Jun 10, 1998
Patients with advanced esophageal cancer now have an alternative to the standard, and often-times painful, Nd: YAG laser therapy. It is called Photofrin, a unique light-activated drug for photodynamic therapy and it's now being used by physicians at The New York Hospital-Cornell Medical Center, one of only three medical centers in the city with this technology.
Photofrin is the first light-activated drug approved in the U.S. for the less-painful treatment of patients with completely obstructing esophageal cancer, or of patients with partially obstructing esophageal cancer who, in the opinion of their physician, cannot be satisfactorily treated with Nd: YAG laser therapy.
Dr. Paul Basuk, Director of the Endoscopy Unit in the Division of Digestive Diseases at The New York Hospital-Cornell Medical Center, said, "Photodynamic therapy is a very acceptable option for patients with advanced esophageal cancer. Though it is not a cure, photodynamic therapy provides a relatively painless and rapid method of symptom relief."
He points out that prior to this technology, three options existed for treating esophageal cancer: (1) the YAG laser, (2) removing the patients' esophagus, a highly traumatic event, or (3) stenting, which involves forcing an opening in the esophagus, however, the tumor would eventually grow around the stent.
Esophageal cancer, which affects men at three times the rate at which it affects women, can block the passage of liquids and solid nutrition, and, at times, may prevent the patient from swallowing saliva. Photodynamic therapy is a desirable treatment because it is a minimally invasive and highly specific technique that is administered on an outpatient basis, or otherwise requires only a short hospital stay.
Photodynamic therapy uses Photofrin and a specially-adapted laser. The laser is positioned at the site of a tumor by a physician and specifically targets and destroys cancer cells. Because Photofrin is retained to a greater degree by cancer cells than by healthy cells, most of the healthy tissue surrounding the tumor is not affected. First, the drug is administered to patients intravenously two days prior to application of the laser. It is absorbed by the tissues in the esophagus, including the cancerous tissue, over a period of approximately 40 to 50 hours. After that time, a small video probe is inserted into the patient's esophagus, where it directs low energy, non-thermal laser light at the cancerous tissue. The laser light activates Photofrin, causing it to destroy tumor cells.
"After two days," says Dr. Basuk "the patient receives a follow-up endoscopy and the difference is remarkable. After three days, the opening in the esophagus is large enough so that the patient can enjoy a nearly normal diet." This process can be repeated up to three times allowing a waiting period of 30 days after each procedure.
The most common side effect of photodynamic therapy is sensitivity of the skin and eyes to light. Patients must avoid exposure to direct sunlight and bright indoor light for about six weeks after the therapy. Other side effects include fever, nausea and/or constipation, and local swelling and inflammation in and around the esophagus, which may cause chest discomfort.