Salvage photodynamic therapy for local failure after chemoradiotherapy for esophageal squamous cell carcinoma

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• 作者：Ken Hatogai ; MD¹ ; ² ; Tomonori Yano ; MD¹ ; ; Takashi Kojima ; MD² ; Masakatsu Onozawa ; MD³ ; Hiroyuki Daiko ; MD ; PhD⁴ ; Shogo Nomura ; MSc⁵ ; Yusuke Yoda ; MD¹ ; Toshihiko Doi ; MD ; PhD² ; Kazuhiro Kaneko ; MD ; PhD¹ ; Atsushi Ohtsu ; MD ; PhD² ; ⁶
• 关键词：CI ; confidence interval ; CRT ; chemoradiotherapy ; EPS ; esophagus-preserved survival ; ESCC ; esophageal squamous cell carcinoma ; HR ; hazard ratio ; OS ; overall survival ; PDT ; photodynamic therapy ; PFS ; progression-free survival
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：83
• 期：6
• 页码：1130-1139.e3
• 全文大小：2864 K

文摘

Photodynamic therapy (PDT) is a less-invasive salvage treatment option for local failure at the primary site after chemoradiotherapy (CRT) for esophageal squamous cell carcinoma. The objective of this study was to clarify the long-term outcomes and prognostic factors of salvage PDT.

Methods

One hundred thirteen consecutive patients treated in our institution with PDT for local failure limited to within T2 without any metastases after definitive CRT performed between 1998 and 2008 were retrospectively enrolled. The complete response rate, adverse events, and survival outcomes were assessed and prognostic factors were investigated using a multivariate analysis.

Results

The complete response rate was 58.4% (95% confidence interval [CI], 49.3%-67.5%). The progression-free survival (PFS) and the overall survival (OS) rates at 5 years after salvage PDT were 22.1% (95% CI, 14.3%-30.0%) and 35.9% (95% CI, 26.7%-45.1%). N0 before CRT was significantly associated with OS (hazard ratio [HR], 0.54; 95% CI, 0.33-0.91, P = .020), whereas the impact of T1 or T2 before CRT on PFS (HR, 0.63; 95% CI, 0.38-1.04, P = .068) and that of a longer period between CRT and PDT on OS (HR, 0.64; 95% CI, 0.39-1.05, P = .078) were marginal. The treatment-related death rate was 1.8%.

Conclusions

Salvage PDT was found to have a superior outcome and a satisfactory safety profile. An earlier clinical stage before CRT and a longer interval between CRT and PDT may be associated with a longer survival period.