Sequential photodynamic therapy (PDT) and high dose brachytherapy for endobronchial tumour control in patients with limited bronchogenic carcinoma
Sequential photodynamic therapy (PDT) and high dose brachytherapy for endobronchial tumour control in patients with limited bronchogenic carcinoma
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DOI：
10.1136/thx.2003.013599
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发表时间：
2004-09-01
期刊：
影响因子：
10
通讯作者：
Macha, HN
中科院分区：
文献类型：
--
作者：
Freitag, L;Ernst, A;Macha, HN
背景：肺癌患者的大体积支气管内肿瘤难以治疗。近距离治疗和光动力治疗（PDT）的效果不同，通常不推荐这些治疗的组合。然而，细胞培养研究和动物研究表明，PDT与电离辐射结合可能产生协同效应。我们评估了近距离放疗和PDT联合治疗大体积支气管内肺癌的安全性和有效性。方法：组织学证实的非小细胞支气管源性癌和大体积支气管内肿瘤患者采用PDT （Photofrin, 2mg /kg）和近距离放疗联合治疗。PDT后6周，每隔一周进行5次4 Gy的近距离放疗。随访每3个月进行一次标准和自身荧光支气管镜检查和组织活检。结果：治疗32例。肿瘤分布广泛，沿支气管长度为10 - 60mm，估计体积为40 - 3500mm(3)。在平均24个月的随访中，26例患者无肿瘤残留和局部复发。其余患者接受PDT、近距离治疗、Nd: YAG激光凝固或外部束辐射的第二次治疗。6例患者中有2例发生远处转移（肺、淋巴结）。目前，32名患者均健康。28例患者无残留或局部复发支气管内癌，无严重并发症。结论：PDT联合近距离放疗治疗肺癌合并广泛支气管内肿瘤是安全的，在本研究中具有良好的治疗效果。
Background: Bulky endobronchial tumours in patients with lung cancer are difficult to treat. Brachytherapy and photodynamic therapy (PDT) are variably effective, and the combination of these treatments is not often recommended. However, cell culture studies and animal studies indicate a possible synergistic effect of combining PDT with ionising radiation. We assessed the safety and effectiveness of combined brachytherapy and PDT in patients with bulky endobronchial lung cancer.Methods: Patients with histologically proven non-small cell bronchogenic carcinoma and bulky endobronchial tumours were treated using a combination of PDT ( Photofrin, 2 mg/kg) and brachytherapy. Six weeks after PDT, brachytherapy was applied with five fractions of 4 Gy at weekly intervals. Follow up was performed with standard and autofluorescence bronchoscopy and tissue biopsies every 3 months.Results: Thirty two patients were treated. Tumours were extensive with lengths ranging from 10 to 60 mm along the bronchus and estimated volumes ranging from 40 to 3500 mm(3). At a mean follow up of 24 months, 26 patients were free of residual tumour and local recurrence. The remaining patients received a second treatment with PDT, brachytherapy, Nd: YAG laser coagulation, or external beam radiation. Distant metastases ( lung, lymph node) developed in two of the six patients. Currently, all 32 patients are well. There is no evidence of residual or local recurrent endobronchial cancer in 28 patients and none had severe complications.Conclusion: The combination of PDT and brachytherapy for treating patients with lung cancer and extensive endobronchial tumour is safe and, in this study, had excellent therapeutic efficacy.