P0493 - A Study of PDT in Stage IB Carcinoma Esophagus in Patients Who Are Not Candidates for Surgery or Chemotherapy

Sammy Hamad, DO¹, Varshita Goduguchinta, DO², Omar Alsalman, MD¹, Yasmin Gerais, MD¹, Bachar Hamad, MD³, Laura Hamad, DO¹, Fares Hamad, DO¹, Rahil Desai, DO², Navkiran Randhawa, DO⁴, Ahamed Khalyfa, DO⁵, Diya Mehta, ⁶, Charvi Kumar, ⁶, Olivia N. Kyeni, MBChB, MD⁷, Mahnoor Inamullah, MD⁶, Kamran Ayub, MD^8
1Ascension Saint Joseph Medical Center, Joliet, IL; ²Franciscan Health Olympia Fields, Chicago, IL; ³Ascension Saint Joseph Hospital, Joliet, IL; ⁴Medical College of Georgia at Augusta University, Augusta, GA; ⁵University of Iowa, Iowa City, IA; ⁶Southwest Gastroenterology, a Division of GI Partners of Illinois, New Lenox, IL; ⁷University of Nairobi, McKinney, TX; ⁸Silver Cross Hospital, New Lenox, IL

Introduction: Photodynamic therapy (PDT) is a clinically approved treatment for
carcinoma esophagus. It is typically used in treatment of patients with stage 1A
disease who are not deemed surgical candidates, and ESD is not possible due to
adhesions, scarring etc. Also used for palliation of dysphagia in advanced cancer in
selected patients. We studied PDT in patients with stage 1B carcinoma esophagus,
who were not surgical candidates, or candidates for chemotherapy or refused such
treatment.

Methods: The study was performed from 2018 to present at 4 hospitals. Five patients
were included in the study, four patient had adenocarcinoma esophagus and one with
squamous carcinoma. All patient had prior ESD with invasion of submucosa on
pathology in 4 patients & positive deep margin in 2. Four patients had cirrhosis
making surgery and chemotherapy undesirable, the fifth patient refused surgery or
chemotherapy despite repeated counselling. All patients received porfimer sodium 2
mg/kg as infusion, followed by EGD with light therapy 48 to 72 hours later. The
endoscopy was repeated twice at 48 to 72 hour intervals, with repeat light application
if deemed appropriate.

Results: All patients had good response after one treatment. Two patients received a
second light application. At 2 year interval all patient had no evidence of local or
distant recurrence with negative biopsies and CT scans. Two patients had chest pain
lasting about one week. One patient developed esophageal stricture, that required
dilation on three separate occasions. All patients were advised to avoid bright lights
and direct sunlight for six weeks and provided with appropriate gear to protect from
sunlight, no skin burns were noted.

Discussion: In this small study PDT appears to be safe and effective in patients
with stage 1B carcinoma esophagus if surgery and chemotherapy is not an option.
Larger multicenter trials are needed to confirm our findings.


Disclosures:


Sammy Hamad, DO¹, Varshita Goduguchinta, DO², Omar Alsalman, MD¹, Yasmin Gerais, MD¹, Bachar Hamad, MD³, Laura Hamad, DO¹, Fares Hamad, DO¹, Rahil Desai, DO², Navkiran Randhawa, DO⁴, Ahamed Khalyfa, DO⁵, Diya Mehta, ⁶, Charvi Kumar, ⁶, Olivia N. Kyeni, MBChB, MD⁷, Mahnoor Inamullah, MD⁶, Kamran Ayub, MD⁸. P0493 - A Study of PDT in Stage IB Carcinoma Esophagus in Patients Who Are Not Candidates for Surgery or Chemotherapy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.