McCaughan J S
The Grant Laser Center and The Laser Medical Research Foundation, Columbus, Ohio 43215, USA.
Lasers Surg Med. 1999;24(3):194-201. doi: 10.1002/(sici)1096-9101(1999)24:3<194::aid-lsm4>3.0.co;2-#.
For the past 15 years we have used photodynamic therapy (PDT) to treat endobronchial tumors. Unfortunately patients who have non-primary lung cancer metastatic to bronchi and who have failed other treatment regimens may not be offered endobronchial tumor management. Thirteen patients with endobronchial tumors metastatic from non-pulmonary primaries were treated with PDT. We: 1) evaluated the effects of PDT on the tumor, the quality of life, and the length of survival; and 2) compared their survival after PDT to that of 27 patients with stage IV primary endobronchial tumors treated with PDT after they failed all other treatment regimens.
Photodynamic therapy was performed using 630-nm light delivered through cylinder diffusing tip quartz fibers passed through the biopsy channel of a flexible bronchoscope after intravenous injection of the photosensitizer dihematoporphyrin ether. One to two days after PDT bronchoscopy was repeated and necrotic tissue was mechanically removed and, if necessary, that site or other new sites were treated. Two days after this another bronchoscopy was performed and the necrotic tissue was mechanically removed. Bronchoscopy was repeated one month after PDT and periodically thereafter as needed to re-treat symptomatic residual tumor. The percent obstruction of the bronchus due to tumor was estimated before and at the end of each bronchoscopy. Clinical effects were evaluated using Wilcoxon signed rank tests for scaled parameters of dyspnea, cough, hemoptysis, and Karnofsky Performance Status (KPS) before and one month after PDT. All patients were followed until their death.
The mean percent obstruction due to metastatic non-pulmonary tumors at 38 different endobronchial treated sites decreased from 85% to 13% at discharge after PDT. The 72% mean decrease of obstruction was statistically significant using the Wilcoxon signed rank test (P < .0001). There was a statistically significant improvement in the level of dyspnea (P = .012), hemoptysis (P = .028), cough (P = .027), and KPS (P = .020). Kaplan-Meier survival curves and Mann-Whitney U rank tests showed the median survival of stage IV primary tumor patients (4 months) vs. metastatic tumor patients (14 months) was statistically significant (P = .008).
PDT of endobronchial metastatic tumors effectively decreased the amount of endobronchial obstruction, and improved the quality of life.
在过去15年中，我们一直使用光动力疗法（PDT）治疗支气管内肿瘤。不幸的是，对于那些非原发性肺癌转移至支气管且其他治疗方案均告失败的患者，可能无法提供支气管内肿瘤的治疗。13例支气管内肿瘤由非肺部原发性肿瘤转移而来的患者接受了光动力疗法治疗。我们：1）评估了光动力疗法对肿瘤、生活质量和生存时长的影响；2）将他们接受光动力疗法后的生存率与27例IV期原发性支气管内肿瘤患者在所有其他治疗方案均告失败后接受光动力疗法的生存率进行了比较。
在静脉注射光敏剂双血卟啉醚后，使用通过柔性支气管镜活检通道插入的圆柱状扩散头石英纤维传输的630纳米光进行光动力疗法。光动力疗法后1至2天重复进行支气管镜检查，机械清除坏死组织，如有必要，对该部位或其他新部位进行治疗。在此之后2天再进行一次支气管镜检查，机械清除坏死组织。光动力疗法后1个月重复进行支气管镜检查，此后根据需要定期重复，以再次治疗有症状的残留肿瘤。在每次支气管镜检查前及结束时评估肿瘤导致的支气管阻塞百分比。使用Wilcoxon符号秩和检验评估光动力疗法前及1个月后呼吸困难、咳嗽、咯血和卡氏功能状态（KPS）等量化参数的临床效果。所有患者均随访至死亡。
在38个不同的接受治疗的支气管内部位处，转移性非肺部肿瘤导致的平均阻塞百分比在光动力疗法后出院时从85%降至13%。使用Wilcoxon符号秩和检验，平均72%的阻塞减轻具有统计学意义（P < .0001）。呼吸困难程度（P = .012）、咯血（P = .028）、咳嗽（P = .027）和KPS（P = .020）均有统计学意义的改善。Kaplan-Meier生存曲线和Mann-Whitney U秩和检验显示，IV期原发性肿瘤患者的中位生存期（4个月）与转移性肿瘤患者的中位生存期（14个月）具有统计学意义（P = .008）。
支气管内转移性肿瘤的光动力疗法有效减少了支气管内阻塞量，并改善了生活质量。
