[Photodynamic therapy for barrett's esophagus and esophageal cancer]

Pichon Riviere A, Augustovski F, Garcia Marti S, Glujovsky D, Alcaraz A, Lopez A, Bardach A
Record ID 32014000291
Authors' objectives: To assess the available evidence on the efficacy, safety and coverage related aspects for the use of PDT in patients with BE and esophageal cancer.
Authors' recommendations: In general, evidence of variable methodological quality was identified in relation to the effectiveness and safety of the technology for BE and esophageal cancer. This evidence consists in RCTs, one cohort study and several non-randomized controlled studies. In BE, the evidence suggests that PDT plus PPI would be more efficacious than PPI in achieving long-term ablation of HGD and to slow down progression to cancer. Due to methodological limitations, the RCTs which compared PDT to APC do not allow to conclude if PDT is better, equal or worse than APC. To assess PDT in patients with early-stage esophageal cancer, observational studies were found which included different populations and sensitizer type. It is not possible to draw conclusions on the effectiveness of the technology in this subgroup of patients. In advanced and obstructive esophageal cancer, in terms of treatment with curative intent, one RCT suggesting that PDT was more efficacious than the Nd:YAG laser therapy was found. No significant differences were found between Stents or PDT. Brachytherapy with PDT seems to be more efficacious than brachytherapy alone. Small RCTs with palliative intent suggest that the addition of PDT to radiotherapy might be beneficial. Nd:YAG Laser and PDT might not differ in terms of mortality. There is no consensus on the optimal scheme in terms of right choice of photosensitizer, wavelength and length of exposure. As regards safety, the most common adverse effects of PDT were esophageal strictures and skin manifestations due to photosensitivity. To conclude, the current evidence suggests a defined role in non-surgical patients with BE and late-stage esophageal cancer, especially with palliative intent. PDT has not been compared in the literature yet against emerging techniques with a better safety profile and growing use, as radiofrequency ablation.
Project Status: Completed
Year Published: 2012
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Argentina
MeSH Terms
  • Photochemotherapy
  • Barrett Esophagus
Organisation Name: Institute for Clinical Effectiveness and Health Policy
Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA
Contact Name: info@iecs.org.ar
Contact Email: info@iecs.org.ar
Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)
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