Photodynamic Therapy and Surgery Comparable for Barrett"s Esophagus

By Martha Kerr

NEW YORK MAY 23, 2007 (Reuters Health) - The results of a Mayo Clinic study show that survival outcomes are comparable with photodynamic therapy and esophagectomy in patients with high-grade dysplasia in Barrett"s esophagus.

A review of the records of 199 patients with high-grade dysplasia of Barrett"s esophagus treated with photodynamic therapy or surgery at the Mayo Clinic College of Medicine in Rochester, Minnesota, between 1994 and 2004, was conducted by Dr. Ganapathy A. Prasad and colleagues.

Seventy patients underwent transhiatal or transthoracic esophagectomy, and 129 were treated with photodynamic therapy. Median follow-up was 61 months in surgical patients and 59 months in the photodynamic therapy patients.

Overall mortality at the end of the follow-up period was 9% with photodynamic therapy and 8.5% with surgery. Treatment modality was not a significant predictor of mortality on multivariate analysis.

"Overall survival in the two groups was comparable despite high-grade dysplasia recurring in 30% of photodynamic therapy-treated patients and progression to cancer in 5.4%," the researchers conclude. "The majority of high-grade dysplasia recurrences were successfully treated endoscopically," according to the report in the April issue of Gastroenterology.

"Additionally, overall survival between the groups was similar despite 12.7% of the surgical group having cancer ultimately discovered in the resected surgical specimen."

"Esophagectomy was an almost knee-jerk response to high-grade dysplasia in Barrett"s esophagus," observes editorialist Dr. Richard E. Sampliner of the Southern Arizona VA HealthCare System in Tucson.

"Patients with Barrett"s esophagus and high-grade dysplasia face an excellent 5-year survival with contemporary surgery at a high-volume center or with endoscopic therapy at an expert center," Dr. Sampliner told Reuters Health. "There were no esophageal cancer deaths in either group after a follow-up of 5 years."

"A paradigm shift in therapy is taking place" away from surgery and toward a more minimally invasive approach in the management of dysplasia in Barrett"s esophagus, Dr. Sampliner points out.

However, "because of the potential of a patient with Barrett"s high-grade dysplasia harboring a concurrent cancer," he cautions, "staging before endoscopic therapy, as done in this endoscopic cohort, is essential."

SOURCE:

• Gastroenterology 2007;132:1226-1233,1607-1608.