Ell C, Gossner L, May A, Schneider H T, Hahn E G, Stolte M, Sroka R
Department of Medicine II, HSK Wiesbaden, Germany.
Gut. 1998 Sep;43(3):345-9. doi: 10.1136/gut.43.3.345.
Radical surgical treatment has been the first choice for early gastric cancer, but high resolution endosonography allows in situ diagnosis with a high sensitivity and specificity and in consequence the option of local endoscopic treatment.
To evaluate photodynamic therapy (PDT) using meso-tetrahydroxyphenyl-chlorin (mTHPC) as the photosensitiser in superficial gastric cancer.
Twenty two patients with superficial early gastric cancer received mTHPC (0.075 mg/kg intravenously) and were treated 96 hours later with red light at 652 nm (20 J/cm2). Tumour response was assessed by endoscopy and extensive biopsy.
Endoscopies performed two to three days after PDT showed a haemorrhagic fibrinoid necrosis of the mucosal layer. Complete remission was achieved in 16/22 (73%) patients: 13/16 (80%) with intestinal type cancer and 3/6 (50%) with a diffuse Lauren's carcinoma. The mean follow up period was 12 months and 20 months, respectively. An average of 1.8 treatment sessions was required. Severe side effects were not observed. Seven patients had mild to moderate skin photo-sensivity reactions; 12 had local pain after PDT for 1-10 days.
PDT using mTHPC as the photosensitiser represents a safe and efficient method for topical treatment of early gastric cancer, especially of Lauren's intestinal carcinoma. If the preliminary results can be verified in larger patient series and during long term follow up, local treatment of early cancers of the stomach by PDT could be considered as a therapeutic option for selected patients.
根治性手术治疗一直是早期胃癌的首选，但高分辨率内镜超声检查可进行原位诊断，具有高敏感性和特异性，因此可选择局部内镜治疗。
评估以中-四羟基苯基氯卟啉（mTHPC）作为光敏剂的光动力疗法（PDT）治疗浅表性胃癌的效果。
22例浅表性早期胃癌患者静脉注射mTHPC（0.075mg/kg），96小时后接受652nm红光照射（20J/cm²）。通过内镜检查和广泛活检评估肿瘤反应。
PDT后两到三天进行的内镜检查显示黏膜层有出血性纤维蛋白样坏死。16/22（73%）例患者实现完全缓解：肠型癌患者13/16（80%），弥漫性劳伦氏癌患者3/6（50%）。平均随访期分别为12个月和20个月。平均需要1.8个疗程。未观察到严重副作用。7例患者有轻度至中度皮肤光敏反应；12例患者PDT后局部疼痛1 - 10天。
以mTHPC作为光敏剂的PDT是局部治疗早期胃癌尤其是劳伦氏肠型癌的一种安全有效的方法。如果初步结果能在更大规模的患者系列中得到验证并进行长期随访，PDT对早期胃癌的局部治疗可被视为特定患者的一种治疗选择。
