Endoscopic combination therapy with photodynamic therapy and endoscopic resection for wide circumferential local recurrence after radiotherapy for esophageal cancer

Background and Aims

For wide-circumferential local recurrence after chemoradiotherapy or radiotherapy (RT) for esophageal squamous cell carcinoma (ESCC), salvage surgery is performed, but combination therapy with photodynamic therapy (PDT) and endoscopic resection (ER) could be an alternative treatment for a T1b-T2 lesion. The aim of this report is to present the case of a patient in whom we achieved local control with combination therapy.

Methods

The patient was an 86-year-old man who underwent RT for cT2N1M0 ESCC. After RT, a local residual lesion was found of 30 mm, three-fourths of the circumference, and type 0-Is+IIc. Laser illumination was first performed to focus on the 0-Is portion, suspected submucosal invasion, and, thereafter, treatments such as ER or additional PDT were planned for nontreated 0-IIc areas, depending on the response of 0-Is after PDT.

Results

After initial PDT, 0-Is markedly shrunk, and a significant response was achieved; therefore, ER was performed on 0-IIc lesions. Subsequently, local recurrence occurred in the laser-illuminated 0-Is; therefore, 2 additional PDT sessions were performed. After the last PDT, local control was achieved and the patient has survived without recurrence for more than 3 years. No severe adverse events occurred.

Conclusions

Combination therapy with PDT and ER may be a less-invasive and potentially curative treatment option for patients with wide-circumferential local recurrence.