Shikowitz M J, Abramson A L, Freeman K, Steinberg B M, Nouri M
Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.
Laryngoscope. 1998 Jul;108(7):962-7. doi: 10.1097/00005537-199807000-00002.
OBJECTIVES/HYPOTHESIS: Recurrent respiratory papillomatosis is a potentially life-threatening disease that affects both children and adults and can result in complete respiratory obstruction. Conventional therapies cannot prevent multiple recurrences. The authors have been evaluating photodynamic therapy (PDT) to treat this disease since 1988. This study compared the efficacy of PDT with dihematoporphyrinether (DHE) with traditional therapy.
This was a randomized prospective trial of DHE-PDT. Patients were randomly assigned to receive one of two doses of DHE--3.25 mg/kg or 4.25 mg/kg body weight. They were compared with a concurrent control group. Disease extent was evaluated by direct laryngoscopy before treatment and over a 1-year period following treatment. Results were also compared with two historical cohorts of patients treated with lower doses of DHE.
Eighty-one patients, ages 4 to 74 years, with moderate to severe recurrent disease were enrolled. Forty-eight received PDT and 33 in the control group were treated with conventional therapy. Both PDT groups received 50 J laser light to activate the drug. Patients received an intravenous infusion of DHE as outpatients 48 to 72 hours before treatment. During direct laryngoscopy, light (630 nm) was delivered by an argon-pumped dye laser. Tissue biopsies were analyzed for presence of human papillomavirus (HPV).
There was notable improvement with either drug dose over the first year. Those receiving 4.25 mg/kg DHE experienced a significantly larger decrease in papilloma growth rate. Three-year follow-up of a subset of patients confirmed that improvement was maintained. There was no impact of DHE-PDT on persistence of HPV DNA.
This therapy holds promise for the treatment of laryngeal papillomas.
目的/假设：复发性呼吸道乳头状瘤病是一种可能危及生命的疾病，可影响儿童和成人，并可导致完全性呼吸道阻塞。传统疗法无法预防多次复发。自1988年以来，作者一直在评估光动力疗法（PDT）治疗这种疾病的效果。本研究比较了PDT联合二血卟啉醚（DHE）与传统疗法的疗效。
这是一项关于DHE-PDT的随机前瞻性试验。患者被随机分配接受两种剂量之一的DHE——3.25毫克/千克或4.25毫克/千克体重。将他们与同期对照组进行比较。在治疗前和治疗后的1年期间，通过直接喉镜检查评估疾病范围。结果还与两个接受较低剂量DHE治疗的历史队列患者进行了比较。
纳入81例年龄在4至74岁之间、患有中度至重度复发性疾病的患者。48例接受PDT治疗，对照组的33例接受传统疗法治疗。两个PDT组均接受50焦耳的激光照射以激活药物。患者在治疗前48至72小时作为门诊病人接受DHE静脉输注。在直接喉镜检查期间，通过氩泵浦染料激光提供光（630纳米）。对组织活检样本进行分析，以检测人乳头瘤病毒（HPV）的存在。
在第一年，两种药物剂量均有显著改善。接受4.25毫克/千克DHE的患者乳头状瘤生长速率的下降明显更大。对一部分患者进行的三年随访证实改善得以维持。DHE-PDT对HPV DNA的持续存在没有影响。
这种疗法有望用于治疗喉乳头状瘤。
