PHOTODYNAMIC THERAPY OF ESOPHAGEAL CANCER

Twenty-three patients, 12 males and 11 females aged 42-86 years (mean age 69.6), with inoperable oesophageal cancer were treated by endoscopic photodynamic therapy. Inoperability in 20 patients was due to extent of tumour and existence of metastases, in two because of poor general condition and in one patient due to recurrence at the site of previous anastomosis. Prior to treatment, patients' degree of dysphagia and their functional status were recorded. Using barium contrast studies and endoscopy, the extent and location of the tumour within the lumen of the oesophagus were mapped out. Treatment protocol consisted of intravenous administration of the photosensitizer, Polyhaematoporphyrin, followed 24-48 h later by illumination of the tumour with 630 nm light produced by a copper vapour pumped-dye laser and delivered via a 400 mu m internal diameter optical fibre with a cylindrical diffusing end. All treatments were undertaken under general anaesthesia as day case procedures. There was no treatment-related mortality nor was there any complication apart from a mild skin photosensitivity reaction in one case. Every patient's swallowing and functional status was improved at 6 weeks post-treatment. Ten patients needed more than one treatment: five required oesophageal dilatation. Thirteen patients survived a mean period of 6.2 months. Two needed oesophageal intubation 3-4 weeks before their death. Ten patients are alive at 6-14 months. This study suggests photodynamic therapy in inoperable oesophageal cancer to be a useful treatment method and in suitable cases an alternative to other forms of palliation. Its value lies in the fact that it can be used to treat cancer at any level of the oesophagus irrespective of histology.