 27 underwent second PDT. The L-CR rates with first and second PDT were 63.0% and 40.7%, respectively. The 2-year overall survival rates after second PDT in patients with L-CR and local-nonCR were 79.5% and 40.5%, respectively. Five of 11 patients with L-CR survived without any recurrence. No grade ≥3 adverse events occurred.
Second PDT demonstrated excellent safety and acceptable efficacy; therefore, it could be a useful treatment for local failure after first PDT.
光动力疗法（PDT）是食管鳞状细胞癌（ESCC）放化疗后局部失败的一种可选挽救治疗方法；然而，PDT后有时仍会出现局部失败。在这种情况下，有时会尝试二次PDT，但其效果仍不明确。本研究旨在评估二次PDT的疗效和安全性。
我们纳入了因ESCC放化疗后局部失败而接受PDT的患者。我们回顾性评估了首次和二次PDT的局部完全缓解（L-CR）率及临床结局。PDT的适应证为病变位于肌层内、大小<3 cm、食管周径<3/4；不适合挽救性手术；且无转移。当病变对首次PDT明显难治时，如黏膜下肿瘤样突出成分持续存在或首次PDT后溃疡处肿瘤迅速复发，则避免进行二次PDT。L-CR定义为肿瘤和PDT后溃疡在内镜下消失且组织学上无癌细胞。
在82例接受首次PDT的患者中，27例接受了二次PDT。首次和二次PDT的L-CR率分别为63.0%和40.7%。二次PDT后，L-CR和局部未完全缓解患者的2年总生存率分别为79.5%和40.5%。11例L-CR患者中有5例存活且无任何复发。未发生≥3级不良事件。
二次PDT显示出良好的安全性和可接受的疗效；因此，它可能是首次PDT后局部失败的一种有效治疗方法。
