光动力学疗法联合局部注射化疗药物治疗进展期食管贲门癌——附202例报告

Photodynamic therapy combined with local chemotherapy for advanced esophagocardiac cancer-a report of 202 cases

目的评价光动力学疗法联合局部注射化疗药物治疗进展期食管贲门癌的疗效。方法应用光动力学疗法（PDT）治疗食管贲门癌202例,按治疗方法分为单纯PDT组（42例）和PDT联合局部化疗组（160例）。对每一患者均先静脉输注光敏剂癌光啉（PSD-007）或血卟啉单甲醚（HMME）3-5 mg/kg,于用药后经内镜以激光照射肿瘤局部。PDT联合局部化疗组除PDT治疗外,于每次激光照射前肿瘤局部注射化疗药物5-Fu或平阳霉素,间隔1个月可重复治疗。结果经治疗后多数患者吞咽困难、下咽痛等临床症状不同程度缓解,其中PDT联合局部化疗组吞咽困难的缓解率显著高于单纯PDT组,生存质量亦提高。PDT联合局部化疗组的近期显效率显著高于单纯PDT组。部分病例随访12-36个月,PDT联合局部化疗组的平均生存期较单纯PDT组显著延长。结论PDT联合局部化疗治疗食管贲门癌的治疗方法安全有效,并能协同提高PDT的治癌效果,有临床推广应用价值。

Objective To study the effect of photodynamic therapy （PDT） combined with local chemotherapy in the treatment of esophagocardiac cancer. Methods 202 patients with advanced esophagocardiac cancer were divided into two groups. The PDT group （ n =42） were treated by PDT, the combined treatment group （ n = 160） were treated by PDT in combination with local chemotherapy under endoscope. The PDT was carried out by giving intravenous injection of photosensitizer- photocarcinorin （PSD- 007 ） or hematoporphyrin monomethyl ether （HMME） 3 -5 mg/kg, followed by laser irradiation of the entire tumor. In combined treatment group, 5 - Fu or pingyangmycin was locally injected prior to each irradiation. Results The rate of dysphagia remission in combined treatment group was significantly higher than that in PDT group. On short - term efficacy, the rate of significant remission in combined treatment group was significantly higher than that in PDT group. The patients were followed - up for 12 -36 months; the mean survival time of combined treatment group was longer than that of PDT group. Conclusion PDT combined with local chemotherapy is safe and effective for advanced esophagocardiac cancer, with its therapeutic effect better than that of PDT alone.