Mang T S, Allison R, Hewson G, Snider W, Moskowitz R
Radiation Oncology Department, Buffalo General Hospital, NY 14203, USA.
Cancer J Sci Am. 1998 Nov-Dec;4(6):378-84.
Chest wall recurrence of breast cancer after mastectomy, radiation therapy, and chemotherapy poses a therapeutic dilemma. Further intervention with any or all of these modalities is often futile and morbid. Left untreated, severe pain, infection, and suffering occur.
To ascertain whether photodynamic therapy may present a palliative option for these individuals.
A total of 86 lesions (2.4-cm mean diameter) were treated on eight patients who had biopsy-proven chest wall recurrence despite surgery, chemotherapy, and radiation therapy. Each patient underwent a single photodynamic therapy session in which 1.2 mg/kg of the drug tin ethyl etiopurpurin (Purlytin) was injected and followed 24 hours later by laser light treatment at 660 +/- 3 nm (at 150 mW/cm2 for a total light dose of 200 J/cm2).
With a minimum 6-month follow-up, the objective response rates after photodynamic therapy were complete response, 92%; partial response, 8%; and no response, 0%. Lesions less than 0.5 cm had a 100% complete response. Morbidity was minimal with no systemic toxicity. One patient had a wound infection that responded to oral antibiotics. No photosensitivity reactions were reported in this set of patients. Posttreatment pain was reported and could be treated with medication and application of cold compresses.
Photodynamic therapy offers an excellent local control rate of chest wall recurrence with minimal morbidity after multimodality treatment failure. The treatment is given in a single session and on an outpatient basis. In patients who may register a partial response or have recurrence or the incidence of further chest wall nodules after photodynamic therapy, the treatment is repeatable.
乳腺癌在乳房切除、放疗及化疗后出现胸壁复发会带来治疗难题。对这些患者进一步采用上述任何一种或全部治疗方式往往徒劳且有害。若不治疗，会出现剧痛、感染及患者痛苦等情况。
确定光动力疗法是否可为这些患者提供一种姑息治疗选择。
对8例经活检证实尽管接受了手术、化疗及放疗仍出现胸壁复发的患者共86个病灶（平均直径2.4厘米）进行治疗。每位患者接受单次光动力治疗，先注射1.2毫克/千克的药物锡乙卟啉（Purlytin），24小时后用波长660±3纳米的激光进行治疗（功率为150毫瓦/平方厘米，总光剂量为200焦/平方厘米）。
至少随访6个月，光动力治疗后的客观缓解率为：完全缓解92%；部分缓解8%；无缓解0%。直径小于0.5厘米的病灶完全缓解率为100%。发病率极低，无全身毒性。1例患者出现伤口感染，口服抗生素后好转。这组患者均未报告有光敏反应。有患者报告了治疗后疼痛，可用药物及冷敷治疗。
在多模式治疗失败后，光动力疗法能很好地局部控制胸壁复发，且发病率极低。该治疗在门诊单次进行。对于光动力治疗后可能出现部分缓解或复发或有更多胸壁结节的患者，该治疗可重复进行。
