Minakata Nobuhisa, Kadota Tomohiro, Yamashita Hiroki, Watanabe Takashi, Inaba Atsushi, Sunakawa Hironori, Nakajo Keiichiro, Shinmura Kensuke, Yano Tomonori
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
VideoGIE. 2025 Apr 22;10(9):455-459. doi: 10.1016/j.vgie.2025.04.007. eCollection 2025 Sep.
For wide-circumferential local recurrence after chemoradiotherapy or radiotherapy (RT) for esophageal squamous cell carcinoma (ESCC), salvage surgery is performed, but combination therapy with photodynamic therapy (PDT) and endoscopic resection (ER) could be an alternative treatment for a T1b-T2 lesion. The aim of this report is to present the case of a patient in whom we achieved local control with combination therapy.
The patient was an 86-year-old man who underwent RT for cT2N1M0 ESCC. After RT, a local residual lesion was found of 30 mm, three-fourths of the circumference, and type 0-Is+IIc. Laser illumination was first performed to focus on the 0-Is portion, suspected submucosal invasion, and, thereafter, treatments such as ER or additional PDT were planned for nontreated 0-IIc areas, depending on the response of 0-Is after PDT.
After initial PDT, 0-Is markedly shrunk, and a significant response was achieved; therefore, ER was performed on 0-IIc lesions. Subsequently, local recurrence occurred in the laser-illuminated 0-Is; therefore, 2 additional PDT sessions were performed. After the last PDT, local control was achieved and the patient has survived without recurrence for more than 3 years. No severe adverse events occurred.
Combination therapy with PDT and ER may be a less-invasive and potentially curative treatment option for patients with wide-circumferential local recurrence.
对于食管鳞状细胞癌（ESCC）经放化疗或放疗（RT）后出现的广泛环周局部复发，需行挽救性手术，但光动力疗法（PDT）与内镜切除术（ER）联合治疗可能是T1b - T2病变的一种替代治疗方法。本报告旨在介绍一例通过联合治疗实现局部控制的患者病例。
该患者为一名86岁男性，因cT2N1M0食管鳞状细胞癌接受放疗。放疗后，发现局部残留病变，大小为30 mm，累及四分之三的周径，病理类型为0-Is + IIc型。首先对怀疑有黏膜下浸润的0-Is部分进行激光照射，然后根据PDT后0-Is的反应，对未治疗的0-IIc区域计划进行ER或额外的PDT等治疗。
初次PDT后，0-Is明显缩小，取得显著反应；因此，对0-IIc病变进行了ER。随后，激光照射的0-Is区域出现局部复发；因此，又进行了2次PDT治疗。最后一次PDT后，实现了局部控制，患者已存活3年以上无复发。未发生严重不良事件。
对于广泛环周局部复发的患者，PDT与ER联合治疗可能是一种侵入性较小且有潜在治愈可能的治疗选择。
