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...
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| Veröffentlicht in: | Gastrointestinal endoscopy 2009-02, Vol.69 (2), p.205-212 |
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| description | 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. |
| doi_str_mv | 10.1016/j.gie.2008.05.032 |
| format | Article |
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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.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2008.05.032</identifier><identifier>PMID: 18950764</identifier><identifier>CODEN: GAENBQ</identifier><language>eng</language><publisher>Maryland heights, MO: Mosby, Inc</publisher><subject>Aged ; Barrett Esophagus - drug therapy ; Barrett Esophagus - pathology ; Biological and medical sciences ; Digestive system. Abdomen ; Diseases of the skin. Cosmetics ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophageal Neoplasms - complications ; Esophageal Neoplasms - drug therapy ; Esophageal Neoplasms - pathology ; Esophagus ; Female ; Gastroenterology and Hepatology ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Other diseases. Semiology ; Photochemotherapy ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Gastrointestinal endoscopy, 2009-02, Vol.69 (2), p.205-212</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2009 American Society for Gastrointestinal Endoscopy</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-6d9eea21f5ed64806d72d45629858d89376d1ebc2da455a490e83d4ad824186f3</citedby><cites>FETCH-LOGICAL-c436t-6d9eea21f5ed64806d72d45629858d89376d1ebc2da455a490e83d4ad824186f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0016510708018579$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21093876$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18950764$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yachimski, Patrick, MD</creatorcontrib><creatorcontrib>Puricelli, William P., RN</creatorcontrib><creatorcontrib>Nishioka, Norman S., MD</creatorcontrib><title>Patient predictors of histopathologic response after photodynamic therapy of Barrett's esophagus with high-grade dysplasia or intramucosal carcinoma</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>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.</description><subject>Aged</subject><subject>Barrett Esophagus - drug therapy</subject><subject>Barrett Esophagus - pathology</subject><subject>Biological and medical sciences</subject><subject>Digestive system. Abdomen</subject><subject>Diseases of the skin. Cosmetics</subject><subject>Endoscopy</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Esophageal Neoplasms - complications</subject><subject>Esophageal Neoplasms - drug therapy</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophagus</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Other diseases. Semiology</subject><subject>Photochemotherapy</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ksuKFDEUhgtRnHb0AdxINuqq2qQuSQpB0MEbDCio63AmOdWVtqpSk5NS-j18YNN0o-DCVRb5_pPwf6coHgu-FVzIF_vtzuO24lxvebvldXWn2AjeqVIq1d0tNjxDZSu4uigeEO15Bqta3C8uhO5armSzKX59huRxTmyJ6LxNIRILPRs8pbBAGsIYdt6yiLSEmZBBnzCyZQgpuMMMU75LA0ZYDsfYG4gRU3pODCksA-xWYj99GvK83VDuIjhk7kDLCOSBhcj8nCJMqw0EI7MQrZ_DBA-Lez2MhI_O52Xx7d3br1cfyutP7z9evb4ubVPLVErXIUIl-hadbDSXTlWuaWXV6VY73dVKOoE3tnLQtC00HUdduwacrhqhZV9fFs9Oc5cYblekZCZPFscRZgwrGSm1ahqpMihOoI2BKGJvlugniAcjuDmqMHuTVZijCsNbk1XkzJPz8PVmQvc3ce4-A0_PAJCFsY8wW09_uCqbrLWSmXt54jBX8cNjNGSzMpt9RbTJuOD_-41X_6Tt6GefH_yOB6R9WOOcOzbCUGW4-XLcmePKcM2FblVX_wYVpL88</recordid><startdate>20090201</startdate><enddate>20090201</enddate><creator>Yachimski, Patrick, MD</creator><creator>Puricelli, William P., RN</creator><creator>Nishioka, Norman S., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090201</creationdate><title>Patient predictors of histopathologic response after photodynamic therapy of Barrett's esophagus with high-grade dysplasia or intramucosal carcinoma</title><author>Yachimski, Patrick, MD ; Puricelli, William P., RN ; Nishioka, Norman S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-6d9eea21f5ed64806d72d45629858d89376d1ebc2da455a490e83d4ad824186f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Barrett Esophagus - drug therapy</topic><topic>Barrett Esophagus - pathology</topic><topic>Biological and medical sciences</topic><topic>Digestive system. Abdomen</topic><topic>Diseases of the skin. Cosmetics</topic><topic>Endoscopy</topic><topic>Endoscopy, Gastrointestinal</topic><topic>Esophageal Neoplasms - complications</topic><topic>Esophageal Neoplasms - drug therapy</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophagus</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Other diseases. Semiology</topic><topic>Photochemotherapy</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yachimski, Patrick, MD</creatorcontrib><creatorcontrib>Puricelli, William P., RN</creatorcontrib><creatorcontrib>Nishioka, Norman S., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yachimski, Patrick, MD</au><au>Puricelli, William P., RN</au><au>Nishioka, Norman S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient predictors of histopathologic response after photodynamic therapy of Barrett's esophagus with high-grade dysplasia or intramucosal carcinoma</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2009-02-01</date><risdate>2009</risdate><volume>69</volume><issue>2</issue><spage>205</spage><epage>212</epage><pages>205-212</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><coden>GAENBQ</coden><abstract>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.</abstract><cop>Maryland heights, MO</cop><pub>Mosby, Inc</pub><pmid>18950764</pmid><doi>10.1016/j.gie.2008.05.032</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Barrett Esophagus - drug therapy Barrett Esophagus - pathology Biological and medical sciences Digestive system. Abdomen Diseases of the skin. Cosmetics Endoscopy Endoscopy, Gastrointestinal Esophageal Neoplasms - complications Esophageal Neoplasms - drug therapy Esophageal Neoplasms - pathology Esophagus Female Gastroenterology and Hepatology Gastroenterology. Liver. Pancreas. Abdomen Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Other diseases. Semiology Photochemotherapy Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Retrospective Studies Treatment Outcome |
| title | Patient predictors of histopathologic response after photodynamic therapy of Barrett's esophagus with high-grade dysplasia or intramucosal carcinoma |
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