Foroulis Christophoros N, Thorpe James A C
The General Infirmary at Leeds, Thoracic Unit, Leeds LS9 3EX, UK.
Eur J Cardiothorac Surg. 2006 Jan;29(1):30-4. doi: 10.1016/j.ejcts.2005.10.033. Epub 2005 Dec 6.
Esophagectomy is the standard treatment for high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) arising within Barrett's esophagus. Results of photodynamic therapy (PDT) were retrospectively studied to evaluate the effectiveness of PDT in ablating HGD and/or IMC complicating Barrett's esophagus.
Thirty-one patients unfit for or refusing esophagectomy (male: 20, mean age: 73.4+/-9.3 years) underwent Porfimer sodium PDT ablation of their HGD (15 patients), HGD plus IMC (10 patients) or submucosal/limited T2 adenocarcinoma (6 patients). The mean Barrett's length was 5.8+/-2.2 cm. Pre-PDT endoscopic mucosal resection or Nd:YAG laser ablation of mucosal nodularity within Barrett's segment was offered in six patients.
The main PDT complications were esophagitis (16.1%), photoreactions (12.9%) and stricture requiring dilatation (6.25%). The median post-PDT follow-up was 14 months. The long-term results were (a) for HGD/IMC: initial complete response (endoscopic and histologic absence of HGD-IMC) to PDT was observed in 80.95% of patients, partial response (no endoscopic abnormality, residual IMC-HGD on biopsy) in 9.52%, no response in 9.52% (the recurrence rate after an initial complete response was 17.64%) and (b) for T1b/limited T2 tumors: two patients died from cancer after 24 and 46 months, no evidence of tumor was found in two patients after 12 and 19 months and tumor recurrence was seen in two after 15 and 17 months. The mean survival was 22.1+/-12.3 months.
PDT is effective in ablating HGD/IMC complicating Barrett's esophagus in the majority of cases, while it also seems to be quite effective in treating T1b/limited T2 carcinomas.
食管切除术是治疗巴雷特食管并发的高级别异型增生（HGD）和黏膜内腺癌（IMC）的标准疗法。对光动力疗法（PDT）的结果进行回顾性研究，以评估PDT消融巴雷特食管并发的HGD和/或IMC的有效性。
31例不适合或拒绝接受食管切除术的患者（男性20例，平均年龄73.4±9.3岁）接受了卟吩姆钠PDT消融治疗，其中HGD患者15例，HGD合并IMC患者10例，黏膜下/局限性T2期腺癌患者6例。巴雷特食管的平均长度为5.8±2.2 cm。6例患者在PDT前接受了内镜黏膜切除术或对巴雷特段内的黏膜结节进行了Nd:YAG激光消融。
PDT的主要并发症为食管炎（16.1%）、光反应（12.9%）和需要扩张的狭窄（6.25%）。PDT后的中位随访时间为14个月。长期结果如下：（a）对于HGD/IMC：80.95%的患者PDT后出现初始完全缓解（内镜及组织学检查无HGD-IMC），9.52%为部分缓解（内镜无异常，活检有残留IMC-HGD），9.52%无反应（初始完全缓解后的复发率为17.64%）；（b）对于T1b/局限性T2期肿瘤：2例患者分别在24个月和46个月后死于癌症，2例患者在12个月和19个月后未发现肿瘤证据，2例在15个月和17个月后出现肿瘤复发。平均生存期为22.1±12.3个月。
PDT在大多数情况下能有效消融巴雷特食管并发的HGD/IMC，同时在治疗T1b/局限性T2期癌方面似乎也相当有效。
