Digestive Care

Photodynamic Therapy (PDT)

Photodynamic therapy allows the doctor to destroy the abnormal cells using a combination of photoactive drug and laser without destroying the healthy tissue surrounding the abnormal cells.

The photoactive drug that is used is called Photofrin (Porfimer Sodium). Photofrin is given intravenously and is absorbed by your body's tissues, including abnormal cells. Significant amount of the drug is eliminated from most healthy tissue but some are left in the abnormal cells and in the skin.

Two days after the Photofrin injection, an upper GI endoscopy is done. Upper GI endoscopy allows the light from a laser to be directed at the abnormal cells in your esophagus. The procedure is about 5 to 20 minutes. The light from the laser activates the drug present within those cells and ultimately will destroy them.

Possible Side Effects of Photodynamic Therapy:
The two major side effects associated with photodynamic therapy are:

· Local swelling and inflammation in and around the esophagus, which may cause chest discomfort; and
· Photosensitivity as a result of the continued presence of the drug in the skin.

From the time you receive Photofrin injection and approximately 30 days thereafter, the skin and eyes will be very sensitive to bright light. Exposure to bright light or sunlight should therefore be avoided to prevent sunburn, redness, and swelling. It is important to protect your eyes and skin from any possible exposure to bright light or sunlight.

Other possible side effects include nausea, fever, and/or constipation. Talk with the doctor about side effects and complications.

Precautions to Take to Prevent Photosensitivity Reaction:
Precaution during the first 30 days after your Photofrin injection is important. The lighting in your home should not be a problem unless you have skylights or your windows allow direct sunlight. If this is the case then it is important that you drape them. Most indoor activities like watching TV or working on a computer are acceptable. Do not sit next to a reading lamp.

If you have to go out of the house, wait until sundown. It is important that you cover much of your skin as possible even on cloudy days and while in a car by wearing tightly woven, light colored long-sleeved shirt and slacks, gloves, socks, shoes, and a wide-brimmed hat or umbrella. It is also important that you protect your eyes from light by wearing dark sunglasses. Sunscreens, regardless of how high the SPF will not protect your skin.

For at least 30 days after the injection, stay away from commercial hair dryers found in beauty salons and from examination lights found in a dentist's office or doctor's office. If you must use a hair dryer, a hand held hair dryer at a very low setting is a safer option.

Duration of Photosensitivity:
The duration of photosensitivity differs from person to person. It is important that you have a discussion with your doctor about this. Generally, at day 31, a test is performed by exposing a small portion of skin such as the back of the hand to sunlight. Create a hole of about 2 inches in a paper bag, the hand is placed into the paper bag, then expose the unprotected patch to sunlight for 10 minutes. If a photosensitivity reaction such as swelling, redness, or blistering occurs within 24 hours of exposure, precaution must be continued for another 2 weeks; then re-test. If no reaction occurs within 24 hours of exposure, a gradual increase of exposure to sunlight is recommended. It is also recommended that outdoor exposure when the light from the sun is at its peak (between the hours of 11 AM and 2 PM) must be limited. Moreover, being alert for any photosensitivity reaction is important.

Signs and Symptoms of Photosensitivity Reaction:
Photosensitivity reaction looks like a bad sunburn (red, swollen, blistering). Call your doctor promptly if you have experience photosensitivity reaction.

Preparations Before Photofrin injection:
Before your scheduled Photofrin injection, the home should be checked to make sure that the skylights and windows have adequate shades or curtains. On the day of the procedure, bring sunglasses, gloves, and a hat with you to the hospital. Remember to wear long sleeved shirt and slacks on the day of the procedure.