Approved treatment — Japan: esophageal cancer remaining or recurring after chemoradiotherapy or radiotherapy (approved by the Ministry of Health, Labour and Welfare in 2015) Sources: Kyoto University, Oncotarget 2017, J Gastroenterol 2026, Esophagus 2021, US National Cancer Institute (NCI)
Esophageal cancer photodynamic therapy is a local treatment that uses light delivered through an endoscope to destroy cancer that remains or comes back in the same place after radiotherapy. Japan became the first country to approve photodynamic therapy (PDT) for this use in 2015. In the phase II trial, 88.5% of 26 patients achieved a local complete response, and the 5-year survival rate was 40.6%. It offers a less invasive option for patients for whom surgery is a heavy burden.
What is photodynamic therapy for esophageal cancer?
Photodynamic therapy (PDT) uses a light-sensitive drug (a photosensitizer) that collects in the tumor, followed by light of a specific wavelength aimed at the tumor. The US National Cancer Institute (NCI) explains that the activated drug produces oxygen radicals that kill cancer cells, can damage the blood vessels that feed the tumor, and may trigger an immune response.
Light only reaches about 1 cm into tissue, so PDT suits cancers lying shallowly on the inner lining of organs rather than large tumors. The esophagus can be viewed directly with an endoscope, which makes it well suited to PDT.
In Japan the drug is talaporfin sodium (brand name Laserphyrin), a second-generation photosensitizer. Based on an investigator-initiated trial led by Professor Manabu Muto of Kyoto University with seven institutions, Japan's Ministry of Health, Labour and Welfare approved the drug, a semiconductor laser and an esophageal laser probe together in 2015. Kyoto University noted that Japan was the first country to grant this approval.
Who can receive it?
The approved use is for adults whose esophageal cancer remains or recurs after chemoradiotherapy (CRT) or radiotherapy (RT). Cancer remaining at the originally treated site is called local failure.
The phase II trial behind the approval enrolled patients who had received at least 50 Gy of radiation and whose remaining cancer was limited to the muscle layer of the esophagus (muscularis propria). In a Kyoto University Hospital report, patients who received repeat PDT also met these conditions:
- The remaining cancer is shallow (clinical T1–T2) with no spread to lymph nodes or other organs
- It cannot be removed by endoscopic resection
- Salvage surgery is not suitable, or the patient prefers not to have surgery
In practice, PDT is mainly considered when routine endoscopy after radiotherapy finds a shallow recurrence. Its biggest advantage is treating the cancer while keeping the esophagus, without major surgery.
Treatment is completed in one day
The steps below follow the method reported by Kyoto University Hospital in the journal Esophagus in 2021. A key feature is that the drug injection and light treatment take place on the same day.
| Step | Timing | What happens |
|---|---|---|
| 1. Drug injection | Treatment day | Talaporfin sodium 40 mg/m² given intravenously; light protection begins |
| 2. Light delivery | 4 hours after injection | 664 nm diode laser delivered through an endoscope at 100 J/cm² |
| 3. Check endoscopy | Next day | The site is reviewed and extra light is given if cancer remains |
| 4. Light protection | 2–4 weeks | Stay indoors under 500 lux and avoid direct sunlight |
| 5. Response check | After discharge | Regular endoscopy and biopsy confirm complete response |
Sources: Tamaoki M et al., Esophagus 2021;18(4):817–824 / Yano T et al., Oncotarget 2017. Details may vary by hospital and patient condition.
The light is delivered in a way similar to an endoscopic examination. Because the esophagus is not removed as in surgery, patients tend to return to eating and daily life relatively quickly.
Results: benefits held up in long-term follow-up
In the multicenter phase II trial that supported approval (Yano et al., Oncotarget 2017), all 26 patients were treated, and 23 patients (25 lesions) achieved a local complete response, meaning no cancer could be seen at the treated site on endoscopy and biopsy.
Long-term results for the same patients, followed for a median of 6.8 years, were published in the Journal of Gastroenterology in 2025. The 5-year local progression-free rate was 84.9%, showing that cancer that disappeared often stayed controlled for a long time. The researchers concluded that PDT, as a minimally invasive salvage treatment, can achieve long-term local complete response and long-term survival.
| Measure | Reported result | Basis |
|---|---|---|
| Local complete response | 88.5% (23 of 26) | Phase II trial, 2017 |
| 5-year local progression-free rate | 84.9% | Long-term follow-up, 2025 |
| Median overall survival | 4.2 years | Long-term follow-up, 2025 |
| 5-year overall survival | 40.6% | Long-term follow-up, 2025 |
| Treatment-related deaths | None | Long-term follow-up, 2025 |
Sources: Yano T et al., Oncotarget 2017;8:22135–22144 / Horimatsu T et al., J Gastroenterol 2026;61(2):131–138 (online November 2025). The 95% confidence interval for local complete response was 69.8–97.6%.
There are options even when one session is not enough. Of 52 patients treated with PDT at Kyoto University Hospital, 13 received it again, and 6 of them (46.2%) achieved a local complete response. The researchers reported that repeat treatment can also be an effective and safe option.
Side effects and light protection
In the phase II trial, no skin photosensitivity occurred and no grade 3 or higher non-hematological side effects were reported. Main side effects of the first treatment, as summarized in the Kyoto University Hospital report, and how they are managed:
| Side effect | Rate | Management |
|---|---|---|
| Esophageal pain | 53.8% | Pain medication |
| Fever | 30.8% | Fever reducers and observation |
| Narrowing (stricture) | 7.7% | Treated with endoscopic dilation and similar methods |
| Skin photosensitivity | 0% | Prevented with 2–4 weeks of light protection |
Source: Tamaoki M et al., Esophagus 2021 (citing earlier reports). Other studies reported stricture in 4.5–6.3%, perforation in 0% and photosensitivity in 0–4.5%.
Light protection is simple: for 2–4 weeks after treatment, stay indoors in light below 500 lux and avoid direct sunlight. Long sleeves, a hat and gloves make going out easier. Repeated treatment of the same spot may raise the risk of stricture, so doctors check the esophagus carefully before another session.
How does it differ from PDT in the US?
The US FDA has also approved PDT for esophageal cancer and Barrett's esophagus, and it is used to relieve symptoms when cancer blocks the esophagus. The drug mainly used in the US is porfimer sodium, a first-generation photosensitizer. Talaporfin, used in Japan, requires a shorter light-protection period.
| Item | Talaporfin (Japan) | Porfimer (US and others) |
|---|---|---|
| Generation | Second-generation photosensitizer | First-generation photosensitizer |
| Light protection period | 2–4 weeks | About 6 weeks |
| Main use in esophageal cancer | Salvage treatment for cancer remaining or recurring after radiotherapy | Treatment of esophageal cancer and Barrett's esophagus, relief of blockage |
Sources: US National Cancer Institute (NCI) PDT fact sheet / Tamaoki M et al., Esophagus 2021 / Kyoto University 2015.
Other radiation options for esophageal cancer are covered in esophageal cancer proton therapy, and the difference between PDT and photoimmunotherapy is explained in PDT vs photoimmunotherapy.
Questions to ask your doctor
- Does the depth of my remaining cancer (T stage) make me eligible for PDT?
- Compared with endoscopic resection or salvage surgery, which treatment suits me better?
- How long is the hospital stay, and how long do I need light protection?
- If complete response is not reached, can I receive PDT again?
- How often will I need follow-up endoscopy after treatment?
Records to prepare: details of your earlier chemoradiotherapy (including radiation dose), recent endoscopy images and biopsy results, and CT/PET scans.
Frequently asked questions
Who can receive photodynamic therapy for esophageal cancer?
In Japan it is for patients whose esophageal cancer remains or recurs after chemoradiotherapy or radiotherapy. The approval trial included patients whose cancer was limited to the muscle layer of the esophagus without spread to lymph nodes or other organs.
How effective is photodynamic therapy for esophageal cancer?
In the phase II trial, 23 of 26 patients (88.5%) achieved a local complete response. In long-term follow-up with a median of 6.8 years, the 5-year local progression-free rate was 84.9% and 5-year survival was 40.6%.
How long should I avoid light after PDT?
With talaporfin, used in Japan, patients stay indoors below 500 lux and avoid direct sunlight for 2–4 weeks after treatment. With porfimer, used in the US, light must be avoided for about 6 weeks.
Can PDT be repeated?
Yes. In a Kyoto University Hospital report, 6 of 13 patients (46.2%) who were treated again achieved a local complete response. Repeated treatment of the same spot may increase the risk of stricture, so the medical team decides based on the patient's condition.
Related: Glioblastoma photodynamic therapy · Basal cell carcinoma PDT FDA approval · Photoimmunotherapy information
Sources
- Yano T, Kasai H, Horimatsu T et al. A multicenter phase II study of salvage photodynamic therapy using talaporfin sodium (ME2906) and a diode laser (PNL6405EPG) for local failure after chemoradiotherapy or radiotherapy for esophageal cancer. Oncotarget 2017;8:22135–22144
oncotarget.com
Checked: 2026-11-02 - Horimatsu T, Yano T, Yamamoto Y et al. Long-term outcome of PDT for local failure after CRT or RT for oesophageal cancer. J Gastroenterol 2026;61(2):131–138
pubmed.ncbi.nlm.nih.gov/41219541
Checked: 2026-11-02 - Tamaoki M, Yokoyama A, Horimatsu T et al. Repeated talaporfin sodium photodynamic therapy for esophageal cancer: safety and efficacy. Esophagus 2021;18(4):817–824
link.springer.com
Checked: 2026-11-02 - Kyoto University — Photodynamic therapy approved for salvage treatment of esophageal cancer (2015-06-30)
kyoto-u.ac.jp
Checked: 2026-11-02 - National Cancer Institute — Photodynamic Therapy to Treat Cancer
cancer.gov
Checked: 2026-11-02
Written by the FTH editorial team. Sources checked 2026-11-02 · Medical review: not applicable
This article is general information based on public sources and does not replace diagnosis or treatment. Please discuss treatment decisions with your medical team.
