Efficacy and Safety of Photodynamic Therapy Sequential Dose-Reduction Concurrent Chemoradiotherapy in Locally Advanced Obstructive Esophageal Carcinoma: A Propensity Score Matching Analysis.

Abstract

Background: Dysphagia is a major symptom in esophageal carcinoma (EC) patients. photodynamic therapy (PDT) was approved for palliative treatment of patients with obstructive EC. Although it can remove the obstruction quickly, PDT may be difficult to achieve eradication alone. Thus, we aimed to assess whether photodynamic therapy sequential Dose-Reduction concurrent chemoradiotherapy (CCRT) can be an effective and safe approach for locally advanced obstructive EC.

Methods: This retrospective study included 121 patients with locally advanced obstructive EC who treated with radical CCRT (conventional treatment) and PDT sequential dose-reduction CCRT (combined treatment). A 1:1 propensity score matching (PSM) was conducted to balance potential bias. The improvement of dysphagia and overall survival (OS) was analyzed as the primary endpoint. Progression-free survival (PFS), local control, nutritional improvement and toxicities were analyzed as secondary endpoints.

Results: After PSM, 15 pairs of patients were selected for final analysis. Although the data failed to identify discrepancy in the remission rate of dysphagia between the two groups (73.3% VS 93.3%, P=0.33), the degree of dysphagia relief deviated significantly (2.13±0.52 VS 2.47±0.52, P=0.005). The onset of dysphagia remission was earlier in the combined treatment group than in the conventional treatment group (17.29±9.29 days VS 33.73±6.77 days, P<0.001). The median OS of conventional treatment group and combined treatment group were 21.10 months (95%CI 10.24∼31.96) and 36.67 months (95%CI 21.54∼51.80), respectively (P=0.048). The median PFS were 14.30 months (95%CI 7.79∼20.81) and 31.23 months (95%CI 13.68∼47.78), respectively (P=0.039). The rates of 1-year, 2-year and 3-year OS of conventional treatment and combined treatment group were 60%, 33.3%, 20% and 86.7%, 66.7%, 41.5%, respectively. The rates of 1-year, 2-year, and 3-year PFS of the two groups were 53.3%, 26.7%, 13.3% and 73.3%, 53.3%, 38.1%, respectively. The improvement of nutritional status in combined treatment group was better than that in conventional treatment group. The grade 3 toxicity rate was 46.7%, and no grade 4 or more toxicity was observed in all patients. The addition of PDT did not increase the risk of toxic reactions compared with concurrent chemoradiotherapy.

Conclusion: Photodynamic therapy sequential dose-reduction concurrent chemoradiotherapy can rapidly relieve dysphagia symptoms in patients with locally advanced obstructive EC. Compared with radical CCRT, it does not increase the incidence of treatment-related adverse reactions.