Grosjean P, Wagnieres G, Fontolliet C, van den Bergh H, Monnier P
Department of Otolaryngology, Head and Neck Surgery, CHUV Hospital, Lausanne, Switzerland.
Br J Cancer. 1998 Jun;77(11):1989-95. doi: 10.1038/bjc.1998.330.
Photodynamic therapy (PDT) for cancer in the oesophagus and bronchi with red (630 nm) light may occasionally lead to wall perforation and fistula. Therefore, we investigated the clinical use of a less penetrating wavelength (514 nm) for the curative treatment of nine superficial carcinomas in the oesophagus and bronchi after photosensitization with Photofrin II. Tumours without infiltration beyond the submucosa in the oesophagus and beyond the lamina propria in the bronchi were considered as superficial cancers. The outcome and complications were compared with those of 13 superficial cancers treated with PDT and 630 nm light. In addition, we evaluated histologically the extent of the long-term tissue damage and scarring following treatment of six oesophageal cancers with either green or red light. At first endoscopic control, 7-10 days after PDT, tissue necrosis simply matched the illuminated area, without evidence of selective tumour damage. Six of nine tumours treated with 514 nm light had a complete response compared with nine of 13 after 630 nm irradiation. No perforation or fistula occurred in either treatment group. However, severe chest pain and fever with or without pleural effusion, consistent with occult perforation, were observed in three patients after 630 nm illumination in the oesophagus. Histologically, fibrous scarring in the three distinct sites treated with green light was limited to the superficial layers of the oesophagus. After red light treatment, transmural fibrosis with marked thinning of the oesophageal wall was evident in two of the three specimens available for inspection. These results indicate that PDT with 514 nm light has the potential to cure superficial cancer in the oesophagus and bronchi with essentially the same probability of success as red light. In the oesophagus, green light prevents deep tissue damage, thus reducing the risk of perforation.
用红光（630纳米）对食管癌和支气管癌进行光动力疗法（PDT）偶尔可能导致管壁穿孔和瘘管形成。因此，我们研究了使用穿透性较弱的波长（514纳米）对9例经Photofrin II光敏化后的食管和支气管浅表癌进行根治性治疗的临床应用。食管中未浸润至黏膜下层以外、支气管中未浸润至固有层以外的肿瘤被视为浅表癌。将结果和并发症与13例接受630纳米光PDT治疗的浅表癌患者进行比较。此外，我们对6例接受绿光或红光治疗的食管癌患者治疗后的长期组织损伤和瘢痕形成程度进行了组织学评估。在PDT后7 - 10天首次内镜检查时，组织坏死仅与光照区域相符，没有选择性肿瘤损伤的证据。514纳米光治疗的9例肿瘤中有6例完全缓解，而630纳米照射后13例中有9例完全缓解。两个治疗组均未发生穿孔或瘘管形成。然而，在食管接受630纳米光照后的3例患者中观察到严重胸痛和发热，伴有或不伴有胸腔积液，符合隐匿性穿孔。组织学上，绿光治疗的三个不同部位的纤维瘢痕仅限于食管表层。在红光治疗后，可供检查的三个标本中有两个出现食管壁明显变薄的透壁纤维化。这些结果表明，514纳米光PDT有治愈食管和支气管浅表癌的潜力，成功概率与红光基本相同。在食管中，绿光可防止深部组织损伤，从而降低穿孔风险。
