δ-氨基酮戊酸光动力疗法治疗皮肤癌的评估

Evaluation of Photodynamic Therapy of Skin Cancers with δ-Aminolevulinic Acid

目的 :探讨和评估δ 氨基酮戊酸光动力疗法 (ALA PDT)治疗皮肤癌的疗效。方法 :88例患者首次接受ALA PDT治疗 ,其中包含 34例基底细胞癌 (BCC) ,32例鳞状细胞癌 (SCC) ,2例基底 鳞状细胞癌 (BSCC) ,1例疣状癌 ,9例Bowen病 ,2例乳房Paget病和 8例乳房外Paget病。随访 1～ 3年。结果 :经过 1～ 4次ALA光动力治疗后 ,所有BCC病例 ,包括 1例浅表型和 2 9例实体型病变 ,都获得完全反应 (CR)。除 1例腺样SCC(Ⅲ级 )外 ,全部SCC病例 (Ⅰ、Ⅱ级 )经过 3～ 6次治疗后CR。 9例Bowen病经 1～ 4次治疗后都获得CR。对于Paget病 ,单纯ALA PDT不能使之治愈 ,但可以控制其症状。随访 1～ 3年 ,BCC的复发率为 11% (4 34) ,SCC为 2 2 % (7 2 2 ) ,再次治疗有效。结论 :ALA PDT是一种疗效好、无痛苦、无创伤、无副作用的治疗方法 ,尤其适用于年迈体弱以及肿瘤部位特殊的患者。

Objective: To explore the efficacy of ALA PDT for skin cancers.Methods:All 88 patients,including 34 cases of basal cell carcinoma(BCC),32 cases of squamous cell carcinoma (SCC),two cases of basal squamous cell carinoma (BSCC),one case of verrucuous carcinoma,nine cases of Bowen diseases,two cases of Paget disease of the nipple and eight cases of extramammary Paget diseases,were treated by the ALA PDT first in China in 1997 to 2000.Results:All BCC,including 11 cases of superficial lesions and 29 solid lesions, was achieved complete reaction (CR) by 1～4 times of the ALA photodynamic therapies. Except one patient with adenoid SCC(grade Ⅲ),all SCC(grade I and grade Ⅱ)patients achieved complete remission by 3～6 times of ALA PDT. All Bowen diseases were achieved complete reaction by 1～4 times.Although for Paget diseases it could not cure the disease simply by ALA PDT,it could controll the symptoms.The recurrence rates for BCC were 11%(4/34),and 22%(7/32) for SCC by following up 1～3 years after the therapy and still effective by continue therapies.Conclusion: ALA PDT is an effective,no trauma for healthy tissues,good cosmetic and well tolerated treatment for patients with BCC,SCC,Bowen diseases and Paget diseases,especially for those who are not tolerated to other therapies and who are older and weaker patients,especially for those tumors in specific anatomical sites.