PHOTODYNAMIC THERAPY WITH PORFIMER SODIUM VERSUS THERMAL ABLATION THERAPY WITH ND-YAG LASER FOR PALLIATION OF ESOPHAGEAL CANCER - A MULTICENTER RANDOMIZED TRIAL

被引:225
作者
LIGHTDALE, CJ
HEIER, SK
MARCON, NE
MCCAUGHAN, JS
GERDES, H
OVERHOLT, BF
SIVAK, MV
STIEGMANN, GV
NAVA, HR
机构
[1] COLUMBIA UNIV COLL PHYS & SURG,NEW YORK,NY 10032
[2] NEW YORK MED COLL,VALHALLA,NY 10595
[3] WELLESLEY HOSP,TORONTO,ON,CANADA
[4] GRANT LASER CTR,COLUMBUS,OH
[5] MEM SLOAN KETTERING CANC CTR,NEW YORK,NY 10021
[6] THOMPSON CANC SURVIVAL CTR,KNOXVILLE,TN
[7] UNIV CLEVELAND HOSP,CLEVELAND,OH 44106
[8] UNIV COLORADO,HLTH SCI CTR,DENVER,CO
[9] ROSWELL PK MEM INST,BUFFALO,NY
关键词
D O I
10.1016/S0016-5107(95)70002-1
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Photodynamic therapy (PDT) is a different type of laser treatment from Nd:YAG thermal ablation for palliation of dysphagia from esophageal cancer. Methods: In this prospective, multicenter study, patients with advanced esophageal cancer were randomized to receive PDT with porfimer sodium and argon-pumped dye laser or Nd:YAG laser therapy. Results: Two hundred thirty-six patients were randomized and 218 treated (PDT 110, Nd:YAG 108) at 24 centers. Improvement in dysphagia was equivalent between the two treatment groups. Objective tumor response was also equivalent at week 1, but at month 1 was 32% after PDT and 20% after Nd:YAG (p < 0.05). Nine complete tumor responses occurred after PDT and two after Nd:YAG. Trends for improved responses for PDT were seen in tumors located in the upper and lower third of the esophagus, in long tumors, and in patients who had prior therapy. More mild to moderate complications followed PDT, including sunburn in 19% of patients. Perforations from laser treatments or associated dilations occurred after PDT in 1%, Nd:YAG 7% (p < 0.05). Termination of laser sessions due to adverse events occurred in 3% with PDT and in 19% with Nd:YAG (p < 0.05). Conclusions: Photodynamic therapy with porfimer sodium has overall equal efficacy to Nd:YAG laser thermal ablation for palliation of dysphagia in esophageal cancer, and equal or better objective tumor response rate. Temporary photosensitivity is a limitation, but PDT is carried out with greater ease and is associated with fewer acute perforations than Nd:YAG laser therapy.
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页码:507 / 512
页数:6
相关论文
共 19 条
[1]   PALLIATION OF MALIGNANT DYSPHAGIA - SURGERY, RADIOTHERAPY, LASER, INTUBATION ALONE OR IN COMBINATION [J].
BOWN, SG .
GUT, 1991, 32 (08) :841-844
[2]  
BOYCE HW, 1984, SEMIN ONCOL, V11, P186
[3]  
DOUGHERTY TJ, 1978, CANCER RES, V38, P2828
[4]   ENDOSCOPIC ND-YAG LASER THERAPY AS PALLIATION FOR ESOPHAGOGASTRIC CANCER - PARAMETERS AFFECTING INITIAL OUTCOME [J].
FLEISCHER, D ;
SIVAK, MV .
GASTROENTEROLOGY, 1985, 89 (04) :827-831
[5]   COMBINED CHEMOTHERAPY AND RADIOTHERAPY COMPARED WITH RADIOTHERAPY ALONE IN PATIENTS WITH CANCER OF THE ESOPHAGUS [J].
HERSKOVIC, A ;
MARTZ, K ;
ALSARRAF, M ;
LEICHMAN, L ;
BRINDLE, J ;
VAITKEVICIUS, V ;
COOPER, J ;
BYHARDT, R ;
DAVIS, L ;
EMAMI, B .
NEW ENGLAND JOURNAL OF MEDICINE, 1992, 326 (24) :1593-1598
[6]   COMPARISON OF LOW-POWER YAG LASER AND BICAP TUMOR PROBE FOR PALLIATION OF ESOPHAGEAL CANCER STRICTURES [J].
JENSEN, DM ;
MACHICADO, G ;
RANDALL, G ;
TUNG, LA ;
ENGLISHZYCH, S .
GASTROENTEROLOGY, 1988, 94 (06) :1263-1270
[7]   PHOTODYNAMIC THERAPY FOR CANCERS - A CLINICAL-TRIAL OF PORFIMER SODIUM IN JAPAN [J].
KATO, H ;
HORAI, T ;
FURUSE, K ;
FUKUOKA, M ;
SUZUKI, S ;
HIKI, Y ;
ITO, Y ;
MIMURA, S ;
TENJIN, Y ;
HISAZUMI, H ;
HAYATA, Y .
JAPANESE JOURNAL OF CANCER RESEARCH, 1993, 84 (11) :1209-1214
[8]  
KNYRIM K, 1993, NEW ENGL J MED, V329, P1345
[9]  
LIGHTDALE CJ, 1987, AM J GASTROENTEROL, V82, P46
[10]  
LIGHTDALE CJ, 1994, SEMIN ONCOL, V21, P438