editorial korean j intern med 2012;27:271-272 http://dx.doi.org/10.3904/kjim.2012.27.3.271 pISSN 1226-3303 eISSN 2005-6648 http://www.kjim.or.kr Photodynamic t herapy: establishing its r ole in Palliation of a dvanced esophageal Cancer Jong-Jae Park Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea See Article on Page 278-284 Photodynamic therapy (PDT) is a unique treatment modality that uses photosensitizers activated by light. Photosensitizers accumulate in malignant tissue, and light energy is used to destroy cancer cells by production of acti- vated oxygen [1]. There are three main steps in PDT: injec- tion of photosensitizers, activation of photosensitizers by endoscopy-guided red light application, and cell death by production of active oxygen [2]. PDT is comprised of three separate components: the photosensitizer, light source, and light delivery system [3]. PDT was first used in the treatment of esophageal can- cer in the 1980s [4]. Since then, its indications have been broadened to include treatment of gastric cancer, biliary cancer, colon cancer, and other non-gastrointestinal ma- lignancies such as skin cancer and lung cancer. Of course, the treatment of choice in esophageal cancer is surgical or endoscopic resection of the malignant tissue. In reality, 40% to 50% of patients diagnosed with esophageal cancer have a cancer lesion that is not completely resectable [5]. Therefore, when disease cure is not expected, palliation with improvement in the patient’s quality of life becomes the next priority. In advanced esophageal cancer, the big- gest problem arising from esophageal lumen obstruction Received: August 20, 2012 Accepted: August 23, 2012 by the ingrowing tumor mass is dysphagia and difficulty maintaining sufficient nutritional support. For pallia- tion of esophageal cancer, many treatment modalities have been used, such as dilation of the lumen with self- expanding metallic stents (SEMS), radiation therapy, che- motherapy, brachytherapy, and argon plasma coagulation. Of all of these treatment methods, insertion of a SEMS into the esophagus has been the primary treatment and is a widespread practice [6]. Nevertheless, restenosis of the esophageal lumen due to tumor ingrowth and overgrowth warrants an additional procedure or another treatment modality. In the current article entitled “Role of photodynamic therapy in the palliation of obstructing esophageal cancer,” the authors describe the effect of PDT as part of a multi- modal treatment strategy for palliation of esophageal lu- men obstruction in advanced esophageal cancer [7]. They enrolled 20 patients with obstructive esophageal cancer who all had dysphagia. After primary treatment with PDT, the patients were given additional treatment with external beam radiation therapy or SEMS for palliation of dyspha- gia, which was the main goal of the treatment. The results of the study showed significant improvement of dysphagia, numerically described as the “dysphagia score.” Only two of the total enrolled patients showed major complica- tions (i.e., esophageal stricture), and these patients were treated by placing a stent across the stricture. The authors Correspondence to Jong-Jae Park, M.D. Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-1771, Fax: 82-505-115-1778, E-mail: gi7pjj@yahoo.co.kr Copyright © 2012 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.