Authors' objectives:

The Ministre de la Sante et des Services Sociaux (MSSS) asked the Agence d'Evaluation des technologies et des modes dintervention en sante (AETMIS) to evaluate the efficacy of photodynamic therapy using porfimer sodium for its approved oncological indications. This report reveals the results of the assessment, attempts to adequately situate this treatment within the therapeutic arsenal available in Quebec, and presents some preliminary observations on its use for the treatment of Barrett's esophagus.

Authors' results and conclusions: With respect to cancers of the lung and bladder and superficial esophageal cancers, findings seem to indicate that photodynamic therapy with Photofrin(R) (PDT-PF) does have a therapeutic effect but that there is insufficient evidence to conclude that it has any advantage over other available treatments. With respect to the palliative treatment for advanced esophageal cancer, studies suggest, with a limited level of evidence, that the efficacy of PDT (PF) appears to be similar to that of other palliative treatments (Nd:Yag laser ablation; metal stents). The cost of treatment with PDT (PF) is apparently much higher than that with stents. This important factor, combined with the fact that stents are easy to use and already in widespread use, diminishes both the interest in using PDT (PF) for this indication and the probability that it will be adopted in the current context. Nevertheless, PDT (PF) could be used as a complementary therapy when other treatments are contraindicated. The recent approval of PDT (PF) in Canada for a new indication - Barrett's esophagus - raises important issues. A more in-depth examination will need to be conducted of the long-term efficacy of PDT for this indication and of its place in the current therapeutic arsenal, which already offers several possible treatments. These issues should preferably be reviewed in a separate assessment report. Finally, there seems to be a near consensus in all the literature reviewed that the field of application of PDT is likely to expand and undergo many technological development, especially with respect to the photosensitizing agents used, which may lead to its increased use in the years to come. Photodynamic therapy is not expected to replace surgery, radiotherapy or chemotherapy; rather, it is meant to complement them. Still, we will need to obtain stronger scientific evidence of the advantages of PDT over other treatments and to examine its impact on the Quebec healthcare system before its use can be justified in these new applications.

Authors' recommendations: In light of its analysis, AETMIS recommends the following: For the treatment of lung and bladder cancers and superficial esophageal cancers, PDT (PF) should be used only for clinical research purposes and should not be authorized for public coverage. For the palliative treatment of advanced esophageal cancer, PDT (PF) should be considered a possible option when recognized treatments are contraindicated and should undergo further clinical research. For the treatment of Barrett's esophagus, PDT (PF) should be fully assessed before it is introduced into current practice. A technology watch should be implemented to track technological advances in PDT in general and its new applications in particular.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.aetmis.gouv.qc.ca/fr/publications/scientifiques/cancer/2004_0 1_res_en.pdf

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé

Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)