Role of photodynamic therapy in the management of gastrointestinal cancer

Background: Surgery for cancer of the gastrointestinal tract is associated with high morbidity and mortality, especially in older patients. A significant proportion of patients cannot be cured and would be referred for palliative therapy. Others may have early cancer but are deemed unfit for surgery. Chemotherapy and external radiotherapy are suitable for only a proportion of patients. Therefore, photodynamic therapy may have a role in the management of these patients. It was the possibility of achieving selective tumour necrosis with sparing of normal tissue that made this treatment extremely appealing compared to other conventional tumour therapy. Method: The literature is reviewed (after an extensive Medline search 1975-1997) regarding the scientific basis of photodynamic therapy and the clinical experience to date with this therapy in the management of malignancies of the gastrointestinal tract. Results and Conclusions: Photodynamic therapy holds the promise of an eradication form of treatment for early cancer especially for patients deemed unfit for other treatment. It may also prove a useful supplement to other techniques in order to eliminate small residual areas of tumour left after the main bulk has been removed by other methods. The use of photodynamic therapy in the palliative management of gastrointestinal tract cancer is likely to be limited.