Chapter 15: Endoscopic Photodynamic Therapy for Advanced Inoperable Esophageal Cancer

Patients suffering from advanced esophageal cancer ineligible for curative surgery still have a poor prognosis. Photodynamic Therapy (PDT) represents a gentle and effective approach beneath the different palliative treatment options for this aggressive malignancy. The mechanism of function is based on the illumination of malignant esophageal tumor tissue after selective accumulation of the specific photosensitizer in these tumor cells. As a result of this photochemical reaction distinct necrosis of the endoluminal tumor load develops quickly and sustainably. In case of esophageal cancer, PDT is performed endoscopically under general anaesthesia. By means of PDT, considerable reduction of the endoluminal tumor load associated with increased quality of life can be achieved which helps conditioning the patient for further palliative treatment procedures. However, local endoluminal palliation with the aim to improve swallowing, decreament of dysphagia and therefore improvement of the patient´s quality of life are the main therapeutic goals of PDT in case of inoperable esophageal cancer. Therefore, PDT has become an accepted as well as safe, feasible and efficient endoscopic treatment option within the various multimodal treatment procedures for advanced inoperable esophageal cancer.