Keeley Samuel B, Pennathur Arjun, Gooding William, Landreneau Rodney J, Christie Neil A, Luketich James
University of Pittsburgh Medical Center, Heart, Lung, and Esophageal Surgery Institute, Pittsburgh, PA, USA.
Ann Surg Oncol. 2007 Aug;14(8):2406-10. doi: 10.1245/s10434-007-9392-x. Epub 2007 May 30.
Photodynamic therapy (PDT) has been used to palliate advanced, obstructing, or bleeding esophageal cancers (ECs) and Barrett's high-grade dysplasia (HGD). Few investigators, though, have described using PDT to cure either disease.
We performed a retrospective review from 1997-2005 of 50 patients with HGD or EC. All patients refused surgical resection or were physiologically unfit. They were instead treated using PDT with curative intent. Clinical follow-up, long-term survival, complications, and recurrence were evaluated.
Thirteen patients (26%) had Barrett's HGD, 6 (12%) had small, intramural carcinomas, 16 (32%) had T1 N0 tumors, 14 (28%) had T2 N0 tumors, and 1 (2%) had a small, polypoid T3 lesion. The mean length of follow-up was 28.1 months. Sixteen patients (32%) are alive without recurrence, 15 (30%) are living with residual or recurrent disease and have received additional PDT, and the remainder (38%) died of recurrent EC or other causes and had known recurrence. Sixteen (32%) patients received adjuvant chemotherapy, radiation, or both. Esophageal stricture occurred in 21 (42%) patients. There was no procedure-related mortality.
PDT may represent a reasonable alternate to esophagectomy for high-risk patients with HGD or superficial esophageal cancer. Due to superior survival and local control, we still favor esophagectomy for patients without physiologic impairment. However, PDT appears to potentially cure approximately one-third of superficial esophageal cancers and provide local control of high-grade dysplasia in a similar subset of patients.
光动力疗法（PDT）已被用于缓解晚期、梗阻性或出血性食管癌（EC）以及巴雷特高级别异型增生（HGD）。然而，很少有研究者描述过使用PDT治愈这两种疾病。
我们对1997年至2005年期间50例HGD或EC患者进行了回顾性研究。所有患者均拒绝手术切除或因生理原因不适合手术。取而代之的是，他们接受了以治愈为目的的PDT治疗。评估了临床随访、长期生存、并发症和复发情况。
13例患者（26%）患有巴雷特HGD，6例（12%）患有小的壁内癌，16例（32%）患有T1 N0肿瘤，14例（28%）患有T2 N0肿瘤，1例（2%）患有小的息肉样T3病变。平均随访时间为28.1个月。16例患者（32%）存活且无复发，15例（30%）患有残留或复发性疾病并接受了额外的PDT治疗，其余患者（38%）死于复发性EC或其他原因且已知有复发。16例（32%）患者接受了辅助化疗、放疗或两者。21例（42%）患者发生了食管狭窄。无手术相关死亡。
对于HGD或浅表食管癌的高危患者，PDT可能是食管切除术的合理替代方案。由于生存率和局部控制效果更佳，我们仍然倾向于对无生理功能损害的患者进行食管切除术。然而，PDT似乎有可能治愈约三分之一的浅表食管癌，并在类似的患者亚组中实现对高级别异型增生的局部控制。
