PHOTODYNAMIC THERAPY OF NONMELANOMA MALIGNANT-TUMORS OF THE SKIN USING TOPICAL DELTA-AMINO LEVULINIC ACID SENSITIZATION AND LASER IRRADIATION
PHOTODYNAMIC THERAPY OF NONMELANOMA MALIGNANT-TUMORS OF THE SKIN USING TOPICAL DELTA-AMINO LEVULINIC ACID SENSITIZATION AND LASER IRRADIATION
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DOI：
10.1111/j.1365-2133.1994.tb03412.x
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发表时间：
1994-06-01
影响因子：
10.3
通讯作者：
SVANBERG, S
中科院分区：
文献类型：
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作者：
SVANBERG, K;ANDERSSON, T;SVANBERG, S
21例80例基底细胞癌（bcc）， 3例10例鲍文病（Bowen’s disease）， 2例4例皮肤t细胞淋巴瘤（cutaneous T-cell lymphoma），采用局部应用血红素前体-氨基乙酰丙酸（ALA）的光动力激光治疗（PDT）。治疗前经组织学确诊。55例bcc为浅表性病变，25例为结节性病变。在80个bcc中，39个（49%）位于躯干，36个（45%）位于头颈区域，4个（15%）位于腿上，1个在手臂上。10例Bowen病病变的两个主要部位是腿部（50%）和躯干（40%）。t细胞淋巴瘤病变位于肩部和手臂。在激光手术前4-6小时，将含有20% ALA的油包水乳膏涂抹在病灶上，边缘距离可见肿瘤边界约10-20毫米。在此期间，高荧光和光动力学活性物质原卟啉IX （Pp IX）通过血红素循环合成。采用激光诱导荧光（LIF）实时监测所有患者治疗前后肿瘤及周围正常皮肤中ppix的分布情况。激光治疗前，LIF显示的Pp-IX分布显示，BCC和Bowen病的肿瘤与正常皮肤的界限约为15:1，t细胞淋巴瘤的界限约为5:1。采用脉冲倍频Nd:YAG激光器泵浦630 nn的染料激光器进行激光治疗。辐照功率密度保持在110 mW/cm(2)以下，以避免过热效应。根据肿瘤大小，总能量为60 J/cm(2)，持续10-20分钟。单次激光治疗后，浅表性基底细胞癌的完全缓解率为100%，结节性基底细胞癌的完全缓解率为64%，再进行一次激光治疗后，完全缓解率达到100%。结节性乳腺癌的治疗。在鲍恩氏病病变中，单次治疗可获得90%的完全缓解。四个t细胞淋巴瘤中有两个完全消失了。随访时间为6 ~ 14个月。
Eighty basal cell carcinomas (BCCs) in 21 patients, 10 lesions of Bowen's disease in three patients, and four lesions of cutaneous T-cell lymphoma in two patients, were treated with photodynamic laser therapy (PDT), using topical application of the haem precursor delta-amino levulinic acid (ALA). The diagnoses were confirmed histologically prior to treatment. Fifty-five of the BCCs were superficial lesions, and 25 were nodular. Of the 80 BCCs, 39 (49%) were located on the trunk, 36 (45%) on the head and neck region, four (15%) on the leg and one on the arm. The two principal locations of the 10 Bowen's disease lesions were the leg (50%) and the trunk (40%). The T-cell lymphoma lesions were located on the shoulder and on the arm. A water-in-oil based cream containing 20% ALA was applied to the lesions, with a margin of about 10-20 mm beyond the visible tumour border, 4-6 h before the laser procedure. During this period of time the highly fluorescent and photodynamically active substance protoporphyrin IX (Pp IX) is synthesized via the haem cycle. Laser-induced fluorescence (LIF) was used for real-time monitoring of the Pp IX distribution in the tumour and in the normal surrounding skin, before and after treatment in all patients. Before laser treatment the Pp-IX distribution demonstrated by LIF showed a demarcation between tumour and normal skin of about 15:1 for BCC and Bowen's disease, and 5:1 for T-cell lymphomas. Laser light from a pulsed frequency-doubled Nd:YAG laser pumping a dye laser with light emission at 630 nn was used for the therapy. The power density in the irradiation was kept below 110 mW/cm(2), in order to avoid hyperthermal effects. A total energy of 60 J/cm(2) was delivered for 10-20 min, depending on the tumour size. A complete response rate of 100% in superficial BCCs and 64% in nodular BCCs occurred after a single laser treatment, and a response rate of 100% was achieved after one additional. treatment in the nodular BCCs. in the Bowen's disease lesions a complete response of 90% was obtained with a single treatment. Two of the four T-cell lymphomas resolved completely. The follow-up time was between 6 and 14 months.