Multimodal Treatment Effective for Barrett's Esophagus–Related Neoplasia
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This single-center study examined the long-term (median, 5 years) outcomes of 58 patients enrolled in a randomized controlled trial comparing photodynamic therapy with porfimer sodium (Photofrin) with photodynamic therapy with 5-aminolevulinic acid (ALA) in patients with Barrett's esophagus–related neoplasia. Dysplasia recurred after initial treatment completion in 7/20 patients (35%) successfully treated with ALA and 7/13 patients (54%) successfully treated with Photofrin. Recurrence was treated with endoscopic mucosal resection (EMR) with or without radiofrequency ablation (RFA) in both groups. Long-term complete resolution of dysplasia reached 90% in the ALA group and 76% in the Photofrin group.
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While there was a high recurrence rate in patients treated with photodynamic therapy using aminolevulinic acid and Photofrin for Barrett's esophagus–related neoplasia, multimodal treatment with EMR and RFA remains an effective option for patients previously treated with photodynamic therapy.
– Samuel Han, MD
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
Photodynamic therapy (PDT) was used as therapy for early neoplasia associated with Barrett's oesophagus (BE). This is 5-year follow-up of patients enrolled into randomised controlled trial of 5-aminolaevulinic acid (ALA) vs. Photofrin PDT.
METHODS
Biopsies were taken from original Barrett's segment during endoscopic follow up using Seattle protocol. Endoscopic mucosal resection (EMR) ± radiofrequency ablation (RFA) was preferred therapy in patients who failed PDT and/or had recurrent neoplasia.
RESULTS
Fifty eight of 64 patients enrolled in the original trial were followed up including 31 patients treated with ALA PDT (17 patients with ≤6 cm, 14 patients with >6 cm segment of BE) and 27 treated with Photofrin PDT (14 patients with ≤6 cm, 13 patients with >6 cm BE). Initial success was achieved in 65% (20/31) ALA and 48% (13/27) Photofrin patients (p = .289). Thirty five percent patients (7/20) relapsed in ALA group and 54% (7/13) relapsed in Photofrin group (p = .472). At a median follow-up of 67 months, no significant difference was found in long-term complete reversal of intestinal metaplasia (CR-IM) and complete reversal of dysplasia (CR-D) between ALA and Photofrin groups (78% vs. 63%; p = .18; 90% vs. 76%; p = .26). Original length of BE did not alter long-term outcome. Four patients from each group progressed to invasive oesophageal adenocarcinoma. Initial success of ALA PDT was associated with significantly better likelihood of long-term remission (p = .03).
CONCLUSIONS
Initial response to PDT plays key role in long term outcome. RFA ± EMR have, however, become preferred minimally invasive ablative therapy for BE-related neoplasia due to poor efficacy of PDT.
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Additional Info
Disclosure statements are available on the authors' profiles:
Long-Term Outcomes of the Randomized Controlled Trial Comparing 5-Aminolaevulinic Acid and Photofrin Photodynamic Therapy for Barrett's Oesophagus Related Neoplasia
Scand. J. Gastroenterol. 2017 Nov 21;[EPub Ahead of Print], D Kohoutova, R Haidry, M Banks, MA Butt, J Dunn, S Thorpe, L LovatFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.