Godoy H, Vaddadi P, Cooper M, Frederick P J, Odunsi K, Lele S
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Eur J Gynaecol Oncol. 2013;34(4):300-2.
There is a need for novel therapies for women with recurrent gynecologic malignancies. In this paper, the authors report their experience with photodynamic therapy (PDT). PDT involves administering a systemic injection of Photofrin II, a selective tumor photosensitizer hematoporphyrin derivative, followed by exposure of tumor tissue to visible light at 630 nm. The photodynamic destruction of tumor exhibits both cytocidal and vascular effects that may contribute to the tumoricidal effects observed.
Patients were injected intravenously with two mg/kg Photofrin II. Approximately 48 hours post-injection, the tumor was exposed to red light (wavelength 630 nm +/- 2 nm) from a laser through a flexible 400-um quartz fiber with an attached microlens to produce a spot of uniform intensity and/or diffuser tip fiber to uniformly illuminate the cavity.
Thirty-two patients with recurrent gynecologic malignancies were treated with photodynamic therapy using Photofrin II dye and laser. A total of 45 PDT treatments were given; 25 patients received only one treatment, five patients received two treatments, two patients received three treatments, and one patient received four treatments. There were nine cervical, six vulvar, six vaginal, five ovarian, five endometrial carcinomas, and one recurrent pagets of the anal canal. Nine out of 11 (82%) patients with metastatic cutaneous lesions had a complete response. Five out of 21 patients (24%) with vaginal, cervical or anal recurrences had a complete response to therapy with median response time of 28 months. Toxicity associated with treatment was limited to burning sensation, pain, and edema at treatment site. There were no treatment related deaths.
PDT is an effective therapy in patients with recurrent gynecologic malignancies and limited treatment options. PDT is an alternative therapy that offers the possibility of complete response in select groups of patient populations. Specifically, it provides palliation for superficial recurrent lesions of skin, cervix, vagina and vulva, in the absence of distant disease.
复发性妇科恶性肿瘤的女性患者需要新的治疗方法。在本文中，作者报告了他们使用光动力疗法（PDT）的经验。光动力疗法包括全身注射光敏剂二血卟啉醚（Photofrin II），一种选择性肿瘤光敏剂血卟啉衍生物，然后将肿瘤组织暴露于630nm的可见光下。肿瘤的光动力破坏表现出细胞杀伤和血管效应，这可能有助于观察到的杀肿瘤效应。
患者静脉注射2mg/kg的光敏剂二血卟啉醚（Photofrin II）。注射后约48小时，通过带有连接微透镜的400μm柔性石英纤维或漫射尖端纤维将肿瘤暴露于激光发出的红光（波长630nm±2nm）下，以产生强度均匀的光斑和/或均匀照亮腔隙。
32例复发性妇科恶性肿瘤患者接受了使用光敏剂二血卟啉醚（Photofrin II）染料和激光的光动力治疗。共进行了45次光动力治疗；25例患者仅接受一次治疗，5例患者接受两次治疗，2例患者接受三次治疗，1例患者接受四次治疗。其中有9例宫颈癌、6例外阴癌、6例阴道癌、5例卵巢癌、5例子宫内膜癌和1例肛管复发性佩吉特病。11例有转移性皮肤病变的患者中有9例（82%）完全缓解。21例阴道、宫颈或肛门复发患者中有5例（24%）对治疗完全缓解，中位缓解时间为28个月。与治疗相关的毒性仅限于治疗部位的烧灼感、疼痛和水肿。没有与治疗相关的死亡病例。
对于复发性妇科恶性肿瘤且治疗选择有限的患者，光动力疗法是一种有效的治疗方法。光动力疗法是一种替代疗法，在特定患者群体中有可能实现完全缓解。具体而言，在没有远处疾病的情况下，它可为皮肤、宫颈、阴道和外阴的浅表复发性病变提供姑息治疗。
