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Photodynamic therapy (PDT) using HPPH for the treatment of precancerous lesions associated with barrett's esophagus
Author(s) -
Nava Hector R.,
Allamaneni Shyam S.,
Dougherty Thomas J.,
Cooper Michele T.,
Tan Wei,
Wilding Gregory,
Henderson Barbara W.
Publication year - 2011
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.21112
Subject(s) - medicine , cancer
Background and Objectives Photodynamic therapy (PDT) with porfimer sodium, FDA approved to treat premalignant lesions in Barrett's esophagus, causes photosensitivity for 6–8 weeks. HPPH (2‐[1‐hexyloxyethyl]‐2‐devinyl pyropheophorbide‐a) shows minimal photosensitization of short duration and promising efficacy in preclinical studies. Here we explore toxicity and optimal drug and light dose with endoscopic HPPH‐PDT. We also want to know the efficacy of one time treatment with HPPH‐PDT. Study Design/Materials and Methods Two nonrandomized dose escalation studies were performed (18 patients each) with biopsy‐proven high grade dysplasia or early intramucosal adenocarcinoma of esophagus. HPPH doses ranged from 3 to 6 mg/m 2 . At 24 or 48 hours after HPPH administration the lesions received one endoscopic exposure to 150, 175, or 200 J/cm of 665 nm light. Results Most patients experienced mild to moderate chest pain requiring symptomatic treatment only. Six patients experienced grade 3 and 4 adverse events (16.6%). Three esophageal strictures were treated with dilatation. No clear pattern of dose dependence of toxicities emerged. In the drug dose ranging study (light dose of 150 J/cm at 48 hours), 3 and 4 mg/m 2 of HPPH emerged as most effective. In the light dose ranging study (3 or 4 mg/m 2 HPPH, light at 24 hours), complete response rates (disappearance of high grade dysplasia and early carcinoma) of 72% were achieved at 1 year, with all patients treated with 3 mg/m 2 HPPH plus 175 J/cm and 4 mg/m 2 HPPH plus 150 J/cm showing complete responses at 1 year. Conclusions HPPH‐PDT for precancerous lesions in Barrett's esophagus appears to be safe and showing promising efficacy. Further clinical studies are required to establish the use of HPPH‐PDT. Lasers Surg. Med. 43:705–712, 2011. © 2011 Wiley‐Liss, Inc.