Ken Hatogai1, Tomonori Yano2, Takashi Kojima3, Masakatsu Onozawa4, Hiroyuki Daiko5, Shogo Nomura6, Yusuke Yoda2, Toshihiko Doi3, Kazuhiro Kaneko2, Atsushi Ohtsu7. 1. Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Gastroenterology, Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 2. Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 3. Department of Gastroenterology, Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 4. Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 5. Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 6. Department of Biostatistics, National Cancer Center, Kashiwa, Chiba, Japan. 7. Department of Gastroenterology, Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.
Abstract
BACKGROUND AND AIMS: 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.
BACKGROUND AND AIMS: 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.
Authors: Matthew C Surdel; Dennis J Horvath; Lisa J Lojek; Audra R Fullen; Jocelyn Simpson; Brendan F Dutter; Kenneth J Salleng; Jeremy B Ford; J Logan Jenkins; Raju Nagarajan; Pedro L Teixeira; Matthew Albertolle; Ivelin S Georgiev; E Duco Jansen; Gary A Sulikowski; D Borden Lacy; Harry A Dailey; Eric P Skaar Journal: Proc Natl Acad Sci U S A Date: 2017-07-24 Impact factor: 11.205