Photodynamic therapy with 5-aminolevulinic acid has proven to be safe and effective in patients with early neoplasia in Barrett's esophagus.
However, long-term results in patients with high-grade intraepithelial neoplasia or with early cancer are still lacking.
Dr Oliver Pech and colleagues from Germany evaluated the efficacy of photodynamic therapy with 5-aminolevulinic acid.
The researchers analyzed the effect of this treatment on the survival of 66 patients with early Barrett's neoplasia.
The team applied 5-aminolevulinic acid orally calculated at 60 mg per kg body weight 4 to 6 hours before photodynamic therapy.
Protoporphyrin IX induced by oral administration of 5-aminolevulinic acid was used as the photosensitizer.
|Disease-free survival in patients with high-grade intraepithelial neoplasia was 89%|
The research team maintained acid suppression in all patients.
The researchers reported that between 1996 and 2002, 667 patients with early neoplasia in Barrett's esophagus were referred for local endoscopic therapy.
The team noted that a total of 558 patients fulfilled the criteria for local endoscopic therapy.
However, only 66 patients with a mean age of 61 years were treated by photodynamic therapy.
The patients were separated into 2 groups, with 35 with high-grade intraepithelial neoplasia in Group 1 and 31 patients with early adenocarcinoma in Group 2.
The researchers reported that a total of 82 photodynamic therapies with 5-aminolevulinic acid were performed.
The team found that 34 of the 35 patients in Group 1 and all patients in group 2 achieved a complete response during a median follow-up period of 37 months.
The researchers observed 1 local recurrence in Group 1 and 10 in group 2.
The team noted that 7 patients died during follow-up, but that all deaths were not tumor related.
No major complications were observed.
The team noted that disease-free survival in patients with high-grade intraepithelial neoplasia was 89%, and, in for mucosal cancer, it was 68%.
The calculated 5-year survival was 97% in Group 1 and 80% in Group 2, but there occurred no death related to Barrett's neoplasia.
Dr Pech's team concluded, “This study shows excellent long-term results of photodynamic therapy with 5-aminolevulinic acid in patients with high-grade intraepithelial neoplasia or mucosal cancer.”
Photodynamic therapy with 5-aminolevulinic acid might be offered as an alternative to surgical esophagectomy and endoscopic resection, especially in cases with multifocal Barrett's neoplasia.”