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肺癌的光动力治疗

Authors
Armin Ernst, MD, FCCP
Joseph LoCicero, III, MD, FCCP
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD
Translators
温居一, 副主任医师，副教授

引言

在美国，肺癌是女性和男性癌症死亡的主要原因。由于肺癌和吸烟之间的关联，许多患者同时还罹患慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)导致的肺功能受损。所以，考虑到患者术后肺功能降低而可能需要长期机械通气，故一些早期肿瘤可能不适宜手术切除。另外，手术成功切除肿瘤的肺癌患者中有高达10%的患者会在日后发生第二原发肺肿瘤，而此时患者可能已不适合再次手术。因此，许多确诊肺癌的患者需要可保留有功能的肺组织的治疗方法。 (参见“肺切除术的术前评价”和“多原发肺癌”)

在过去的10年中，肺癌的非手术治疗方法日臻完善。已有大量临床试验证实了全身性化疗、外照射放疗和内照射放疗(近距离治疗)的疗效，且已证明光动力疗法(photodynamic therapy, PDT)、内镜下激光治疗、气道支架和冷冻治疗亦为支气管内病变和中央气道阻塞患者的有效辅助治疗手段。 (参见“中央气道阻塞的诊断与处理”)

PDT在肺癌治疗中的作用和技术应用将总结在此。一些研究已证实了该疗法的安全性和有效性，美国食品药品监督管理局(Food and Drug Administration, FDA)目前批准将其用于治疗不适合手术和放疗的微浸润性支气管内非小细胞肺癌(non-small cell lung cancer, NSCLC)患者，其也可用于部分或完全阻塞性支气管内NSCLC患者，以减轻阻塞并缓解症状。该技术也可用于治疗食管癌、胃癌、膀胱癌、皮肤癌和口咽癌，并且正在评估其对中枢神经系统和胆管树恶性肿瘤的治疗作用。 (参见“Barrett食管的治疗”和“食管癌的内镜下姑息治疗”和“早期胃癌的流行病学、临床表现、诊断和分期”和“胆管细胞癌的流行病学、发病机制及分型”)

光毒性反应

应用药物-光照相互作用治疗肿瘤始于1903年，当时有人采用外用曙红和光照来治疗皮肤癌[1,2]。20世纪70年代，随着可注射型血卟啉衍生物的出现，采用光动力疗法治疗脏器内表面肿瘤成为可能[3,4]。

目前最常用的光敏剂是不同卟啉基低聚物的混合物，例如卟吩姆(卟吩姆钠)，以2mg/kg的标准剂量缓慢静脉注射5-10分钟。该药物可在72小时内从大多数器官系统中清除，但在肿瘤、皮肤(最长达30日)、肝脏和脾中的存留时间较长。

       

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Literature review current through: 2017-07 . | This topic last updated: 2016-10-13.
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