Photodynamic therapy with Photofrin followed by thermal ablation for elimination of dysplasia and early cancer in Barrett's esophagus: follow-up in 100 patients

Masoud Panjehpour; Bergein F. Overholt M.D.; John M. Haydek M.D.

doi:10.1117/12.308135

19 May 1998 Photodynamic therapy with Photofrin followed by thermal ablation for elimination of dysplasia and early cancer in Barrett's esophagus: follow-up in 100 patients

Masoud Panjehpour, Bergein F. Overholt M.D., John M. Haydek M.D.

Author Affiliations +

Proceedings Volume 3247, Optical Methods for Tumor Treatment and Detections: Mechanisms and Techniques in Photodynamic Therapy VII; (1998) https://doi.org/10.1117/12.308135
Event: BiOS '98 International Biomedical Optics Symposium, 1998, San Jose, CA, United States

Abstract

Photodynamic therapy (PDT) using Photofrin and 630 nm laser light was used to treat 100 Barrett's esophagus patients with dysplasia and early cancer. Twelve patients had superficial esophageal cancers (T1-T2, NO, MO). Laser light was delivered to the esophageal mucosa by cylindrical diffuser inserted through the endoscope or via a 3, 5 or 7 cm windowed esophageal centering balloons. Nd:YAG laser ablation was used on small residual islands of Barrett's mucosa during long term follow-up after PDT. Patients were maintained on omeprazole and were followed for 6 - 84 months following photodynamic therapy. Photodynamic therapy produced destruction of normal, dysplastic and malignant mucosa in treated areas. Approximately 75 - 80% of treated Barrett's mucosa healed as normal squamous epithelium in all patients. Complete elimination of Barrett's epithelium was found in 43 patients. Nd:YAG laser was required to ablate small residual areas of Barrett's mucosa in 35 of these patients. Dysplasia was eliminated in 77 patients. Ten of the 12 malignancies were ablated with no recurrence being found during follow-up. Healing was associated with esophageal strictures in 34% but after using the 5 and 7 cm balloons, the incidence of strictures decreased to 18%. All strictures were treated successfully by dilation. In summary, PDT alone or combined with Nd:YAG laser ablation, in conjunction with long-term acid inhibition provides an effective endoscopic treatment to eliminate dysplasia and superficial cancer in Barrett's patients, and reduce the amount of or eliminate Barrett's mucosa completely.

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Masoud Panjehpour, Bergein F. Overholt M.D., and John M. Haydek M.D. "Photodynamic therapy with Photofrin followed by thermal ablation for elimination of dysplasia and early cancer in Barrett's esophagus: follow-up in 100 patients", Proc. SPIE 3247, Optical Methods for Tumor Treatment and Detections: Mechanisms and Techniques in Photodynamic Therapy VII, (19 May 1998); https://doi.org/10.1117/12.308135

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KEYWORDS

Photodynamic therapy

Cancer

Esophagus

Endoscopy

Biopsy

Nd:YAG lasers

Diffusers

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