Zhang Ming, Sun Zhenhua, Qiu Gang, Wei Hualin, Fang Baoshuan, Wang Ying, Zhang Xiaopeng, Li Juan
Department of Oncology, Hebei General Hospital, Shijiazhuang, China.
Department of Radiotherapy, Zhengzhou Yihe Hospital, Zhenzhou, China.
Photodiagnosis Photodyn Ther. 2025 Apr;52:104509. doi: 10.1016/j.pdpdt.2025.104509. Epub 2025 Jan 31.
Dysphagia is a major symptom in esophageal carcinoma (EC) patients. photodynamic therapy (PDT) was approved for palliative treatment of patients with obstructive EC. Although it can remove the obstruction quickly, PDT may be difficult to achieve eradication alone. Thus, we aimed to assess whether photodynamic therapy sequential Dose-Reduction concurrent chemoradiotherapy (CCRT) can be an effective and safe approach for locally advanced obstructive EC.
This retrospective study included 121 patients with locally advanced obstructive EC who treated with radical CCRT (conventional treatment) and PDT sequential dose-reduction CCRT (combined treatment). A 1:1 propensity score matching (PSM) was conducted to balance potential bias. The improvement of dysphagia and overall survival (OS) was analyzed as the primary endpoint. Progression-free survival (PFS), local control, nutritional improvement and toxicities were analyzed as secondary endpoints.
After PSM, 15 pairs of patients were selected for final analysis. Although the data failed to identify discrepancy in the remission rate of dysphagia between the two groups (73.3 % VS 93.3 %, P = 0.33), the degree of dysphagia relief deviated significantly (2.13 ± 0.52 VS 2.47 ± 0.52, P = 0.005). The onset of dysphagia remission was earlier in the combined treatment group than in the conventional treatment group (17.29 ± 9.29 days VS 33.73 ± 6.77 days, P < 0.001). The median OS of conventional treatment group and combined treatment group were 21.10 months (95 %CI 10.24∼31.96) and 36.67 months (95 %CI 21.54∼51.80), respectively (P = 0.048). The median PFS were 14.30 months (95 %CI 7.79∼20.81) and 31.23 months (95 %CI 13.68∼47.78), respectively (P = 0.039). The rates of 1-year, 2-year and 3-year OS of conventional treatment and combined treatment group were 60 %, 33.3 %, 20 % and 86.7 %, 66.7 %, 41.5 %, respectively. The rates of 1-year, 2-year, and 3-year PFS of the two groups were 53.3 %, 26.7 %, 13.3 % and 73.3 %, 53.3 %, 38.1 %, respectively. The improvement of nutritional status in combined treatment group was better than that in conventional treatment group. The grade 3 toxicity rate was 46.7 %, and no grade 4 or more toxicity was observed in all patients. The addition of PDT did not increase the risk of toxic reactions compared with concurrent chemoradiotherapy.
Photodynamic therapy sequential dose-reduction concurrent chemoradiotherapy can rapidly relieve dysphagia symptoms in patients with locally advanced obstructive EC. Compared with radical CCRT, it does not increase the incidence of treatment-related adverse reactions.
吞咽困难是食管癌（EC）患者的主要症状。光动力疗法（PDT）已被批准用于梗阻性EC患者的姑息治疗。尽管它可以快速解除梗阻，但PDT单独使用可能难以实现根除。因此，我们旨在评估光动力疗法序贯减量同步放化疗（CCRT）是否是局部晚期梗阻性EC的一种有效且安全的治疗方法。
这项回顾性研究纳入了121例接受根治性CCRT（传统治疗）和PDT序贯减量CCRT（联合治疗）的局部晚期梗阻性EC患者。进行1:1倾向评分匹配（PSM）以平衡潜在偏倚。将吞咽困难的改善和总生存期（OS）分析作为主要终点。无进展生存期（PFS）、局部控制、营养改善和毒性分析作为次要终点。
PSM后，选择15对患者进行最终分析。尽管数据未能确定两组间吞咽困难缓解率的差异（73.3%对93.3%，P = 0.33），但吞咽困难缓解程度有显著差异（2.13±0.52对2.47±0.52，P = 0.005）。联合治疗组吞咽困难缓解的起始时间早于传统治疗组（17.29±9.29天对33.73±6.77天，P < 0.001）。传统治疗组和联合治疗组的中位OS分别为21.10个月（95%CI 10.24∼31.96）和36.67个月（95%CI 21.54∼51.80）（P = 0.048）。中位PFS分别为14.30个月（95%CI 7.79∼20.81）和31.23个月（95%CI 13.68∼47.78）（P = 0.039）。传统治疗组和联合治疗组的1年、2年和3年OS率分别为60%、33.3%、20%和86.7%、66.7%、41.5%。两组的1年、2年和3年PFS率分别为53.3%、26.7%、13.3%和73.3%、53.3%、38.1%。联合治疗组的营养状况改善优于传统治疗组。3级毒性率为46.7%，所有患者均未观察到4级或更高级别的毒性。与同步放化疗相比，添加PDT并未增加毒性反应的风险。
光动力疗法序贯减量同步放化疗可快速缓解局部晚期梗阻性EC患者的吞咽困难症状。与根治性CCRT相比，它不会增加治疗相关不良反应的发生率。
