McCaughan J S, Williams T E
Grant Laser Center, Columbus, Ohio, USA.
J Thorac Cardiovasc Surg. 1997 Dec;114(6):940-6; discussion 946-7. doi: 10.1016/S0022-5223(97)70008-4.
After intravenous injection, the photosensitizer dihematoporphyrin either is selectively retained in tumor cells. This photosensitizer absorbs 630 nm wavelength light energy and produces a singlet oxygen that destroys the tumor. Photodynamic therapy was performed on endobronchial tumors with the use of light generated by an argon dye laser system delivered through cylinder diffusing tip quartz fibers passed through the biopsy channel of a flexible endoscope.
Our objectives were to determine factors affecting survivals, benefits, and complications.
From 1982 to May 1996, photodynamic therapy was performed on 175 patients with endobronchial tumors. Sixteen had stage I disease, 9 stage II, 42 stage IIIA, 64 stage IIIB, and 44 stage IV. All were followed up until death or November 1996.
Multivariate analysis of survival of the effects of age, sex, race, histologic features, Karnofsky Performance Status, and clinical stage showed the clinical stage (p < 0.0001) to be the most statistically significant factor. Sixteen patients with stage I disease had a 93% 5-year disease-related estimated survival. Median (months) survivals were as follows: stage I = not reached; stage II = 22.5; stage IIIA = 5.7; stage IIIB = 55; and stage IV = 5.0. Performance status does become significant when it reaches 50 but was not significant for stages I or II.
Photodynamic therapy may be considered as an alternative treatment for patients under consideration for surgical treatment for stage I carcinoma in whom the risk of surgery is high. The length of palliation for patients with noncurative disease was equal to or better than that reported historically for most other treatment regimens.
静脉注射后，光敏剂二血卟啉选择性地滞留于肿瘤细胞中。这种光敏剂吸收630纳米波长的光能并产生单线态氧以破坏肿瘤。使用通过柔性内窥镜活检通道的圆柱状扩散头石英纤维传输的氩染料激光系统产生的光，对支气管内肿瘤进行光动力治疗。
我们的目的是确定影响生存率、疗效及并发症的因素。
1982年至1996年5月，对175例支气管内肿瘤患者进行了光动力治疗。其中16例为Ⅰ期疾病，9例为Ⅱ期，42例为ⅢA期，64例为ⅢB期，44例为Ⅳ期。所有患者均随访至死亡或1996年11月。
对年龄、性别、种族、组织学特征、卡诺夫斯基功能状态和临床分期对生存影响的多因素分析显示，临床分期（p<0.0001）是最具统计学意义的因素。16例Ⅰ期疾病患者的5年疾病相关估计生存率为93%。中位（月）生存期如下：Ⅰ期=未达到；Ⅱ期=22.5；ⅢA期=5.7；ⅢB期=55；Ⅳ期=5.0。当功能状态达到50时具有显著意义，但对Ⅰ期或Ⅱ期不显著。
对于手术风险高的Ⅰ期癌患者，若考虑手术治疗，光动力治疗可作为一种替代治疗方法。对于无法治愈的疾病患者，姑息治疗的时长等于或优于历史上报道的大多数其他治疗方案。
