Locally recurrent central-type early stage lung cancer < 1.0 cm in diameter after complete remission by photodynamic therapy.
Locally recurrent central-type early stage lung cancer < 1.0 cm in diameter after complete remission by photodynamic therapy.
复制标题
光动力治疗完全缓解后直径<1.0cm的局部复发中心型早期肺癌。
作者：
K. Furukawa;H. Kato;C. Konaka;T. Okunaka;J. Usuda;Y. Ebihara
背景
众所周知，直径< 1.0 cm的中心型早期肺癌对光动力治疗（PDT）几乎显示100%的完全反应（CR）。然而，我们遇到过表面直径< 1.0 cm的肿瘤CR后局部复发的病例。
患者和方法
随访93例患者的114个病灶，并检查了直径< 1.0 cm的初始肿瘤获得CR后复发的病例。我们比较了CR后局部复发的细胞学结果与PDT前的细胞学结果。评估PDT前和复发时细胞特征与支气管肿瘤浸润深度之间的关系。
结果
病灶< 1.0 cm的患者CR率和5年生存率分别为92.8%（77/83）和57.9%;病灶≥ 1.0 cm的患者CR率和5年生存率分别为58.1%（18/31）和59.3%。两组疗效比较有显著性差异（p < 0.001）。<1.0cm病灶CR后复发9例（11.7%）。当复发的肿瘤细胞在最初治疗的同一部位显示I-II型（低至中度的凋亡）时，可以通过第二次PDT获得CR。III型细胞（高度恶性）显示来自支气管壁深层的肿瘤细胞的特征。由于激光照射和穿透不足，深层残留的肿瘤细胞可能导致同一部位的局部复发。
结论
为降低复发率，在进行PDT治疗前，准确掌握肿瘤的范围和深度至关重要。CR后复发病灶的细胞特征分析似乎是一个有用的信息来源，癌症在支气管壁的浸润深度。
BACKGROUND
It is well known that central-type early stage lung cancer < 1.0 cm in diameter shows almost 100% complete response (CR) to photodynamic therapy (PDT). However, we have encountered cases of local recurrence after CR of tumors with a surface diameter < 1.0 cm.
PATIENTS AND METHODS
Ninety-three patients with 114 lesions were followed up, and cases of recurrence after CR has been obtained with initial tumors that had a diameter < 1.0 cm were examined. We compared the cytologic findings of local recurrence after CR to the cytologic findings before PDT. The relationship between the cell features and the depth of bronchial tumor invasion before PDT and on recurrence was evaluated.
RESULTS
The CR and 5-year survival rates of patients with lesions < 1.0 cm were 92.8% (77 of 83 patients) and 57.9%, respectively; meanwhile, in the group of patients with lesions > or = 1.0 cm, CR and 5-year survival rates were 58.1% (18 of 31 patients) and 59.3%. There was a significant difference in efficacy between the two groups (p < 0.001). Recurrences after CR were recognized in 9 of 77 lesions (11.7%) < 1.0 cm. When the recurrent tumor cells showed type I-II (low-to-moderate atypia) at the same site initially treated, CR could be obtained by a second PDT. Type III cells (high-grade atypia) showed the characteristics of tumor cells from deeper layers of the bronchial wall. Local recurrence at the same site may be caused by residual tumor cells from deep layers because of inadequate laser irradiation and penetration.
CONCLUSIONS
To reduce the recurrence rate, it is essential to accurately grasp the tumor extent and the depth of the bronchogenic carcinoma before performing PDT. Analysis of cell features of recurrent lesions after CR appears to be a useful source of information as to the depth of cancer invasion in the bronchial wall.
血卟啉衍生物支气管镜光疗治疗局限性支气管癌：5 年经验。
影响因子：
8.9
作者：
Edell,ES;Cortese,DA
通讯作者：
Cortese,DA