Salvage Photodynamic Therapy Is an Effective and Safe Treatment for Patients with Local Failure after Definitive Chemoradiotherapy for Esophageal Squamous Cell Carcinoma
- 1 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 2 Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 3 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 4 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 5 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 6 Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 7 Department of Experimental Therapeutics, Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, Japan
- 8 Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 9 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 10 Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- 11 Department of Gastrointestinal Oncology, Osaka Medical Centre for Cancer and Cardiovascular Diseases, Osaka, Japan
- 12 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 13 Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Abstract
Although chemoradiotherapy (CRT) is one curative treatment option for patients with esophageal squamous cell carcinoma (ESCC), local failure after CRT remains a major problem for patients’ curability. The aim of this study was to evaluate the efficacy and safety of photodynamic therapy (PDT) as a salvage treatment for local failure. From August 2007 to March 2012, 193 consecutive ESCC patients were treated with definitive CRT in Kyoto University Hospital. Eighteen of the patients with T2 or earlier T-stage local failure after CRT underwent salvage PDT. After the salvage PDT, 11 patients (61.1%) achieved a complete response at the primary site. Over a median follow-up period of 28.3 months, the 1-year survival and progression-free survival rates were 77.8% and 38.9%, respectively; and the 2-year survival and progression-free survival rates were 60.6% and 33.3%, respectively. Adverse events were mild esophageal stricture in seven (38.9%), esophageal obstruction because of necrotic tissue in nine (50.0%), and photosensitivity in three (16.7%) patients. There were no severe complications or treatment-related deaths. Salvage PDT may be a promising treatment option for the patients with a local residual or recurrent tumor after CRT for ESCC when the lesion is suspected to be in T2 or earlier.
- Herskovic, A., Marts, K., Al-Sarraf, M., Leichman, L., Brindle, J., Vaitkevicius, V., et al. (1992) Combined Chemotherapy and Radiotherapy Compared with Radiotherapy Alone in Patients with Cancer of the Esophagus. New England Journal of Medicine, 326, 1593-1598. http://dx.doi.org/10.1056/NEJM199206113262403
- Muro, K., Hamaguchi, T., Ohtsu, A., Boku, N., Chin, K., Hyodo, I., et al. (2004) A Phase II Study of Single-Agent Docetaxel in Patients with Metastatic Esophageal Cancer. Annals of Oncology, 15, 955-959. http://dx.doi.org/10.1093/annonc/mdh231
- Swisher, S.G., Wynn, P., Putnam, J.B., Mosheim, M.B., Correa, A.M., Komaki, R.R., et al. (2002) Salvage Esophagectomy for Recurrent Tumors after Definitive Chemotherapy and Radiotherapy. Journal of Thoracic and Cardiovascular Surgery, 123, 175-183. http://dx.doi.org/10.1067/mtc.2002.119070
- Onozawa, M., Nihei, K., Ishikura, S., Minashi, K., Yano, T., Muto, M., et al. (2009) Elective Nodal Irradiation (ENI) in Definitive Chemoradiotherapy (CRT) for Squamous Cell Carcinoma of the Thoracic Esophagus. Radiotherapy and Oncology, 92, 266-269. http://dx.doi.org/10.1016/j.radonc.2008.09.025
- Yano, T., Muto, M., Hattori, S., Minashi, K., Onozawa, M., Nihei, K., et al. (2008) Long-Term Results of Salvage Endoscopic Mucosal Resection in Patients with Local Failure after Definitive Chemoradiotherapy for Esophageal Squamous Cell Carcinoma. Endoscopy, 40, 717-721. http://dx.doi.org/10.1055/s-2008-1077480
- Sibille, A., Lambert, R., Souquet, J.C., Sabben, G. and Descos, F. (1995) Long-Term Survival after Photodynamic Therapy for Esophageal Cancer. Gastroenterology, 108, 337-344. http://dx.doi.org/10.1016/0016-5085(95)90058-6
- Yano, T., Muto, M., Minashi, K., Ohtsu, A. and Yoshida, S. (2005) Photodynamic Therapy as Salvage Treatment for Local Failures after Definitive Chemoradiotherapy for Esophageal Cancer. Gastrointestinal Endoscopy, 62, 31-36. http://dx.doi.org/10.1016/S0016-5107(05)00545-6
- Yano, T., Muto, M., Minashi, K., Onozawa, M., Nihei, K., Ishikura, S., et al. (2011) Long-Term Results of Salvage Photodynamic Therapy for Patients with Local Failure after Chemoradiotherapy for Esophageal Squamous Cell Carcinoma. Endoscopy, 43, 657-663. http://dx.doi.org/10.1055/s-0030-1256373
- UICC (Union for International Cancer Control) (1997) TNM Classification of Malignant Tumors. 5th Edition, Wiley- Liss, New York.
- Tahara, M., Ohtsu, A., Hironaka, S., Boku, N., Ishikura, S., Miyata, Y., et al. (2005) Clinical Impact of Criteria for Complete Response (CR) of Primary Site to Treatment of Esophageal Cancer. Japanese Journal of Clinical Oncology, 35, 316-323. http://dx.doi.org/10.1093/jjco/hyi095