Comparison of high- vs low-dose 5-aminolevulinic acid for photodynamic therapy of Barrett's esophagus
Comparison of high- vs low-dose 5-aminolevulinic acid for photodynamic therapy of Barrett's esophagus
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DOI：
10.1007/s00464-003-9062-4
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发表时间：
2004-03-01
影响因子：
3.1
通讯作者：
Reed, MWR
中科院分区：
文献类型：
--
作者：
Kelty, CJ;Ackroyd, R;Reed, MWR
背景资料：Barrett食管是食管腺癌的主要危险因素，其发病率在西方世界迅速增加。氨基乙酰丙酸光动力疗法（ALA-PDT）是治疗Barrett食管的有效方法，但关于ALA的最佳剂量存在争议。本研究的目的是建立ALA-PDT治疗Barrett食管的最佳剂量方案：25例Barrett食管患者随机接受30（低剂量）或60（高剂量）mg/kg口服ALA在4或6小时或30 mg/kg的两个部分4和6小时PDT前。PDT使用红光（635 nm）标准化。取活检标本用于原卟啉IX（PpIX）定量。结果：所有患者均表现出肉眼可见的反应，鳞状上皮再形成。这种反应在30 mg/kg和分次ALA组中最大。PDT前4小时或6小时给药的反应无显著差异。所有剂量组的PpIX组织水平相似，不能预测临床反应。结论：小剂量ALA-PDT治疗Barrett食管是一种安全的治疗方案。
Background: Barrett's esophagus is the major risk factor for esophageal adenocarcinoma, the incidence of which is increasing rapidly in the Western world. Aminolevulinic acid for photodynamic therapy (ALA-PDT) is effective in the treatment of Barrett's esophagus, but controversy exists regarding optimum ALA dosage. The aim of this study was to establish the optimum dosage regime for ALA-PDT for Barrett's esophagus.Methods: Twenty-five patients with Barrett's esophagus were randomized to receive 30 (low-dose) or 60 (high-dose) mg/kg oral ALA at 4 or 6 h or 30 mg/kg in two fractions 4 and 6 h before PDT. PDT was standardized using red (635 nm) light. Biopsy specimens were taken for protoporphyrin IX (PpIX) quantification. Endoscopy was repeated 4 weeks later.Results: All patients showed a macroscopic response, with squamous re-epithelialization. This response was greatest in the 30 mg/kg and fractionated ALA groups. There was no significant difference in response between dosing 4 or 6 h prior to PDT. Tissue levels of PpIX were similar for all dosage groups and were not predictive of clinical response. Side effects were more common with the higher dose of ALA.Conclusion: Low-dose ALA-PDT appears to be a safe protocol for the ablation of Barrett's esophagus.