Photodynamic ablation of high-grade dysplasia and early cancer in Barrett's esophagus by means of 5-aminolevulinic acid
Photodynamic ablation of high-grade dysplasia and early cancer in Barrett's esophagus by means of 5-aminolevulinic acid
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DOI：
10.1016/s0016-5085(98)70527-x
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发表时间：
1998-03-01
期刊：
影响因子：
29.4
通讯作者：
Ell, C
中科院分区：
文献类型：
--
作者：
Gossner, L;Stolte, M;Ell, C
背景和目标：传统光敏剂二血卟啉酯治疗Barrett食管的首次治疗经验显示了光动力疗法（PDT）的治疗潜力。本研究的目的是测试5-氨基乙酰丙酸（5-ALA）诱导的原卟啉IX，一种具有高粘膜特异性的光敏剂，对皮肤没有光毒副作用，作为一种新形式的PDT。研究方法：治疗了32例经组织学证实的Barrett食管高度异型增生（n = 10）和粘膜癌（n = 22）患者（平均年龄68.5岁）。口服5-ALA（剂量，60 mg/kg体重）后4 - 6小时，用染料激光系统（635 nm）以150 J/cm（2）的光剂量进行照射。PDT后患者每天接受20-80 mg奥美拉唑。结果如下：在平均9.9个月（范围，1-30个月）的随访中，所有患者（10/10）的高度异型增生均被根除，22例患者中有17例（77%）的粘膜癌被消除。所有厚度小于或等于2 mm的肿瘤均被完全消融（17/17）。方法相关死亡率和发病率为0%。结论：重度异型增生和薄粘膜癌（小于或等于2 mm）的Barrett食管可以完全消融。PDT可能提供一种微创治疗方式作为食管切除术的替代。
Background & Aims: The first therapeutic experiences with the conventional photosensitizer dihematoporphyrinester in the treatment of Barrett's esophagus show the curative potential of photodynamic therapy (PDT). The aim of this study was to test 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX, a photosensitizer with a high mucosa specificity without phototoxic side effects on the skin, as a new form of PDT. Methods: Thirty-two patients (mean age, 68.5 years) with histologically proven high-grade dysplasia (n = 10) and mucosal cancer (n = 22) in Barrett's esophagus were treated. Four to 6 hours after oral ingestion of 5-ALA (dose, 60 mg/kg body wt), irradiation was conducted with a dye laser system (635 nm) with a light dose of 150 J/cm(2). The patients received 20-80 mg omeprazole daily after PDT. Results: High-grade dysplasia was eradicated in all patients (10 of 10), and mucosal cancer was eliminated in 17 of 22 patients (77%) at a mean follow-up of 9.9 months (range, 1-30 months). All tumors less than or equal to 2 mm in thickness were completely ablated (17 of 17). The method-related mortality and morbidity was 0%. Conclusions: Severe dysplasia and thin (less than or equal to 2 mm) mucosal cancer of Barrett's esophagus can be completely ablated. PDT might offer a minimally invasive treatment modality as an alternative to esophagectomy.