一项评估联合局部光动力疗法和手术治疗乳房外佩吉特病的前瞻性试点研究。
A prospective pilot study to evaluate combined topical photodynamic therapy and surgery for extramammary paget's disease.
作者信息
Wang Hong-wei, Lv Ting, Zhang Ling-lin, Lai Yong-xian, Tang Li, Tang Yi-chen, Huang Zheng, Wang Xiu-li
机构信息
Department of Dermatology and Venereology, Shanghai Skin Diseases Hospital, 200 Wuyi Road, Shanghai, P.R. China.
出版信息
Lasers Surg Med. 2013 Jul;45(5):296-301. doi: 10.1002/lsm.22142. Epub 2013 Jun 5.
BACKGROUND AND OBJECTIVE
Extramammary Paget's disease (EMPD) is a rare intra-epithelial neoplasm. Surgical excision is the treatment of choice. The usefulness of topical photodynamic therapy (PDT) in the treatment of EMPD has been reported. The objective of this prospective pilot study was to investigate the feasibility of combined PDT and surgery in the treatment of EMPD.
SUBJECTS AND METHODS
A total of 13 patients with 19 large EMPD lesions were recruited and assigned to surgery (n = 5) or PDT + surgery (n = 8) group. For the PDT + surgery group, four sessions of topical PDT mediated with 20% 5-aminolevulinic acid (ALA-PDT) were applied prior to surgery. Patients were followed up for 12 months. Treatment outcomes, adverse reactions and recurrence were compared.
RESULTS
In the surgery group, recurrence was seen in 2 out of 8 lesions (25%). In the combination group, over 58% reduction in lesion size was achieved after 4-sessions of PDT and recurrence was seen in 1 out of 11 lesions (9.1%) after surgery.
CONCLUSIONS
Multiple ALA-PDT could be applied to reduce the severity of EMPD lesion and improve the success of surgery.
背景与目的
乳房外佩吉特病（EMPD）是一种罕见的上皮内肿瘤。手术切除是首选治疗方法。已有报道局部光动力疗法（PDT）治疗EMPD的有效性。这项前瞻性初步研究的目的是探讨PDT联合手术治疗EMPD的可行性。
受试者与方法
共招募了13例患有19处大型EMPD病变的患者，并将其分为手术组（n = 5）或PDT+手术组（n = 8）。对于PDT+手术组，在手术前应用4个疗程的20% 5-氨基酮戊酸介导的局部PDT（ALA-PDT）。对患者进行了12个月的随访。比较了治疗效果、不良反应和复发情况。
结果
手术组8处病变中有2处复发（25%）。联合组在4个疗程的PDT后病变大小减少超过58%，手术后11处病变中有1处复发（9.1%）。
结论
多次ALA-PDT可用于减轻EMPD病变的严重程度并提高手术成功率。
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