Patient predictors of histopathologic response after photodynamic therapy of Barrett's esophagus with high-grade dysplasia or intramucosal carcinoma

Background

Photodynamic therapy (PDT) has been used extensively for endoscopic ablation of Barrett's esophagus with high-grade dysplasia (HGD) or intramucosal carcinoma.

Objective

To identify patient variables that influence the likelihood of response to PDT.

Design

A retrospective cohort study.

Setting

Tertiary-referral center.

Patients

A total of 116 patients with Barrett's esophagus and with HGD, intramucosal carcinoma, or T1 cancer.

Interventions

PDT with porfimer sodium.

Main Outcome Measurements

(1) Ablation of HGD and/or intramucosal carcinoma and (2) eradication of all Barrett's epithelium.

Results

Of the patients, 51% underwent treatment for HGD and 49% of patients had intramucosal carcinoma or T1 cancer. At 12-month follow-up, ablation of HGD and/or cancer was observed in 70% of patients, and ablation of all Barrett's epithelium was observed in 39%. In multivariate analysis, the pretreatment length of Barrett's esophagus was inversely correlated with successful ablation of all Barrett's epithelium. Patients with Barrett's esophagus length more than 3 cm were less likely to experience complete ablation compared with patients with Barrett's esophagus length 3 cm or less (odds ratio [OR] 0.15 [95% CI, 0.04-0.50]). Patients with intramucosal carcinoma were not significantly less likely to experience elimination of HGD and/or cancer (OR 0.77 [95% CI, 0.30-2.00]) or ablation of all Barrett's epithelium (OR 0.82 [95% CI, 0.32-2.07]) compared with patients with HGD alone.

Limitations

Retrospective study, limited sample size without a control group for comparison.

Conclusions

PDT of Barrett's esophagus with HGD, intramucosal carcinoma, or T1 cancer can result in ablation of dysplasia and/or eradication of all Barrett's epithelium. Factors associated with the likelihood of response include length of Barrett's esophagus. The presence of intramucosal carcinoma or T1 cancer was not associated with higher likelihood of treatment failure.

Abbreviations: BMI, body mass index, HGD, high-grade dysplasia, IV, intravenous, OR, odds ratio, PDT, photodynamic therapy, PPI, proton pump inhibitor