臨牀消化器内科 Vol.14 No.8(3-5)


特集名 レーザー内視鏡の理論と実際 --21世紀消化器内視鏡学への提言
題名 光線力学的治療(PDT) (5) 進行癌に対するPDT照射の工夫
発刊年月 1999年 07月
著者 中村 哲也 国立神戸病院研究検査科
【 要旨 】 光線力学的療法(PDT)が適応となる進行消化管癌は,手術不能でかつほかに有効な治療法がない食道,胃,直腸癌である.しかし早期癌と異なり腫瘍が大きく厚いため,一度のPDTのみでは目立った効果は得られない.そこで以下の工夫を行った.
(1)eximer-dye laser(EDL)のパルス周波数を80Hzに上げ,先端出力を倍にする.(2)polyhematoporphyrin ethers and esters(PHE)静注後,48時間目と72時間目の2日間にわたってレーザー照射を行う.(3)高周波やYAG照射により,あらかじめある程度の腫瘍縮小を行った後にPDTを行う.これらを計画的に組み合わせた新しい併用療法(endoscopic combined therapy;ECT)により,進行癌に対しても高い奏効率が期待でき,症例によっては局所治癒も得られた.
Theme Laser Endoscopy in Theory and Practice --Perspective of GI Endoscopy in the 21st Century
Title New Strategy in Photodynamic Therapy (PDT) for Advanced Gastrointestinal Cancer
Author Tetsuya Nakamura Department of Clinical Pathology & Laboratory Medicine, Kobe National Hospital
[ Summary ] A new strategy in photodynamic therapy (PDT) for inoperable advanced gastrointestinal cancers is described. In general, advanced cancers are larger in size than early cancers ; therefore a single administration of PDT is not effective in advanced cases. Consequently, we considered a new strategy as follows : 1) Laser power was doubled by changing the wave length from 40 to 80Hz. 2) An excimer-dye laser was used for irradiated 48 and 72 hours after injecting the patient with a photosensitizer. 3) Before PDT, the tumor was reduced by electro-coagulation or by irradiation with a Nd : YAG laser. This new combined therapy was given the designation endoscopic combined therapy (ECT). ECT was applied to 13 patients, with advanced cancer (10 gastric, 3 rectal). Eleven of the 13 (84.6%) cancerous lesions almost disappeared, four disappeared completely and no recurrence was found in the follow-up examinations. ECT is proposed as an effective treatments for advanced cancer.
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