Improved long-term survival of PDT and PDT plus for Advanced Obstructive Esophageal Cancer by dual modulating Systematic Macroenvironment and Local Immune Microenvironment

his study evaluates the effects of photodynamic therapy (PDT) alone and in combination with chemotherapy, immunotherapy, and targeted therapy in treating advanced esophageal cancer, focusing on short-term tumor shrinkage and long-term suppression. We retrospectively analyzed 80 patients with advanced obstructive esophageal cancer treated between November 2019 and November 2024. Patients were grouped based on PDT combined with various therapies. Clinical outcomes, tumor responses, and immune changes were assessed using endoscopy, histology, flow cytometry, and RNA sequencing. The effectiveness rate was 100%, with an objective response rate of 66.3%. Dysphagia scores improved significantly (P < 0.05). The median survival was 11 months, with the combination PDT+T+I showing the best outcome (13.5 months). Immune analysis indicated increased local immune cell infiltration and decreased PD-1 expression. PDT alone and combined therapies show promising efficacy in esophageal cancer, improving both tumor shrinkage and immune responses.