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Introduction:
Esophageal cancer is one of the most common cancers worldwide. Chemoradiotherapy (CRT) is one of the curative treatments for esophageal cancer in patients with unresectable tumors or those who refuse surgery.
Talaporfin sodium, a second-generation photosensitizer, is rapidly cleared from the skin and requires a shorter sun-shade period (2 weeks).
In this study, we evaluated the efficacy of PDT with talaporfin sodium for local failure after CRT for esophageal cancer.
Methods:
Patients with histologically proven local failure limited within the muscularis propria after radiotherapy (RT) of 50 Gy or more for esophageal cancer were eligible.
The PDT procedure commenced with intravenous administration of a 40 mg/m2-dose of talaporfin sodium, followed by laser irradiation at a 664 nm wavelength 4 to 6 hours after administration. The fluence of the diode laser was set at 100 J/cm2 with a fluence rate of 150 mW/cm2.
The local efficacy was classified based on endoscopic evaluation as local complete response (L-CR).
Result:
Sixteen patients with a total of 19 lesions received additional laser irradiation. The median total laser exposure dose was 298 (range: 100–800) J. Thirteen patients with a total of 16 lesions achieved L-CR after PDT (L-CR rate: 84.2%); all of L-CR achieved within 12 weeks after PDT. The L-CR rate of T1 failure lesions was 92.8% (13/14), whereas the L-CR rate of T2 failure lesions was 60.0% (3/5).
Two patients (9.1%) who underwent PDT developed an esophageal perforation and were managed with non-surgical measures. There was no case of treatment-related death.
Conclusion:
PDT using talaporfin sodium and a diode laser is a safe and curative salvage treatment for local failure after CRT for patients with esophageal cancer. The possibility of esophageal perforation after PDT should be considered for longer than 1 month post-therapy.
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