Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laser therapy is a well-established, relatively safe, rapid, and highly effective method of palliation for the dysphagia that usually accompanies esophageal and esophagogastric cancer. It is the treatment of choice in many patients, although there remains some disagreement regarding technique and predictors of outcome. The major limitation of laser therapy is the need for repeated treatments, although the interval between treatments may be lengthened by concomitant external beam or endoluminal radiotherapy. When laser therapy is available, use of an esophageal stent should be reserved for special circumstances, such as esophagopulmonary fistulas or extrinsic compression. In addition, stent placement usually is effective when laser photoablation fails or must be performed too frequently. It remains to be seen whether or not technical improvements in esophageal stents will reduce the frequency of complications associated with these devices. Other promising modalities that may be less expensive and more readily available, such as the BICAP tumor probe or injection therapy, deserve further study. It appears that most of these methods are complementary and different modalities may be suited to different types of lesions. The results of phase III clinical trials with PDT, now underway, should help to define the role of this promising modality in the overall scheme of treatment for esophageal cancer. The concept of PDT is attractive, although refinements in photosensitive compounds and methods of light delivery may be needed. Current information suggests a moderately high complication rate for PDT, although this may decrease with technical improvements and increasing experience. Issues surrounding the palliation of esophageal cancer are complex. Whereas the tendency is to focus on technical aspects of therapy and the relief of dysphagia, broader aspects of a patient's quality of life cannot be ignored. Ultimately, the choice of therapy may depend as much on a patient's psychosocial circumstances as on the appearance of the lesion. For instance, the patient who lives at a great distance from the center where laser therapy is performed may be better served by placement of an esophageal stent despite the higher complication rate for this procedure. PDT would be inappropriate for the patient who wishes to spend the remaining few months of life outdoors in the sun. Guiding the patient to the best choice requires the skills of a physician as much as the technical ability of an endoscopist.
 ...
PMID:Palliation of esophageal carcinoma. Laser and photodynamic therapy. 751 23

Evaluation of resected cases of esophageal superficial cancer have shown that lymph node metastasis was absent, and radical local treatment would be possible for m1 and m2 cancer. However, the depth of cancer invasion is difficult to diagnose before treatment. Endoscopic mucosal resection (EMR) is useful for not only treating but also diagnosing cancer. Therefore, EMR is recommended as the treatment of choice for m1 or m2 lesions. On the other hand, treatment of esophageal superficial cancer by PDT is effective even for deep sm cancers. In particular, the use of excimer dye laser increases light transmittance, there by improving the treatment results for sm cancer. EMR was not effective for treating sm cancer or diagnosing the depth of its invasion. In sm cancer, since lymph node metastasis is observed in 30-50% of the cases, local treatment cannot be radical. Therefore, PDT is best indicated as a local treatment for sm cancer that cannot be treated by operation. Local healing after PDT prevents dysphagia caused by stenosis due to cancer, which may allow medical management at home.
 ...
PMID:[Photodynamic therapy for esophageal cancer]. 854 67

Primary small cell carcinoma of the esophagus is a rare and aggressive disease. We report on our experience with two patients having a small cell cancer of the esophagus, being treated with photodynamic therapy combined with irradiation and induction-chemotherapy as well as a review of literature. Both patients were admitted with severe dysphagia, weight loss and a Karnovsky performance status of 90. Diagnostic work-up revealed tumor-stenosis in the proximal third in one and in the distal third in the other case. Clinical staging showed T4N2M0 and T3N2M0, pure small cell carcinoma. Due to dysphagia and lymph node enlargement, local and systemic therapy were considered as first-line treatment. Restaging after three cycles of induction-chemotherapy revealed partial response in both cases. Esophagectomy as a second-line treatment was considered. However, in the preoperative period, one patient developed motorical aphasia. The CT-scan of the brain showed multiple brain metastases. External beam irradiation and further chemotherapy was initiated. The patient died 12 months after admission. The other patient revealed anatomical inoperability at the staging laparoscopy. External beam irradiation and a second session of PDT was performed. The patient is still alive, 12 months after his first admission. The biological behavior of this aggressive disease and metastases in about 50% of patients at admission, as well as significant dysphagia makes combined systemic and local treatment necessary. Nevertheless, after reviewing the literature, esophagectomy and adjuvant chemotherapy may have an advantage pertaining to survival time when anatomical and functional operability is given.
 ...
PMID:Local and systemic treatment in small cell carcinoma of the esophagus. 1060 16

There are now a variety of treatment options available to palliate dysphagia in patients with advanced esophageal carcinoma. The decision as to which therapy to recommend for a patient should be based on a though understanding of the therapies and must be individualized for each patient and on the experience of the endoscopist or surgeon. In addition, consideration should be given as to resource availability at a particular institution. External beam radiation currently has little role as primary treatment for dysphagia. Brachytherapy is labor intensive; requires 2 to 3 weekly treatments, highly specialized radiation equipment, and an experienced radiation oncologist; and is therefore limited to tertiary care centers. Endoluminal YAG-laser tumor ablation is feasible at many institutions and provides immediate dysphagia relief but has limited durability (weeks) if not followed by adjuvant therapy, and requires an endoscopist with significant laser experience. PDT is relatively easy to perform and has a lower perforation rate and longer durability than YAG laser therapy but it is relatively costly and less patient friendly due to the morbidity of its attendant 6 weeks of photosensitivity. Advances in stent technology have rendered this a safe, readily available treatment for the palliation of dysphagia. Palliation of dysphagia is an important but difficult goal that may require creative use of a variety of endoscopic interventions, either in combination or serially. Ideally, physicians who palliate dysphagia secondary to esophageal cancer should be facile in both endoscopic ablative and stenting techniques and have a close working relationship with both radiation and medical oncologists.
 ...
PMID:Endoluminal palliation for dysphagia secondary to esophageal carcinoma. 1247 28

The aim of this paper is to present the updated experience of the Yorkshire Laser Centre in PDT for esophageal cancer and to identify its role in specific subsets of patients. Also, in the light of this experience, to compare and contrast the results of PDT with appropriate subsets of patients treated in my esophageal surgery practice. 102 consecutive patients; 84 with advanced (Group A) and 18 with early (Group E) stage esophageal cancer undergoing endoscopic PDT were entered into a prospective study. Every patient had standard work up including clinical staging. PDT protocol was intravenous administration of Photofrin 2mg/kg body weight followed 24-72 hours later by endoscopic illumination using 630 nm laser light. Assessment of results was made on the basis of mortality, morbidity, patient satisfaction to treatment, symptom relief and survival. For comparison of PDT role with non PDT treated patients, reference is made to 3 previous publications comprising over 1100 patients [Moghissi, K., Br. J. Surg. 79, 935-937 (1992) (ref. 1); Sawant, D., Moghissi, K. Eur. J. Cardio-Thorac. Surg. 8, 113-117 (1994) (ref. 2); Sharpe, D. A. C., Moghissi, K. Eur. J. Cardiothorac. Surg. 10, 359-364 (1996) (ref. 3)]. There was no mortality associated with PDT. All patients expressed satisfaction to treatment. Post PDT complications consisted of photosensitivity skin reaction (sunburn) in 5 patients (5%) and esophageal stricture in 8 (8%) patients. Group A: There was significant symptom and dysphagia grade improvement. Mean survival was 9.5 months. Group E: There were no significant symptoms pre or post PDT and mean survival was 60.5 months. Comparison of PDT results in Group A with results of other palliative treatment methods, indicates that palliation can be achieved in all intraluminal cancer using PDT which is at least as good as other treatments. There is, in addition, advantage over other methods in patients with cervical esophageal cancer and in cases with re-growth of tumor obstructing previously placed stents. In early cases PDT appears capable of replicating surgical results in selected cases. PDT is an effective and safe treatment method in esophageal cancer. In advance disease it improves swallowing. In early stage disease it offers long survival and the prospect of cure in some patients. At present the role of PDT in early stage cancer should be limited to patients who are unsuitable for surgical resection. Therefore, PDT should be considered as a valid oncological option to be applied in selected cases.
 ...
PMID:Photodynamic therapy (PDT) in esophageal cancer: a surgical view of its indications based on 14 years experience. 1289 14

Malignant tumors of the esophagus continue to be a major health issue associated with high mortality primarily because most present with symptoms of dysphagia or anaemia. The disease at that stage is advanced and not likely curable. The big issue for squamous dysplasia and that associated with BE is that only a small proportion are discovered in surveillance programs when they are asymptomatic, either because the patient lives in a high-incidence geographical area, has a family history, previously diagnosed head and neck cancer or chronic reflux, as in Barrett's. Current endoscopic methods are hampered by the endoscopist's inability to recognize subtle topographic clues of dysplasia, sampling errors related to biopsy protocols, and confounding inflammation-induced artifacts both for the endoscopist and pathologist. What is desperately needed would be a biomarker (e.g. serological, fecal, urinary) that selects patients for endoscopy. However, such a test is not yet on the horizon. This article examines the current status in practice and research of novel optically based 'bioendoscopic' devices (i.e. fluorescence spectroscopy and imaging, confocal fluorescence microendoscopy (CFM), light scattering spectroscopy (LSS), Raman spectroscopy (RS), and immunophotodiagnostic endoscopy) which may enhance the diagnosis of dysplasia in all patients undergoing conventional white light endoscopy. Perhaps these new technologies will lead to more cost-effective diagnosis, mapping (e.g. surface), and staging (e.g. depth) of dysplasia, thereby allowing timely cure by endoscopic means (e.g. EMR and/or PDT), biological interventions (e.g. Cox-2 inhibitors) rather than esophajectomy.
 ...
PMID:Spectroscopy and fluorescence in esophageal diseases. 1647