RATIONALE: Photodynamic therapy uses light and drugs that make cancer cells more sensitive
to light to kill tumor cells. This may be an effective treatment for esophageal cancer.
PURPOSE: Phase II trial to study the effectiveness of photodynamic therapy in treating
patients with Barrett's esophagus who have in situ esophageal cancer.
OBJECTIVES: I. Evaluate the efficacy of photodynamic therapy (PDT) using porfimer sodium
(Photofrin) and controlled uniform laser light in patients with carcinoma in situ in
Barrett's esophagus or severe dysplasia in Barrett's esophagus. II. Evaluate the safety of
the treatment on this patient.
OUTLINE: This is a noncomparative study. PDT consists of IV porfimer sodium followed 40-50
hours later by laser red light delivered by optic fibers passed through the biopsy channel
of an endoscope. Retreatment, if necessary, consists of up to 3 injections at least 30 days
apart and up to 6 laser light treatments, with a maximum of 2 following each injection.
Patients are followed monthly for 4 months, and then periodically for at least 5 years.
PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.
DISEASE CHARACTERISTICS: Histologically confirmed primary, stage 0 carcinoma in situ (CIS)
in conjunction with Barrett's esophagus or severe dysplasia in Barrett's esophagus who are
medically unsuitable for or have refused surgery Previously biopsied Barrett's mucosa with
areas of severe dysplasia and/or CIS
PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky greater than 50%
Life expectancy: Not specified Hematopoietic: WBC at least 2,000/mm3 Platelet count at
least 50,000/mm3 Hepatic: No porphyria or hypersensitivity to porphyrins Bilirubin no
greater than 3.0 mg/dL Alkaline phosphatase no greater than 3 times ULN SGOT no greater
than 3 times ULN PT no greater than 1.5 times the upper limit of normal (ULN) Renal:
Creatinine no greater than 3.0 mg/dL Other: No contraindication to endoscopy Not pregnant
or nursing Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY: Biologic therapy: Not specified Chemotherapy: No concurrent
chemotherapy At least 1 month since prior chemotherapy Endocrine therapy: Not specified
Radiotherapy: No concurrent radiation therapy No concurrent laser therapy At least 1 month
since prior radiation therapy At least 1 month since prior laser therapy Surgery: Not