Lightdale C J, Heier S K, Marcon N E, McCaughan J S, Gerdes H, Overholt B F, Sivak M V, Stiegmann G V, Nava H R
Columbia University College of Physicians and Surgeons, New York 10032, USA.
Gastrointest Endosc. 1995 Dec;42(6):507-12. doi: 10.1016/s0016-5107(95)70002-1.
Photodynamic therapy (PDT) is a different type of laser treatment from Nd:YAG thermal ablation for palliation of dysphagia from esophageal cancer.
In this prospective, multicenter study, patients with advanced esophageal cancer were randomized to receive PDT with porfimer sodium and argon-pumped dye laser or Nd:YAG laser therapy.
Two hundred thirty-six patients were randomized and 218 treated (PDT 110, Nd:YAG 108) at 24 centers. Improvement in dysphagia was equivalent between the two treatment groups. Objective tumor response was also equivalent at week 1, but at month 1 was 32% after PDT and 20% after Nd:YAG (p < 0.05). Nine complete tumor responses occurred after PDT and two after Nd:YAG. Trends for improved responses for PDT were seen in tumors located in the upper and lower third of the esophagus, in long tumors, and in patients who had prior therapy. More mild to moderate complications followed PDT, including sunburn in 19% of patients. Perforations from laser treatments or associated dilations occurred after PDT in 1%, Nd:YAG 7% (p < 0.05). Termination of laser sessions due to adverse events occurred in 3% with PDT and in 19% with Nd:YAG (p < 0.05).
Photodynamic therapy with porfimer sodium has overall equal efficacy to Nd:YAG laser thermal ablation for palliation of dysphagia in esophageal cancer, and equal or better objective tumor response rate. Temporary photosensitivity is a limitation, but PDT is carried out with greater ease and is associated with fewer acute perforations than Nd:YAG laser therapy.
光动力疗法（PDT）是一种与用于缓解食管癌吞咽困难的钕：钇铝石榴石（Nd：YAG）热消融不同类型的激光治疗。
在这项前瞻性多中心研究中，晚期食管癌患者被随机分配接受用卟吩姆钠和氩泵染料激光进行的光动力疗法或Nd：YAG激光治疗。
24个中心的236例患者被随机分组，218例接受了治疗（光动力疗法110例，Nd：YAG激光治疗108例）。两个治疗组在吞咽困难改善方面相当。在第1周时客观肿瘤反应也相当，但在第1个月时，光动力疗法后为32%，Nd：YAG激光治疗后为20%（p<0.05）。光动力疗法后出现9例完全肿瘤反应，Nd：YAG激光治疗后出现2例。在食管上三分之一和下三分之一部位的肿瘤、长肿瘤以及接受过先前治疗的患者中，观察到光动力疗法反应改善的趋势。光动力疗法后出现更多轻至中度并发症，包括19%的患者出现晒伤。光动力疗法后激光治疗或相关扩张导致的穿孔发生率为1%，Nd：YAG激光治疗为7%（p<0.05）。因不良事件导致激光治疗终止的发生率，光动力疗法为3%，Nd：YAG激光治疗为19%（p<0.05）。
用卟吩姆钠进行的光动力疗法在缓解食管癌吞咽困难方面总体疗效与Nd：YAG激光热消融相当，且客观肿瘤反应率相等或更高。暂时的光敏性是一个限制因素，但光动力疗法比Nd：YAG激光治疗实施起来更容易，且急性穿孔更少。
