Evaluation of the efficacy and safety of salvage photodynamic therapy by talaporfin sodium for cervical esophageal cance
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ORIGINAL ARTICLE
Evaluation of the efficacy and safety of salvage photodynamic therapy by talaporfin sodium for cervical esophageal cancers and lesions larger than 3 cm Tomoyuki Hayashi1 · Yoshiro Asahina1 · Hiroyoshi Nakanishi1 · Takeshi Terashima1 · Koichi Okamoto2 · Shinya Yamada1 · Hajime Takatori1 · Kazuya Kitamura1 · Eishiro Mizukoshi1 · Itasu Ninomiya2 · Shuichi Kaneko1 Received: 3 September 2020 / Accepted: 4 November 2020 © The Japan Esophageal Society 2020
Abstract Background Salvage photodynamic therapy with talaporfin sodium has a high local control rate for esophageal cancer after definitive chemoradiotherapy. The eligibility criteria for photodynamic therapy include the absence of invasion to the cervical esophagus and a 3 cm maximum longitudinal lesion length. There is little evidence regarding the efficacy and safety of lesions outside the eligibility criteria. This retrospective cohort study evaluated the efficacy and safety of photodynamic therapy of such lesions. Methods Patients with consecutive lesions between February 2016 and May 2020 (n = 36) were enrolled. The local complete response rates and adverse events were compared between patients with cervical and non-cervical lesions and those with lesions larger and smaller than 3 cm. Results The local complete response rate was 77.8% and was significantly lower in cervical than in non-cervical lesions (20.0% vs 80.6%, p = 0.005). Esophageal stricture, laryngeal pain, and fever were significantly higher in the cervical than in the non-cervical lesion group; however, the detected adverse events were up to grade 2. Laser exposure dose was high in lesions larger than 3 cm (median, 650 vs 400 J; p 3 cm, PDT is not recommended due to increased laser irradiation, which may lead to an increased risk of complications, such as perforation and stricture. However, there is insufficient evidence regarding the safety and efficacy of cervical esophageal lesions or lesions > 3 cm. Despite the limited treatment methods for esophageal cancer after RT, there is a high demand for PDT. Therefore, as long as consent is provided by the patient, PDT could be conducted even in cervical esophageal lesions or those > 3 cm. We evaluated the efficacy and safety of PDT using talaporfin sodium and assessed the adequacy of PDT for cervical esophageal lesions and lesions > 3 cm.
Patients/materials and methods Patients This single center (Kanazawa University Hospital, Ishikawa, Japan) retrospective cohort study included patients with consecutive lesions who underwent PDT for esophageal neoplasia between February 2016 and May 2020. After informed consent was provided by the physicians, the treatment was conducted for one lesion at a time. Only the first treatment was included in this study.
Eligibility Local failure after CRT or RT was an essential eligibility criterion. Local failure was proven histologically. Even when the patients were candidates for salvage surgery, we conducted PDT where possible. We did not conduct salvage endoscopic resection prior to PDT because
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