Abstract
Background and Study Aims: Patients with cancers of the head and neck have a strong tendency to develop early
synchronous and metachronous carcinomas of the esophagus. In many of these patients,
whose general condition is poor as a result of alcohol and tobacco abuse, the second
primary cancers require minimally invasive treatment. The aims of this study were
to evaluate the efficacy of photodynamic therapy for the treatment of early esophageal
carcinomas and to compare the results obtained with three different photosensitizers
(hematoporphyrin derivative), porfimer sodium (Photofrin II), and meta-(tetrahydroxyphenyl)chlorin
(m-THPC).
Patients and Methods: Thirty-one early squamous cell carcinomas (Tis or T1a) of the esophagus were treated by photodynamic therapy in 24 patients. Nine tumors
were treated with hematoporphyrin derivative, eight with Photofrin II and 14 with
m-THPC.
Results: The early cancers were cured in 84 % of patients after a mean follow-up period of
2 years. Because the number of cases included in each group was small, the differences
in recurrence rates for the different photosensitizers could not be evaluated statistically,
but m-THPC was more phototoxic, induced a shorter period of photosensitization of
the skin, and had better selectivity than either of the other photosensitizers. There
were four major complications: two stenoses and two esophagotracheal fistulas.
Conclusions: Photodynamic therapy eradicates early squamous cell carcinomas (Tis and T1a) of the esophagus efficiently. Transmural necroses leading to fistulas can be avoided
by using a low-penetrating wavelength of laser light (green light at 514.5 m instead
of red light at 630 or 652 nm). Stenoses always result from circumferential irradiation
of the esophageal wall, and this can be avoided by using a 180° or 240° windowed cylindrical
light distributor.
