Radu A, Grosjean P, Fontolliet C, Wagnieres G, Woodtli A, Bergh H V, Monnier P
Department of Otolaryngology Head and Neck Surgery CHUV Hospital Lausanne CH-1011 Switzerland.
Diagn Ther Endosc. 1999;5(3):145-54. doi: 10.1155/DTE.5.145.
Cancer, when detected at an early stage, has a very good probability of being eradicated by surgery or radiotherapy. However, less aggressive treatments also tend to provide high rates of cure without the side effects of radical therapy. We report on the results of our clinical experience with photodynamic therapy (PDT) for the treatment of early carcinomas in the upper aerodigestive tract, the esophagus, and the tracheobronchial tree. Sixty-four patients with 101 squamous cell carcinomas were treated with three different photosensitizers: hematoporphyrin derivative (HPD), Photofrin II, and tetra (m-hydroxyphenyl)chlorin (mTHPC). Seventy-seven (76%) tumors showed a complete rsponse with no recurrence after a mean follow-up period of 27 months. There was no significant difference in terms of cure rates among the three dyes. However, mTHPC has a stronger phototoxicity and induces a shorter skin photosensitization than either of the other photosensitizers. There were eight major complications: three esophagotracheal fistulae after illumination with red light in the esophagus, two esophageal stenoses following 360 degrees circumferential irradiation, and three bronchial stenoses. Illumination with the less penetrating green light and the use of a 180 degrees or 240 degrees windowed cylindrical light distributor render the risk of complications in the esophagus essentially impossible, without reducing the efficacy of the treatment. Therefore, PDT may be considered as a safe and effective treatment for early carcinomas of the upper aerodigestive tract, the esophagus, and the tracheobronchial tree.
癌症若在早期被发现，通过手术或放疗有很大概率被根除。然而，侵入性较小的治疗方法往往也能提供较高的治愈率，且没有根治性疗法的副作用。我们报告了光动力疗法（PDT）治疗上消化道、食管和气管支气管树早期癌的临床经验结果。64例患有101例鳞状细胞癌的患者接受了三种不同的光敏剂治疗：血卟啉衍生物（HPD）、第二代光敏素（Photofrin II）和四（间羟基苯基）氯卟啉（mTHPC）。77例（76%）肿瘤在平均27个月的随访期后显示完全缓解且无复发。三种染料在治愈率方面无显著差异。然而，mTHPC的光毒性比其他两种光敏剂更强，且引起的皮肤光敏反应持续时间更短。有8例主要并发症：3例因食管红光照射后出现食管气管瘘，2例因360度环形照射后出现食管狭窄，3例出现支气管狭窄。使用穿透性较弱的绿光照射以及采用180度或240度开窗圆柱形光导器，在不降低治疗效果的情况下，基本消除了食管并发症的风险。因此，光动力疗法可被视为治疗上消化道、食管和气管支气管树早期癌的一种安全有效的方法。
