The Clinical Research Of Photodynamic Therapy In The Treatment Of Advanced Digestive Tract Tumors

Objective: To prospectively observe the clinical efficacy and toxicreaction of photodynamic therapy for upper gastrointestinal tumor patientswho lose the chance of operation and failure after chemotherapy andradiotheraphy treatment or recurrence after radiotherapy and chemotherapytreatment (gastric cancer and esophageal cancer, cardia cancer)，to assess thefeasibility、validity and safety of the treatment method. In order to providetreatment basis for patients with advanced upper gastrointestinal tumors.Methods:From January2011to October2012,In Hebei People’s Hospital21patients with upper gastrointestinal cancer had been enrolled for the trial,There were15males,6females; The median age was67years years old（range from46~82years old）.according to the location of the lesions,thepatients can be divided into3groups,there were9patients with esophagealcancer for first group,9patients with cardiac carcinoma for second group,3patients with gastric cancer for third group; Among the three grups,9patientswith squamous cell carcinoma,12patients with adenocarcinoma; KPSscore≥70points:13cases, KPS score <70points:8cases. The patients wereplaced into the dark room before Photodynamic therapy, Photosensitizer(photosan) was gave by intravenous and drip for1hour, and calculated as2mg/kg, dissolved in100ml0.9%sodium chloride solution. After48hoursbegin photodynamic therapy,6hours of fasting before operation, establishingvenous access, total intravenous anesthesia, intraoperative oxygen2L/min andECG monitoring, finger pulse oximetry. Lesions were observed underelectronic gastroscope, distance lesions1cm into the optical fiber, according tolesion size determine the length and scope of exposure required optical fiber,set with different power and irradiation time. In order to ensure adequatecoverage of foci irradiation range, beyond the tumor edge luminescence of 1-2cm, For long lesions can be segmented irradiation, overlapping1cm persegment, irradiation energy density is200-250J/cm2, each section irradiated15-20min.24hours after treatment, endoscopic removal of necrotic tissue,using the same method carries on second times of irradiation, the completionof1cycles of treatment. Fasting for24hours after operation, intravenousnutrition, acid suppression, hemostasis in patients with symptomatic treatment,side effects observed,1weeks after discharge from hospital, patients strictlyavoid light for1months, treatment to date,1months after the comprehensivereview, Effective treatment of patients after a monthly endoscopy, a detailedrecord of tumor changes.Results:In this study, the follow-up deadline is2013January, the medianfollow-up time was6months(3~14months). After photodynamic therapy onshort-term outcome total efficiency (CR+SR+MR) was85.7%(18/21),significant efficiency (CR+SR) of57.1%,The esophageal carcinoma (CR+SR)of44.4%(4/9), cardiac cancer (CR+SR) of66.7%(6/9), gastric cancer(CR+SR) of66.7%(2/3); More than half (57.1%) of patients withdysphagia relieved in different degree after photodynamic therapy, dysphagiascore from3.23±0.83to1.77±0.83,(P <0.05). No dysphagia interval time92.23±29.3days; Different pathological types of tumors in photodynamictherapy showed a similar sensitivity; all the patients had a median survival of8months, the KPS score≥70median survival period was9months, the KPSscore <70of patients had a median survival of5months. According to KPSscore were stratified analysis showed that the KPS score of patients, havesignificant effects on the survival of the patients (P<0.001).Conclusion:1. photodynamic therapy is an effective method in the treatment of advancedgastrointestinal cancer, less toxicity.2.photodynamic therapy can effectively alleviate the advanced upper digestivetract tumor patients with obstructive symptoms, and improve their quality oflife.3.The different types of pathology of tumors had similar sensitivity to photodynamic therapy.4.Photodynamic therapy can prolong the survival time of advanced upperdigestive tract tumor patients, KPS score have significant effects on survivalof patients with advanced disease.