Ken Hatogai, MD, from the Department of Gastroenterology, Endoscopy Division, at the National Cancer Center Hospital East, in Kashiwa, Chiba, Japan discusses this article, “Salvage photodynamic therapy for local failure after chemoradiotherapy for esophageal squamous cell carcinoma.”

The present study clarified the long-term results and prognostic factors of salvage photodynamic therapy (PDT) for local failure after definitive chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) in a large cohort of 113 patients.

Although chemoradiotherapy is a definitive treatment option for ESCC, local failure such as residual or recurrent lesions remains a major obstacle to achieving a cure. Salvage surgery is generally considered in this setting, however patients are often intolerant to surgery because of its high incidence of postoperative adverse events. We have performed PDT for local failure lesions with T1-2N0M0 after chemoradiotherapy for such patients. It is important to clarify the long-term results and the appropriate candidate for such a less-invasive endoscopic salvage therapy. Figure 4. Endoscopic examination of a patient who achieved a complete response with photodynamic therapy. A, cT3N1M0 (stage III) before chemoradiotherapy. B, A local residual lesion after chemoradiotherapy. The tumor depth was T1b, as observed using EUS. C, One week after photodynamic therapy. A deep ulceration with dense necrotic tissue was observed almost circumferentially. D, At 3 years after photodynamic therapy, no evidence of recurrence is visible.

PDT for local failure after chemoradiotherapy for ESCC showed an effective local control power, an acceptable long-term survival, and a sufficient safety profile. In multivariate analysis, N0 before CRT was significantly associated with a better overall survival. A longer period from CRT until PDT demonstrated a tendency for a better overall survival.

For patients who cannot tolerate salvage surgery because of a poor medical condition, PDT can be an option for definitive salvage treatment if patients are selected appropriately. It is important to consider not only the tumor status at the time of salvage treatment, but also the baseline tumor status before chemoradiotherapy and the preceding therapeutic course of chemoradiotherapy when deciding whether salvage PDT is indicated.

Read the article abstract here.

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