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Acta Endoscopica

, Volume 33, Issue 4, pp 511–519 | Cite as

Thérapie photodynamique de l’œsophage de Barrett et du cancer précoce de l’œsophage

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Photodynamic therapy in Barrett’s oesophagus and early oesophageal cancer

Résumé

La photothérapie dynamique (PTD) permet d’éradiquer le cancer de l’œsophage à un stade précoce et souvent asymptomatique, lorsqu’il est détecté au cours de programmes de dépistage ou de surveillance. En compétition avec d’autres techniques endoscopiques, la PTD est particulièrement indiquée dans l’éradication de zone de dysplasie de l’oesophage de Barrett. Elle peut être proposée comme thérapie curative de cancer au début ou au stade précancéreux chez des patients qui refusent un traitement chirurgical radical ou à risque de morbidité, ou encore lorsque celui-ci ne peut être proposé. La PTD utilisée dans les carcinomes épithélioïdes ou les adénocarcinomes permet un allongement du temps de survie. Les patients porteurs de cancer T1 ou T2, stadifiés par ultrasonographie endoscopique, chez lesquels un traitement chirurgical n’est pas indiqué accèdent à une PTD. La survie à 5 ans n’est pas affectée par une chimiothérapie ou une radiothérapie et est de 74%. De nouvelles données démontrent l’efficacité de l’éradication des adénocarcinomes au début développés sur un oesophage de Barrett. Le traitement est applicable en ambulatoire et un traitement complémentaire inhibiteur de la sécrétion acide par IPP doit leur être prescrit. La PTD est devenu une thérapie endoscopique importante et les premiers résultats indiquent une possible interruption de la progression vers un cancer invasif chez les patients porteurs d’un œsophage de Barrett avec dysplasie de haut degré.

Summary

Photodynamic therapy offers the possibility of eradication of early and often asymptomatic oesophageal cancer detected during screening or surveillance programmes. There are other competing endoscopic techniques but photodynamic therapy is particularly useful for the eradication of the field change associated with dysplasia in Barrett’s oesophagus. It can be offered as curative therapy for early cancers or precancerous change in patients unfit or unwilling to be subjected to radical and morbid surgery. Endoscopic photodynamic therapy for both early squamous cell carcinoma and adenocarcinoma has been followed by prolonged survival. Patients with T1 and T2 cancers, staged using endoscopic ultra-sound, who were unsuitable for surgical treatment, received endoscopic photodynamic therapy. The disease specific five year survival was unaffected by the addition of chemotherapy or radiotherapy and was 74 %. There is now consistent data demonstrating the effectiveness for the eradication of early adenocarcinoma arising from Barrett’s oesophagus. Treatment can be performed on an outpatient basis and patients must all receive profound acid suppression with proton pump inhibitor therapy. Photodynamic therapy is becoming an important endoscopic therapy and early results indicate that patients with high-grade dysplasia in Barrett’s oesophagus may not progress to invasive cancer.

Mots-clés

acide amino-lévulinique cancer précoce de l’œsaphage laser œsophage de Barrett Photofrin thérapie photodynamique 

Key-words

aminolaevulinic acid Barrett’s oesophagus early oesophageal cancer laser photodynamic therapy Photofrin 

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Références

  1. 1.
    BLOT W.J., DEVESA S.S., KNELLER R.W., FRAUMENI J.F. Jr. - Rising incidence of adenocarcinoma of the oesophagus and gastric cardia.JAMA, 1991,265, 1287–1289.PubMedCrossRefGoogle Scholar
  2. 2.
    SPECHLER S.J., ZEROOGIAN J.M., ANTONOLLI D.A., WANG H.H., GOYAL R.K. - Prevalence of metaplasia at the gastroesophageal junction.Lancet, 1994,344, 1533–1536.PubMedCrossRefGoogle Scholar
  3. 3.
    SPECHLER S.J. - The role of gastric carditis in metaplasia and neoplasia at the gastroesophageal junction.Gastroenterology, 1999,117, 218–228.PubMedCrossRefGoogle Scholar
  4. 4.
    WIJNHOVEN B.P.L., SIERSEMA P.D., HOP W.C. J.et al. - Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity.Br. J. Surg., 1999,86, 529.PubMedCrossRefGoogle Scholar
  5. 5.
    JANKOWSKI J., HARRISON R.F., PERRY I., BALKWILL F., TSEPLIS C. -Barrett’s metaplasia.Lancet, 2000,356, 2079–2086.PubMedCrossRefGoogle Scholar
  6. 6.
    SHEPHERD N.A. - Dysplasia in Barrett’s oesophagus.Acta Endoscopica, 2000,30, 123–132.Google Scholar
  7. 7.
    VAN SANDICK J.W., VAN LANSCHOT J.J.B., KUIKEM B.W.et al. - Impact of endoscopic biopsy surveillance of Barrett’s oesophagus on the pathological stage and clinical out-come of Barrett’s carcinoma.Gut, 1998,43, 216–220.PubMedCrossRefGoogle Scholar
  8. 8.
    AITORKI N.K., SUNAGAWA M., LITTLE A.G.et al. - High-grade dysplasia in columnar-lined esophagus.American Journal of Surgery, 1991,161, 97–102.CrossRefGoogle Scholar
  9. 9.
    LEVINE D.S., HAGGITT R.C., BLOUNT P.L., RABINO-VITCH P.S., RUSCH V.W., REID B.J. - An endoscopic biopsy protocol can differentiate high-grade dysplasia from early carcinoma in Barrett’s esophagus.Gastroenterology, 1993,105, 40–48.PubMedGoogle Scholar
  10. 10.
    CAMERON A.J., CARPENTER H.A. - Barrett’s esophagus, high-grade dysplasia, early carcinoma: a pathological study.Am. J. Gastroenterol., 1997,92, 586–589.PubMedGoogle Scholar
  11. 11.
    FULJAMES C., STONE N., BENNETT D., BARR H. - Beyond White Light Endoscopy: the Prospects for Endoscopic Optical Biopsy.Italian Journal of Gastroenterology and Hepatology, 1999,31, 695–704.Google Scholar
  12. 12.
    ACKROYD R., BROWN N.J., STEPHENSON T.J., STOD-DARD C.J., REED M.W. - Ablation treatment for Barrett oesophagus: what depth of tissue destruction is neededJ. Clin. Pathol., 1999,52, 509–512.PubMedCrossRefGoogle Scholar
  13. 13.
    BIDDLESTONE L.R., BARRHAM C.P., WILKINSON S.P., BARR H., SHEPHERD N.A. - The histopathology of treated Barrett’s Oesophagus: Squamous re-epithelialisation following acid suppression, laser and photodynamic therapy.American Journal of Surgical Pathology, 1998,22, 239–245.PubMedCrossRefGoogle Scholar
  14. 14.
    ELL C., MAY A., GOSSNER L., PECH O., GUNTER E., MAYER G., HENRICH R., VIETH M., MÜLLER H., SEITZ G., STOLTE M. -Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus.Gastroenterology, 2000,118, 670–677.PubMedCrossRefGoogle Scholar
  15. 15.
    BUTTAR N.S., WNAG K.K., SEBO T.J., RIEHE D.M., KRISHNADUTH K.K., LUTZKE L.S., ANDERSON M.A., PETTERSON T.M., BURGART L.J. - Extent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma.Gastroenterology, 2001,120, 1630–1639.PubMedCrossRefGoogle Scholar
  16. 16.
    BARR H. - Barrett’s esophagus: treatment with 5-aminolevulinic acid photodynamic therapy.Gastrointestinal Endoscopy Clinics of North America, 2000,10, 421–438.PubMedGoogle Scholar
  17. 17.
    GOSSNER L., STOLTE M., STROKE R.et al. - Photodynamic therapy of high-grade dysplasia and early stage carcinomas by means of 5-aminolaevulinic acid.Gastroenterology, 1998,114, 447–455.CrossRefGoogle Scholar
  18. 18.
    ACKROYD R., BROWN N.J., DAVIES M.F., STEPHENSEN T.J., STODDARD C.J., REED M.W.R. - Aminolaevulinic acid-induced photodynamic therapy in the treatment of dysplastic Barrett’s oesophagus and adenocarcinoma.Las. Med. Sci. 1999,14, 278–285.CrossRefGoogle Scholar
  19. 19.
    TAN W.C., FULLIJAMES C., STONE N., DIX A.J., SHEPHERD N., ROBEETS D.J.H., BROWN S.B., KRASNER N., BARR H. - Photodynamic therapy using 5-aminolaevulinic acid for oesophageal adenocarcinoma associated with Barrett’s metaplasia.J. Photochem. Photobiol. B., 1999,53, 75–80.PubMedCrossRefGoogle Scholar
  20. 20.
    BARR H., SHEPHERD N.A., DIX A., ROBERTS D.J.H., TAN W.C., KRASNER N. - Eradication of high grade dysplasia in columnar-lined (Barrett’s) oesophagus using photodynamic therapy with endogenously generated protoporphyrin IX.Lancet, 1996,348, 584–585.PubMedCrossRefGoogle Scholar
  21. 21.
    GOSSNER L., MAY A., PECH O., RABENSTEIN T., SCHNEIDER H.T., HAHN E.G., STOLTE M., ELL C. - Photodynamic therapy of Barrett’s esophagus with dysplasia or early cancer.Gastroenterology, 1999,116, G1811.Google Scholar
  22. 22.
    GROSJEAN P., SAVARY J.F., WAGNIERES G., MIXERET J., WOODTLI A., THEUMAN J.F., FONTOLLIET C., VAN DEN BERG H., MONNIER P. - Tetra (m-hydroxyphenyl) chlorin clinical photodynamic therapy of early bronchial and oesophageal cancers.Las. Med. Sci., 1996,11, 227–235.CrossRefGoogle Scholar
  23. 23.
    SIBILLE A., LAMBERT R., SOUQUET J.-C., SABBEN G., DESCOS F. -Long-term survival after photodynamic therapy for esophageal cancer.Gastroenterology, 1995,108, 337–344.PubMedCrossRefGoogle Scholar
  24. 24.
    PATRICE T., FOULTIER M.T., YACTAYO S., ADAM F., GALMICHE J.P., DOUET M.C., LE BODIC L. - Endoscopic photodynamic therapy with hematoporphyrin Derivative for primary treatment of gastrointestinal Neoplasms in inoperable patients.Dig. Dis. Sci., 1990,35, 545–552.PubMedCrossRefGoogle Scholar
  25. 25.
    HOCHAIN P., DUCROTTE P., PAILOTT B., TOUCHAIS J.-Y., THOREL J.-M., PETIT A., OUVRY D., HECHETS-WEILER P. - La photothérapie dynamique par laser a colorant.Gastroenterol. Clin. Biol., 1992,16, 552–557.PubMedGoogle Scholar
  26. 26.
    SPINELLI P., MANCINI A., DAL FANTE M., MERONI E. - Photodynamic therapy of early stage esophageal carcinoma: Results and Survival. Proceedings of International Photodynamic Association, 1996.Google Scholar
  27. 27.
    CORTI L., SKARLATOS J., BOSO C., CARDIN F., KOSMA L., KOUKOURAKIS M.I., GIATROMANOLAKI A., NORBERTO L., SAFFER M., BEROUKAS K. - Out-come of patients receiving photodynamic therapy for early esophageal cancer.Int. J. Radiation Oncology Biol. Phys., 2000,47, 419–424.CrossRefGoogle Scholar
  28. 28.
    HAYATA Y., KATO H., FURUSE K., KUSUMOKI Y., SUKUKI S., MIMURA S. - Photodynamic therapy of 168 early stage cancers of the lung and oesophagus: A Japanese multicentre study.Las. Med. Sci., 1996,11, 255–259.CrossRefGoogle Scholar
  29. 29.
    OVERHOLT B.F., PANJEPOUR M., HAYDEK J.M. - Photodynamic therapy for Barrett’s esophagus: follow-up in 100 patients.Gastrointest. Endosc., 1999,49, 1–7.PubMedCrossRefGoogle Scholar
  30. 30.
    RADU A, WAGNIERES G., VAN DEN BERG H., MONNIER P. - Photodynamic therapy of early squamous cell cancers of the esophagus.Gastrointestinal Endoscopy Clinics of North America, 2000,10, 439–460.PubMedGoogle Scholar
  31. 31.
    WANG K.K., WONG KEE SONG L.M., NOURBAKASHet al. - Can consistent tissue necrosis be achieved during photodynamic therapy for high-grade dysplasia or cancer within Barrett’s esophagus?Gastroenterology, 1997,112, A676.Google Scholar
  32. 32.
    SPINELLI P., DAL FANTE M., MANICI A.et al. - Endoscopic photodynamic therapy of early cancer and severe dysplasia of the esophagus. In Photodynamic therapy and biomedical lasers pp262–265 eds. Spinelli P, Dal Fante M, Marchesini R, Amsterdam: Elsevier Science Inc 1992.Google Scholar
  33. 33.
    VAN DEN BOOGERT J., VAN HILLESBERGER R., DE ROOD F.W.M., DE BRUINR W.F., EDIXHOVEN-BOSDIJIK A., HOUTSMULLER A.B., SIERSEMA P.D., WILSON J.H.P., TILANUS H.W. - 5-aminolaevulinic acid-induced protoporphyrin accumulation in tissues: pharmacokinetics after oral or intravenous administration.Journal of Photochemistry and Photobiology B: Biology, 1998,44, 29–38.CrossRefGoogle Scholar
  34. 34.
    ORTNER M., ZUMBUSCH K., LIEBTRUTH J.et al. - Photodynamic therapy in Barrett’s esophagus after local administration of 5-aminolaevulinic acid.Gastroenterology, 1997,112, A633.Google Scholar
  35. 35.
    JAMIESON N.F., THORPE S., MOSSE A., BOWN S.G., LOVAT L.G. -Photodynamic therapy using MTHPC for early Barrett’s -associated cancer.Gut, 2003,52 (suppl. 1) 170.Google Scholar
  36. 36.
    OVERHOLT B.F., HAGGITT R.C., BRONNER P., TAYLOR S.L., YONG H., COLIN P., SPENARD J. - A multi-centre, partially blinded, randomized study of the efficacy of photodynamic therapy (PDT) using Porfimer Sodium (POR) for ablation of high-grade dysplasia (HGD) in Barrett’s esophagus (BE): results of 6 month follow-up.Gastroenterology, 2001,120, A77.Google Scholar
  37. 37.
    BARR H., FITZGERALD R.C. - Ablative mucosectomy is the procedure of choice to prevent Barrett’s cancerGut, 2003,52, 14–17.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • H. Barr
    • 1
  1. 1.Cranfield Postgraduate Medical School in GloucestershireGloucestershire Royal HospitalGloucesterUK

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