PHOTOSENSITIZATION AND PHOTODYNAMIC THERAPY OF ESOPHAGEAL, DUODENAL, AND COLORECTAL RUMORS USING 5-AMINOLEVULINIC ACID-INDUCED PROTOPORPHYRIN-IX - A PILOT-STUDY
PHOTOSENSITIZATION AND PHOTODYNAMIC THERAPY OF ESOPHAGEAL, DUODENAL, AND COLORECTAL RUMORS USING 5-AMINOLEVULINIC ACID-INDUCED PROTOPORPHYRIN-IX - A PILOT-STUDY
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作者：
REGULA, J;MACROBERT, AJ;BOWN, SG
首次研究了光动力疗法在人体胃肠道使用5氨基乙酰丙酸（ALA）诱导的原卟啉IX作为光敏剂。研究了18例结直肠、十二指肠和食管肿瘤患者。口服ALA 30-60 mg/kg后，1-72小时后取肿瘤和邻近正常粘膜活检标本。通过定量荧光显微镜检查这些标本，以评估原卟啉IX的致敏性。几周后，10名患者接受了第二次ALA治疗，他们的肿瘤用红色激光（628 nm）治疗。在30 mg/kg ALA时，在十二指肠和食管中检测到最高的荧光值，而在大肠中检测到最低的荧光值。在结肠直肠肿瘤患者中加倍ALA剂量得到与上消化道病变患者相似的原卟啉IX荧光强度，并改善了肿瘤：正常粘膜原卟啉IX敏化比率。接受治疗的患者在暴露于激光的区域显示出浅表粘膜坏死。6例患者出现一过性门冬氨酸转氨酶升高、皮肤光敏反应，5例轻度恶心呕吐。总之，全身给予ALA的光动力疗法可能是治疗小肿瘤和发育不良区域（如Barrett食管）的一种有前途的技术。
The first study of photodynamic therapy in the human gastrointestinal tract using 5 aminolaevulinic acid (ALA) induced protoporphyrin IX as the photosensitising agent is described. Eighteen patients with colorectal, duodenal, and oesophageal tumours were studied. After 30-60 mg/kg of ALA given orally, biopsy specimens of tumour and adjacent normal mucosa were taken 1-72 hours later. These specimens were examined by quantitative fluorescence microscopy for assessment of sensitisation with protoporphyrin IX. Ten patients were given a second dose of ALA a few weeks later and their tumours were treated with red laser Light (628 nm). With 30 mg/kg ALA, the highest fluorescence values were detected in the duodenum and oesophagus, and the lowest in the large bowel. Doubling the ALA dose in patients with colorectal tumours gave protoporphyrin IX fluorescence intensities similar to those in patients with upper gastrointestinal lesions and improved the tumour:normal mucosa protoporphyrin IX sensitisation ratio. The treated patients showed superficial mucosal necrosis in the areas exposed to laser light. Six had transient rises patients aspartate aminotransferases, skin photosensitivity reactions, and five mild nausea and vomiting. In conclusion, photodynamic therapy with systemically administered ALA may be a promising technique for the treatment of small tumours and areas of dysplasia such as in Barrett's oesophagus.