Photodynamic Therapy for Colorectal Cancer: A Systematic Review of Clinical Research

BACKGROUND: Photodynamic therapy (PDT) is a therapeutic modality that can be used to ablate tumors using the localized generation of reactive oxygen species by combining a photosensitizer, light, and molecular oxygen. This modality holds promise as an adjunctive therapy in the management of colorectal cancer and could be incorporated into neoadjuvant treatment plans under the auspices of prospective clinical trials. METHODS: We conducted a search of primary literature published until January 2021, based on PRISMA guidelines. Primary clinical studies of PDT for the management of colorectal cancer were included. Screening, inclusion, quality assessment, and data collection were performed in duplicate. Analyses were descriptive or thematic. RESULTS: Nineteen studies were included, most of which were case series. The total number of patients reported to have received PDT for colorectal cancer was 137, almost all of whom received PDT with palliative intent. The most common photosensitizer was hematoporphyin derivative or Photofrin. The light dose used varied from 32 J/cm(2) to 500 J/cm(2). Complete tumor response (cure) was reported in 40%, with partial response reported in 43.2%. Symptomatic improvement was reported in 51.9% of patients. In total, 32 complications were reported, the most common of which was a skin photosensitivity reaction. CONCLUSIONS: PDT for the management of colorectal cancer has not been well studied, despite promising results in early clinical case series. New, well designed, prospective clinical trials are required to establish and define the role of PDT in the management of colorectal cancer.