Document Detail


Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in barrett esophagus after endoscopic resection.
MedLine Citation:
PMID:  15844019     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND STUDY AIMS: The aim of the study was to evaluate the efficacy of photodynamic therapy (PDT) in the treatment of residual high-grade dysplasia or early cancer (HGD/EC) after endoscopic resection in Barrett esophagus. PATIENTS AND METHODS: Study patients were separated into group A, with proven residual HGD/EC, and group B with possible HGD/EC (positive lateral margins in the endoscopic resection specimen, without HGD/EC in the remaining Barrett esophagus). PDT treatment consisted of 5-aminolevulinic (5-ALA) photosensitization (40 mg/kg) followed by illumination of the Barrett esophagus with a total light dose of 100 J/cm (2). Complete remission was defined as the absence of HGD/EC in biopsies taken in two consecutive follow-up endoscopies. The percentage regression of Barrett esophagus, as well as the recurrence rate of HGD/EC, was calculated. RESULTS: 20 patients underwent PDT (group A, 11; group B, 9). Mild complications were seen in 4/26 procedures. The overall success rate was 15/20 (75 %). There was a significant difference in success rate between group A (55 %) and group B (100 %); P = 0.03. All patients had residual Barrett esophagus after PDT; the median regression percentage was 50 % (IQR 25 - 70 %). Recurrence of HGD/EC occurred in four patients (two each in groups A and B) after a median follow up of 30 months. CONCLUSIONS: In this selected group of patients, the addition of 5-ALA-PDT after endoscopic resection for HGD/EC had a disappointing success rate in patients who had residual HGD/EC after endoscopic resection. Most patients undergoing 5-ALA-PDT have residual Barrett mucosa after PDT and 5-ALA-PDT does not seem to prevent recurrences during follow-up.
Authors:
F Peters; M Kara; W Rosmolen; M Aalders; F Ten Kate; K Krishnadath; J van Lanschot; P Fockens; J Bergman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Endoscopy     Volume:  37     ISSN:  0013-726X     ISO Abbreviation:  Endoscopy     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-21     Completed Date:  2005-08-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  418-24     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aminolevulinic Acid / therapeutic use*
Barrett Esophagus / drug therapy*,  pathology,  surgery*
Chemotherapy, Adjuvant
Cohort Studies
Esophagoscopy*
Female
Humans
Male
Middle Aged
Neoplasm Staging
Photochemotherapy*
Photosensitizing Agents / therapeutic use*
Recurrence
Treatment Failure
Chemical
Reg. No./Substance:
0/Photosensitizing Agents; 106-60-5/Aminolevulinic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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