Photodynamic therapy promising after failed chemo for ESCC

By Sarah Guy

Photodynamic therapy (PDT) is a potentially curative and tolerable salvage treatment option for patients with esophageal squamous cell carcinoma (ESCC) when chemoradiotherapy (CRT) has failed, report researchers.

Three-quarters of ESCC patients in their small phase II study had a complete response (CR) after PDT, and other than one treatment-related death, no adverse events greater than grade 3 occurred.

However, the team highlights that all of the study participants had local failure and none had metastasis, thus PDT may be most effective in this carefully selected population.

"In general, salvage surgery is indicated for patients with local failure after CRT," write Tomonori Yano (National Cancer Center Hospital Easr, Kashiwa, Japan) and co-investigators in the International Journal of Cancer.

"However, the most serious problems with salvage surgery are the high rates of complications and treatment-related mortality," they add, remarking that such mortality rates are known to be between 8% and 22%.

The team assessed CR (eradication of local recurrence), toxicity, progression-free survival, and overall survival in 25 ESCC patients treated with PDT after CRT failure, and followed up for a median 48 months.

A total of 19 (76%) patients achieved CR, including a significantly higher proportion of patients with stage T1 or T2 disease than patients with T3-stage disease, at 77% versus 42% by 1 year, respectively.

The most frequently reported adverse events were chest pain (61%) - of which the majority (79%) of occurrences were grade 1 - and fever (48%), of which all instances were grade 1.

No grade 3 or worse adverse events were recorded, however, except one fatality (4% of the cohort), which resulted from a PDT-related gastrointestinal hemorrhage.

Overall survival rates at 1 and 3 years post-PDT were 80.0% and 38.4%, respectively.

Like CR, overall survival was significantly higher among patients with stage T1 or T2 cancer before PDT compared with their stage T3 counterparts, both at 1 year (92.3 vs 66.7%) and 3 years (61.5 vs 0%) post-PDT.

In conclusion, say the researchers, "salvage PDT is an effective and tolerable salvage treatment option for local failure after CRT for ESCC in patients whose failure lesion is limited to the submucosal layer without any metastasis."

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