光动力治疗在食管肿瘤中的疗效及安全性分析

Effectiveness and safety of photodynamic therapy for esophageal neoplasms

摘要:

目的 观察光动力治疗在食管早癌及食管贲门恶性肿瘤中的疗效及安全性。方法 4例不符合ESD、手术、放疗指征、或不愿进行上述治疗的食管早癌及进展期食管贲门恶性肿瘤患者行内镜下光动力治疗,于治疗前及治疗后第2天,1周,1月,3月行内镜及并发症评估。结果 4例患者平均随访时间为3月, 2例进展期肿瘤患者肿瘤体积接近50%至少1个月,1例早癌患者在随访中病理检查保持阴性。所有患者术后无食管穿孔、出血、急性心包炎、肝肾功能损害发生。光敏反应和术后狭窄为主要并发症。结论 光动力治疗在食管早癌及食管贲门恶性肿瘤中疗效明确,不良反应少,可作为不适宜行ESD、手术或放疗人群的替代选择。

Abstract:

Objective: To evaluate effectiveness and safety of photodynamic therapy (PDT) for patients with early esophageal cancer (EEC) or esophageal and cardiac carcinoma (ECC). Methods: 4 patients with diagnosis of EEC or ECC who were unable to or unwilling to receive conventional esophageal surgery or chemoradiotherapy were enrolled. Effects and complications were evaluated before and the 2nd day, 1 week, 1 month and 3 months after therapy by endoscopy and physical examinations. Results: The average follow-up was 3 months. A nearly 50% reduction of tumor size were observed in two patients with advanced carcinoma for at least one month. One EEC patient obtained constant negative biopsies during the follow-up. Complications like perforation, major bleeding, acute pericarditis, liver and renal toxicity were not occurred in all the patients. Skin sensitivity and postoperative stenosis were the main adverse effects. Conclusion: PDT offers an effective and safe alternative approach to treat early esophageal cancer and esophageal and cardiac carcinoma.