Sibille A, Descamps C, Jonard P, Dive C, Warzeé P, Schapira M, Geubel A
Department of Gastroenterology, St-Luc University Hospital, Brussels, Belgium.
Gastrointest Endosc. 1995 Oct;42(4):340-5. doi: 10.1016/s0016-5107(95)70134-6.
Endoscopic treatment of superficial gastric cancer has been reported to be effective by many Japanese teams. In this study, the Nd:YAG laser was used to treat superficial gastric carcinoma in inoperable Caucasian patients with the aim of obtaining a complete response, i.e., disappearance of the lesion endoscopically and biopsy specimens negative for cancer. Eighteen patients unsuitable for surgery with various endoscopic patterns of superficial gastric cancer were treated with the Nd:YAG laser. The endoscopic pattern was type I in 4 patients, type II in 10 (5 type IIa, 1 type IIb, 2 type IIc, 2 mixed IIa + IIc), and type III in 4. Staging by echoendoscopy was performed in 11 patients (T1N0). Nd:YAG laser destruction of the gastric tumor was performed in all cases, with a mean of 4.4 laser sessions per patient. Tumor response was assessed by endoscopy and biopsy. Follow-up averaged 33 +/- 23 (SD) months. Five patients died of diseases unrelated to gastric cancer. An initial complete response was obtained in 16 (89%) patients after a mean of 1.7 laser sessions; histologic evidence of cancer persisted in 2 patients during the entire follow-up period. Among patients with an initial complete response, recurrence was observed in 2. One of them was successfully re-treated. At the end of the follow-up period, 14 (77.7%) of the 18 patients had a complete tumoral response; only 4 patients had histologic evidence of cancer. In 3 of these 4 patients, pretherapeutic echoendoscopic staging had not been performed. Among the 14 patients exhibiting a complete response, 3 had negative biopsy results more than 5 years after diagnosis. No complications occurred. In gastric cancer classified as T1N0 on the basis of pretherapeutic echoendoscopy, a high tumor response rate and even 5-year disease-free survival can be obtained with endoscopic Nd:YAG laser treatment. Endoscopic laser destruction thus appears to be a valuable therapeutic alternative to surgery in inoperable patients with superficial gastric cancer.
许多日本团队报告称内镜治疗浅表性胃癌有效。在本研究中，使用钕钇铝石榴石（Nd:YAG）激光治疗无法手术的白种人浅表性胃癌患者，目的是实现完全缓解，即内镜下病变消失且活检标本癌症阴性。18例因各种内镜表现的浅表性胃癌而不宜手术的患者接受了Nd:YAG激光治疗。内镜表现为I型4例，II型10例（5例IIa型、1例IIb型、2例IIc型、2例IIa + IIc混合型），III型4例。11例患者（T1N0）进行了超声内镜分期。所有病例均采用Nd:YAG激光破坏胃肿瘤，每位患者平均进行4.4次激光治疗。通过内镜检查和活检评估肿瘤反应。随访平均为33±23（标准差）个月。5例患者死于与胃癌无关的疾病。16例（89%）患者在平均1.7次激光治疗后获得初始完全缓解；2例患者在整个随访期间癌症组织学证据持续存在。在初始完全缓解的患者中，观察到2例复发。其中1例成功接受了再次治疗。随访期末，18例患者中有14例（77.7%）肿瘤完全缓解；只有4例患者有癌症组织学证据。在这4例患者中的3例中，术前未进行超声内镜分期。在14例表现为完全缓解的患者中，3例在诊断后5年以上活检结果为阴性。未发生并发症。对于术前超声内镜分类为T1N0的胃癌，内镜Nd:YAG激光治疗可获得较高的肿瘤反应率，甚至5年无病生存率。因此，内镜激光破坏似乎是无法手术的浅表性胃癌患者手术的一种有价值的治疗替代方法。
