光动力疗法治愈上消化道癌5例的临床分析

Analysis on Five Patients Cured of Upper Gastrointestinal Tract Cancer with Photodynamic Therapy

目的分析光动力疗法治愈5例上消化道癌的临床特点和治疗参数的选择。方法分期较早的上消化道癌患者5例,光敏剂应用血卟啉衍生物治疗患者2例,卟吩姆钠治疗患者3例,给药剂量分别为5 mg/kg和2 mg/kg。给药后24～72 h分别应用金蒸气激光和半导体激光照射,功率密度100～150 mW/cm2,能量密度100～150 J/cm2。结果 3例患者行1个疗程光动力治疗后获得治愈;1例胃窦癌患者1个疗程光动力治疗后获得治愈,4年后,胃体再发癌变,再行1个疗程光动力治疗后治愈;1例患者病灶侵犯固有肌浅层,行1个疗程光动力治疗后病灶少许残留,再次光动力治疗后,病灶完全消失。所有患者随访2～8年未见复发或转移,总体不良反应轻微,1例患者治愈后出现食管瘢痕性狭窄。结论应用光动力疗法治疗分期较早的上消化道癌,可取得根治效果,不良反应轻、耐受性好,值得进一步探讨研究。

Objective To analyze the treatment parameters adopted in curing upper gastrointestinal tract cancer with photodynamic therapy and Ule clinical characteristics thereof. Methods Five patients with upper gastrointestinal tract cancer in early stage were treated with photodynamic therapy. HpD and pot- timer s.odium （Photofrin） were used as photosensitizers, which were given intravenously in doses of 5 mg/kg and 2 mg/kg respectively 24-72 hours before irradiation. Gold vapor laser and diode laser were used as light source for the irradiation respectively at a power den- sity of 100 to 200 mW/cm2 and an energy density of 100 to 200 J/cm2. Results Of the five patients cured of upper gastrointestinal tract cancer, three were healed with one course of photodyuamic therapy. One patient with gastric antrum cancer was cured with one course of photodynamic therapy and the cancerous change to his corpus ven- triculi, found 4 years later, was also healed after another course of photodynamic therapy： Another patient, whose cancer focus had in-vaded the shallow layer of intrinsic muscle, was cured after two courses of photodynamic therapy. Neither relapse nor metastasis of cancer occurred to any of the five patients in the follow-up period of 2 to 8 years. In general, the adverse effects were mild, and only one patient developed esophagus cicatricial stenosis after the therapy. Conclusions Photodynamic therapy can safely cure certain types of early-stage upper gastrointestinal tract cancer with mild adverse effects, and it is worth furthering the exploration and resem^ch in this area