挽救性光动力疗法使用替拉泊芬钠治疗食管癌放化疗或单纯放疗后局部失败的优势。
Advantages of salvage photodynamic therapy using talaporfin sodium for local failure after chemoradiotherapy or radiotherapy for esophageal cancer.
机构信息
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
出版信息
Surg Endosc. 2020 Feb;34(2):899-906. doi: 10.1007/s00464-019-06846-3. Epub 2019 May 28.
BACKGROUND
Photodynamic therapy (PDT) is a salvage treatment for local failure following chemoradiotherapy (CRT) for esophageal cancer. This study aimed to evaluate the efficacy and safety of salvage PDT using the second-generation photosensitizer, talaporfin sodium (L-PDT), and compare L-PDT to PDT using porfimer sodium (P-PDT).
METHODS
We retrospectively analyzed clinical outcomes of patients treated with L-PDT and P-PDT. Patients with histologically proven local failure limited to the shallow muscularis propria layer (T2) after CRT or radiotherapy (RT) for esophageal cancer were enrolled.
RESULTS
A total of 121 patients were enrolled in this study. L-PDT and P-PDT groups consisted of 44 and 77 patients, respectively. The overall local complete response (L-CR) rate was 62.1% (95% confidence interval [CI], 52.6-70.9), and the L-PDT group showed a better L-CR rate than did the P-PDT group (69.0% [95% CI 52.9-82.4] vs. 58.1% [95% CI 46.1-69.5]). The common complications of skin phototoxicity, esophageal stricture, and esophageal fistula were all less frequent in the L-PDT group than in the P-PDT group. The only treatment-related death in this study was in the P-PDT group. With a median follow-up period of 15.8 months (interquartile range 7.1-37.4) in all 121 patients, overall survival rate at 1 year was significantly higher among patients who achieved L-CR (91.2% [95% CI 80.2-96.3]) than among those who could not achieve L-CR with PDT (50.8% [95% CI 33.6-65.6]).
CONCLUSIONS
L-PDT represented better short-term outcomes than P-PDT as a salvage treatment for local failure following CRT or RT for esophageal cancer.
背景
光动力疗法（PDT）是放化疗（CRT）治疗食管癌后局部复发的挽救性治疗方法。本研究旨在评估第二代光敏剂替泊芬钠（L-PDT） salvage PDT 的疗效和安全性，并将 L-PDT 与 PDT 用卟吩姆钠（P-PDT）进行比较。
方法
我们回顾性分析了接受 L-PDT 和 P-PDT 治疗的患者的临床结果。入组标准为 CRT 或放疗（RT）后病理证实的局限于浅肌层（T2）的局部复发食管癌患者。
结果
本研究共纳入 121 例患者。L-PDT 和 P-PDT 组分别有 44 例和 77 例患者。总的局部完全缓解（L-CR）率为 62.1%（95%可信区间[CI]：52.6-70.9），L-PDT 组的 L-CR 率优于 P-PDT 组（69.0% [95% CI：52.9-82.4] vs. 58.1% [95% CI：46.1-69.5]）。皮肤光毒性、食管狭窄和食管瘘等常见并发症在 L-PDT 组均少于 P-PDT 组。本研究中唯一的治疗相关死亡发生在 P-PDT 组。在所有 121 例患者中，中位随访时间为 15.8 个月（四分位间距 7.1-37.4），在 L-CR 患者中，1 年总生存率显著高于 PDT 未能达到 L-CR 的患者（91.2% [95% CI：80.2-96.3] vs. 50.8% [95% CI：33.6-65.6]）。
结论
L-PDT 作为 CRT 或 RT 治疗食管癌后局部复发的挽救性治疗，其短期疗效优于 P-PDT。
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