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Photodynamic destruction of high grade dysplasia and early carcinoma of the esophagus after the oral administration of 5‐aminolevulinic acid
Author(s) -
Gossner Liebwin,
May Andrea,
Sroka Ronald,
Stolte Manfred,
Hahn Eckehard G.,
Ell Christian
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19991115)86:10<1921::aid-cncr7>3.0.co;2-n
Subject(s) - medicine , esophagus , dysplasia , carcinoma , oral administration , administration (probate law) , dermatology , general surgery , gastroenterology , political science , law
BACKGROUND Photodynamic therapy (PDT) is a new local, endoscopically controlled therapeutic concept based on the selective sensitization of malignant and precancerous lesions prior to light‐induced tissue destruction. 5‐aminolevulinic acid (5‐ALA) appears to be a promising alternative photosensitizer with a high mucosa specificity without phototoxic side effects on the skin. The authors report on their experiences with this new form of PDT in 27 patients. METHODS Twenty‐seven patients (6 females and 21 males; ages 47–79 years) with histologically proven high grade dysplasia (n = 9) and early carcinoma (normal endoultrasonography or classified as uT1N0M0; n = 19; 1 patient had 2 lesions) of the esophagus were included in this study. Approximately 4–6 hours after oral ingestion of 5‐ALA in a dosage of 60 mg/kg of body weight, laser light irradiation was conducted with a dye laser system with a wavelength of 635 nanometers at a light dose of 150 J/cm 2 . RESULTS The length of the segment of the esophagus with severe dysplasia or carcinoma of the mucosa varied between 0.5–9.0 cm (mean length, 2.5 cm). High grade dysplasia was eradicated in all patients. In addition, 19 mucosal tumors in 18 patients were treated successfully in 10 of 19 cases with an average of 1.7 treatment sessions and a mean follow‐up of 16.9 months (range, 3–37 months). Method‐related morbidity and mortality were not observed. CONCLUSIONS Severe dysplasia and superficial (≤2 mm) mucosal carcinoma of the esophagus can be ablated completely by 5‐ALA‐PDT. PDT with 5‐ALA has few side effects and might offer an alternative to esophagectomy or radiochemotherapy. Cancer 1999;86:1921–8. © 1999 American Cancer Society.