Case report
Photodynamic therapy in palliative treatment of esophageal cancer

Introduction: Esophageal carcinoma has poor prognosis and five years survival is reached only in 10% of patients. Surgery is the present standard of treatment, but palliative therapy can be only applied in most of patients with advanced and metastatic stage of disease. Aim: To assess the usefulness of photodynamic therapy as a kind of palliative treatment in advanced esophageal carcinoma. Material and methods: Four patients with dysphagia to solid and pap like food were observed. Dysphagia has been presented longer than 3 months before admission. All patients had advanced stage of the neoplastic disease with metastases in distant organs (lymph nodes, lungs or liver) and very narrow oesophagus lumen. No infiltration in local blood vessels and no broncho-esophageal fistulas have been detected on X-ray imaging and CT scans. All patients were not fit for radical surgical treatment. Photofrin of 2 mg/kg b.m. was administered intravenously 48 hours before irradiation by Laser Diomed 630 PDT (2 W) with laser beam of 630 nm wave length and 350 J energy to the length of 2,5 cm of esophagus in time 720 sec. In upper part of esophagus and midesophagus two illuminations have been performed to each segment of 2.5 cm length. This procedure has been repeated 2 days later. Result: In three cases normal esophageal lumen has been obtained as well as the reduction of dysphagia. In one case the slight widening of stricture has been observed. Conclusion: Photodynamic therapy is promising minimally invasive technique in palliative treatment of esophageal cancer and cardia.