内镜下光动力治疗食管鳞癌及癌前病变的临床价值

Short-term clinical effect of endoscopic photodynamic therapy on esophageal squamous cell carcinoma and precancerous lesion

目的评价内镜下光动力治疗食管鳞癌及癌前病变的短期疗效和安全性。方法2013年9月至2015年4月，在河南省肿瘤医院胸外科内镜微创治疗中心行内镜下光动力治疗的30例食管鳞癌及癌前病变患者纳入回顾性分析，总结治疗的适应证，以及治疗后1年组织病理学的缓解率、复发情况以及并发症发生情况。结果3例中度异型增生、18例重度异型增生和4例原位鳞癌患者，放射学诊断淋巴结转移阴性并要求行内镜下光动力根治性治疗，治疗后3个月和12个月的组织学完全缓解率分别为72．0％（18／25）和88．0％（22／25），术后1年随访期内3例（12．O％）复发、4例（16．0％）出现食管狭窄，无穿孔并发症发生。5例进展期鳞癌患者行内镜下光动力姑息性治疗，治疗后3个月和12个月的组织学部分缓解率分别为60．0％（3／5）和40．0％（2／5），至术后1年2例因肿瘤转移、1例因消化道大出血死亡，无穿孔并发症发生。结论对影像学诊断淋巴结转移阴性并要求接受光动力治疗的食管早期鳞癌及癌前病变患者，行内镜下光动力治疗安全可行，短期疗效确切；对于进展期食管鳞癌患者行内镜下光动力治疗，短期内同样安全有效。

Objective To evaluate the short-term efficacy and safety of endoscopic photodynamic therapy （ PDT ） for esophageal squamous cell carcinoma （ ESCC ） and precancerous lesion. Methods Retrospective analysis was performed on 30 patients with early ESCC or precancerous lesions who received PDT between September 2013 and April 2015 in Endoscopy Center, Henan Tumor Hospital, and its indications were summarized. The main outcomes including histological complete response rate （CR）, recurrence rate and adverse events after treatment of one year were analyzed. Results Three patients with middle grade dyspIasia（ MGD）, 18 with high grade dysplasia（HGD） and 4 with squamous cell carcinoma in situ, all negative lymph node metastasis, received PDT. CRs were 72. 0% （ 18/25 ） and 88.0% （22/25）after one PDT session in 3 months and 12 months, respectively. One-year follow-up showed 3 recurrences （12. 0%）,4 （16. 0%） severe strictures, and no perforation. Five patients with advanced squamous cell carcinoma received palliative PDT. Partial remission rate was 60. 0% （ 3/5 ） after one PDT session in 3 months, and 40.0% （2/5） after 12 months. Two died of tumor metastasis, one died of gastrointestinal bleeding one year after PDT. No perforation occurred. Conclusion Endoscopic photodynamic therapy for esophageal squamous cell carcinoma and precancerous lesions is safe and feasible, with remarkable short- term effect. As for the patients with advanced squamous cell carcinoma, it is equally safe and effective in the short term.