The role of photodynamic therapy (PDT) in inoperable oesophageal cancer
The role of photodynamic therapy (PDT) in inoperable oesophageal cancer
复制标题
DOI：
10.1016/s1010-7940(99)00350-4
复制
发表时间：
2000-02-01
影响因子：
3.4
通讯作者：
Moore, PJ
中科院分区：
文献类型：
--
作者：
Moghissi, K;Dixon, K;Moore, PJ
目的：评价光动力疗法在不能手术的食道癌患者的姑息治疗中的作用，并确定这一作用在其中具有特殊意义的亚组。方法：65例晚期食道癌患者，男37例，女28例，年龄42~89岁，平均65.6岁。不能手术61例是由于晚期，4例是因为一般情况。58例(%)有过PDT以外的其他治疗方法。所有患者均有吞咽困难，其中20例不能吞咽液体。治疗前进行临床、放射学和内窥镜检查。评估表现状态(PS)和临床分期。PDT方案包括：静脉注射PHOTOFRIN(或等效的聚血卟啉)2 mg/kg，24~72 h后用630 nm激光进行内窥镜照射。主要观察指标：(1)吞咽困难的缓解情况，特别是接受过外照射(EBR)(n=6)的宫颈癌和环状突后癌患者(n=6)，以及有插管或支架治疗(n=9)的患者；(2)生存期。结果：无PDT相关死亡。3名患者(4.6%)出现轻微的皮肤光敏反应。所有患者吞咽困难均得到缓解。58例死亡患者的平均生存期为7.7个月，中位生存期为6个月。7例存活2~30个月，平均16个月。肿瘤组织学、食道位置、入院时吞咽困难的严重程度或既往治疗对生存率没有显著影响。生存受治疗前表现状态的显著影响(PS小于或等于2vs.PS=3)，最显著的是疾病的分期(III期和IV期，P=0.0001)。结论：(1)PDT治疗不能手术的食道癌患者吞咽困难是安全有效的。这在以前用其他方法治疗的环状后食道癌和颈段食道癌以及以前插管或支架置入术的复发恶性梗阻患者中尤其重要。(2)较好的PS(小于或等于2)和疾病III期患者而不是TV期患者的生存受到影响。这项研究一直无法确定完整肿瘤分期对生存率的影响，因为除了4名患者外，其他所有患者都是III和IV期癌症。(C)2000 Elsevier Science B.V.保留所有权利。
Objective: To evaluate the role of PDT in palliation of patients with inoperable oesophageal cancer and to identify subgroups in which this role is of particular significance. Methods: Sixty-five patients (37 male, 28 female) aged 42-89 (mean 65.6) with advanced and inoperable oesophageal cancer were the subjects of this study. Inoperability was due to advanced stage of the disease in 61 and because of general condition in 4. Fifty-eight (89%) had previous treatments, other than PDT. All patients had dysphagia of whom 20 could not swallow fluid. Pre-PDT clinical, radiological and endoscopic examinations were carried out. Performance status (PS) and clinical staging was assessed. PDT protocol consisted of: intravenous injection of 2 mg/kg; photofrin (or equivalent polyhaematoporphyrin) followed 24-72 h later by endoscopic illumination using 630 nm laser light. Main outcome measurements: (1) Relief of dysphagia generally and specifically in those with cervical and post-cricoid carcinoma who were previously treated by external beam radiotherapy (EBR) (n = 6) and those with previous intubation or stent (n = 9); (2) Survival. Results: There was no PDT related mortality. Three patients (4.6%) developed a mild skin photosensitivity reaction. Dysphagia was relieved in all patients. The mean and median survival of the 58 patients who have died was 7.7 and 6 months respectively. Seven patients are alive from 2-30 months (mean 16). Survival was not significantly influenced by tumour histology, location in the oesophagus, severity of dysphagia on admission, or by previous therapy. Survival was significantly influenced by Performance Status prior to treatment (P = 0.03 log rank, for PS less than or equal to 2 vs. PS = 3), and most significantly by the stage of the disease (P = 0.0001 log rank, for Stage III vs. Stage IV). Conclusions: (1) PDT is safe and effective for palliation of dysphagia in inoperable oesophageal cancer. This is particularly important in post-cricoid and cervical oesophageal cancer previously treated by other methods and for patients with recurrent malignant obstruction who previously had intubation or stent placement. (2) Survival is influenced by better PS (less than or equal to 2) and in those with disease Stage III rather than patients in Stage TV. This study has not been able to determine the influence of complete tumour staging on survival because, apart from four patients, all others were Stages III and IV cancer. (C) 2000 Elsevier Science B.V. All rights reserved.