光动力疗法治疗梗阻性食管癌：光剂量测定及与Nd:YAG激光疗法的随机对照比较

Photodynamic therapy for obstructing esophageal cancer: light dosimetry and randomized comparison with Nd:YAG laser therapy.

作者信息

Heier S K, Rothman K A, Heier L M, Rosenthal W S

机构信息

Division of Gastroenterology, New York Medical College, Valhalla, USA.

出版信息

Gastroenterology. 1995 Jul;109(1):63-72. doi: 10.1016/0016-5085(95)90269-4.

DOI:10.1016/0016-5085(95)90269-4

PMID:7541003

Abstract

BACKGROUND & AIMS: Light dosimetry analysis to achieve predictable tumor necrosis has not been performed for photodynamic therapy (PDT) in the gastrointestinal tract. We evaluated dihematoporphyrin ethers for sensitizing esophageal carcinomas to 630 nm light and compared PDT with neodymium:yttrium-aluminum-garnet (Nd:YAG) laser therapy in a randomized trial.

METHODS

Of 52 patients with dysphagia, 32 received palliative PDT. Ten patients treated with PDT participated in a preliminary trial using various doses of 630-nm light, and 22 patients treated with PDT participated in a randomized trial using a derived standardized light dose for comparison with 20 patients treated with the Nd:YAG laser.

RESULTS

Light dosimetry correlated with depth of tumor necrosis (r = 0.664; P < 0.001). PDT activity was similar for squamous cell and adenocarcinoma. Among randomized patients, both PDT and Nd:YAG therapy relieved dysphagia, but PDT resulted in improved Karnofsky performance status at 1 month (+7 vs. -7; P < 0.001) and longer duration of response (84 vs. 57 days; P = 0.008). Skin photoreactions were unique to PDT.

CONCLUSIONS

The extent of PDT tumor ablation correlates with light dosimetry, enabling selection of a standardized light dose. PDT can relieve esophageal obstruction from squamous cell and adenocarcinoma and is an alternative to Nd:YAG thermal necrosis with a longer duration of response. However, PDT requires patient precautions to minimize skin photoreactions.

摘要

背景与目的

尚未对胃肠道光动力疗法（PDT）进行光剂量分析以实现可预测的肿瘤坏死。我们评估了二血卟啉醚使食管癌对630nm光敏感的效果，并在一项随机试验中将PDT与钕：钇铝石榴石（Nd：YAG）激光疗法进行比较。

方法

52例吞咽困难患者中，32例接受了姑息性PDT。10例接受PDT治疗的患者参与了使用不同剂量630nm光的初步试验，22例接受PDT治疗的患者参与了一项随机试验，使用推导的标准化光剂量与20例接受Nd：YAG激光治疗的患者进行比较。

结果

光剂量测定与肿瘤坏死深度相关（r = 0.664；P < 0.001）。鳞状细胞癌和腺癌的PDT活性相似。在随机分组的患者中，PDT和Nd：YAG疗法均缓解了吞咽困难，但PDT使1个月时的卡诺夫斯基功能状态得到改善（+7对-7；P < 0.001），且缓解持续时间更长（84天对57天；P = 0.008）。皮肤光反应是PDT所特有的。