Barr H
Gloucestershire Royal and Cranfield University Institute of Medical Sciences, Gloucestershire Royal Hospital, Gloucester, England.
Drugs Aging. 2000 Feb;16(2):81-6. doi: 10.2165/00002512-200016020-00001.
Photodynamic therapy is now a useful and practical option of the local treatment of gastrointestinal cancers. There is increasing screening and surveillance of patients at risk of oesophageal and gastric cancers. The early detection of disease is often unhelpful if an elderly or frail patient needs to be subjected to radical resectional surgery. Photodynamic therapy can eradicate and cure early mucosal disease following a single endoscopic treatment. If the disease is more advanced good local control and palliation is often possible. Overall, palliation can often be achieved using simpler methods which are highly effective and not associated with the problems of prolonged photosensitisation. It is rapidly becoming clear that the ideal indication is for the treatment of dysplastic lesions in the oesophagus associated with columnar-lined oesophagus (Barrett's oesophagus). In these circumstances a heterogeneous field change often with multifocal dysplasia or cancer can be widely eradicated. Similar areas of squamous dysplasia in the upper oesophagus can be treated. At present a major complication of stricture formation is associated with the use of some photosensitisers. The treatment of cancer at the ampulla of Vater and choriocarcinoma is also proving very effective. The treatment can be performed at endoscopy and is well tolerated and safe.
光动力疗法现已成为胃肠道癌症局部治疗的一种实用选择。对食管癌和胃癌高危患者的筛查与监测日益增多。如果老年或体弱患者需要接受根治性切除手术，疾病的早期检测往往并无帮助。光动力疗法可在单次内镜治疗后根除并治愈早期黏膜疾病。如果疾病处于更晚期，通常也能实现良好的局部控制和姑息治疗。总体而言，使用更简单的方法往往就能实现姑息治疗，这些方法高效且不会出现长时间光敏化的问题。越来越明显的是，理想的适应证是治疗与柱状上皮化生食管（巴雷特食管）相关的食管发育异常病变。在这些情况下，常伴有多灶性发育异常或癌症的异质性区域变化可被广泛根除。食管上段类似的鳞状上皮发育异常区域也可进行治疗。目前，狭窄形成是使用某些光敏剂的主要并发症。对 Vater 壶腹癌和绒毛膜癌的治疗也证明非常有效。该治疗可在内镜下进行，耐受性良好且安全。
