δ-氨基酮戊酸光动力治疗皮肤癌的评估

摘要

Objective To use δ-aminolevulinic acid induced photodynamic therapy (ALA-PDT) increasingly in treating skin cancers and other diseases in many countries and to explore the efficacy of ALA-PDT for skin cancers in China. Methods Eighty-eight patients, including 34 cases of basal cell carcinoma (BCC), 32 cases of squamous cell carcinoma (SCC), two cases of basal-squamous cell carcinoma (BSCC), one case of verrucuous carcinoma, nine cases of Bowen disease, two cases Paget disease of the nipple and eight cases of extramammary Paget disease, were treated by the δ-aminolevulinic acid induced photodynamic therapy first in China from 1997 to 2000. Results All BCC, including 11 cases of superficial lesions and 29 solid lesions, achieved complete reaction (CR) by 1-4 times of the ALA-PDT. Except one patient with adenoid SCC (grade Ⅲ), all SCC (grade Ⅰ and grade Ⅱ) patients achieved complete remission by 3-6 times of ALA-PDT. All Bowen diseases achieved complete reaction by 1-4 times. Although for Paget diseases it could not cure the disease simply by ALA-PDT, it could control the symptoms. The recurrence rates were 11% (4/34) for BCC, and 22% (7/32) for SCC by following up 1-3 years after the therapy. The continuous therapy is still effective. Conclusions ALA-PDT is an effective, non-traumatic treatment for patients with BCC, SCC, Bowen and Paget diseases. It is especially suitable for older and weaker patients or those who are not tolerable to other therapies. It also has a unique advantage for tumors in specific anatomical areas. It is a new alternative modality for skin cancer therapies.%目的近年来,许多国家日益广泛地将δ-氨基酮戊酸光动力疗法(ALA-PDT)用于治疗皮肤癌和其它疾病.本研究的目的是探讨和评估ALA-PDT在中国治疗皮肤癌的疗效.方法共有88例患者于1997-2000年间在我院首次接受ALA-PDT治疗,其中包括34例基底细胞癌(BCC),32例鳞状细胞癌(SCC),2例基底-鳞状细胞癌(BSCC),1例疣状癌,9例Bowen病,2例乳房Paget病和8例乳房外Paget病.随访时间为1-3年.结果经过1-4次ALA光动力治疗后,所有BCC病例,包括11例浅表型和29例实体型病变,都获得痊愈(CR).全部SCC病例(Ⅰ、Ⅱ级)经过3-6次ALA-PDT治疗后完全消退,只有1例腺样SCC(Ⅲ级)除外.接受1-4次治疗后,所有Bowen病的病例都获得完全缓解.对于Paget病,虽然单纯依靠ALA-PDT不能使之治愈,但可以控制其症状.随访1-3年,BCC的复发率为11%(4/34),SCC为22%(7/22),再次治疗有效.结论 ALA-PDT对于BCC、SCC、Bowen病和Paget病患者来说,是一种疗效好、无创伤性、无副作用的治疗手段,患者有很好的耐受性,尤其适用于对其它疗法不能耐受、年龄太大和体弱的患者,以及肿瘤发生部位特殊的患者.它是治疗皮肤癌的一种新的替代疗法.