Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

A Case of Early Esophageal Cancer Treated by Photodynamic Therapy in a Patient with Liver Cirrhosis Accompanied by Esophageal Varix

식도 정맥류를 동반한 간경변 환자에서 광역동 치료로 호전된 조기 식도암 1예

  • Chung, Yoon-Yung (Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Chung, Woo-Chul (Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Chang, U-Im (Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Oak, Ju-Hyun (Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jeong, Yeon-Oh (Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Min-Ju (Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Paik, Chang-Nyol (Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Kang-Moon (Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine)
  • 정윤영 (가톨릭대학교 의과대학 성빈센트병원 내과학교실) ;
  • 정우철 (가톨릭대학교 의과대학 성빈센트병원 내과학교실) ;
  • 장우임 (가톨릭대학교 의과대학 성빈센트병원 내과학교실) ;
  • 옥주현 (가톨릭대학교 의과대학 성빈센트병원 내과학교실) ;
  • 정연오 (가톨릭대학교 의과대학 성빈센트병원 내과학교실) ;
  • 김민주 (가톨릭대학교 의과대학 성빈센트병원 내과학교실) ;
  • 백창렬 (가톨릭대학교 의과대학 성빈센트병원 내과학교실) ;
  • 이강문 (가톨릭대학교 의과대학 성빈센트병원 내과학교실)
  • Received : 2010.06.11
  • Accepted : 2010.08.04
  • Published : 2010.11.30
⟨ Previous Next ⟩

Abstract

Photodynamic therapy (PDT) is a non-invasive treatment for cancer that works through a photochemical effect after the administration of a photosensitizer. At first, PDT had been used for the relief of obstructive symptoms caused by exophytic esophageal cancer or for control of tumor overgrowth. Recently, several investigators have reported the use of PDT in early esophageal cancer with encouraging results. This report describes a case of a 52-year-old man with early esophageal cancer, who had a long history of liver cirrhosis with esophageal varix. The patient was treated successfully with PDT using porfimer sodium as the photosensitizer. PDT is an alternative to surgical treatment of early esophageal cancer, especially in patients with liver cirrhosis.

광역동치료는 광과민제를 이용하여 암세포에 선택적으로 작용하는 비침습적인 치료법이다. 초기에 광역동치료는 상부 식도 괄약근 근처의 종양으로 인한 폐색이 있을 때, 증상을 경감해주는 목적으로 사용하거나 종양의 과증식을 억제하기 위한 국소적 치료로 사용되어 왔지만, 최근 연구에서 광역동치료는 조기 식도암의 근치적 제거술로 좋은 결과를 보이고 있다. 이번 증례는 간경변증과 식도 정맥류를 동반한 52세 남자 환자에서 상부 식도 점막에 조기 식도암이 진단되었지만, 근치적 식도 절제술이나 점막 절제술이 어려웠던 경우이다. 이에 포르피머 소디움(porfimer sodium)을 이용한 광역동치료를 실시하여 간기능의 악화나 정맥류의 출혈을 일으키지 않고 완전 관해를 보였다. 광역동 치료는 동반 질환으로 인해 제거가 불가능할때, 고식적인 수술적 치료를 대치할 수 있는 방법이다.

Keywords

References

  1. McCaughan JS Jr, Nims TA, Guy JT, Hicks WJ, Williams TE Jr, Laufman LR. Photodynamic therapy for esophageal tumors. Arch Surg 1989;124:74-80. https://doi.org/10.1001/archsurg.1989.01410010084018
  2. McCaughan JS Jr, Guy JT, Hawley P, et al. Hematoporphyrinderivative and photoradiation therapy of malignant tumors. Lasers Surg Med 1983;3:199-209. https://doi.org/10.1002/lsm.1900030302
  3. McCaughan JS Jr, Hicks W, Laufman L, May E, Roach R. Palliation of esophageal malignancy with photoradiation therapy. Cancer 1984;54:2905-2910. https://doi.org/10.1002/1097-0142(19841215)54:12<2905::AID-CNCR2820541215>3.0.CO;2-N
  4. Cheon YK, Ryu CB, Ko BM, et al. Long-term follow-up results of endoscopic mucosal resection for early gastric cancer and gastric flat adenoma. Korean J Gastrointest Endosc 2000;21:891-897.
  5. Hayata Y, Kato H, Okitsu H, Kawaguchi M, Konaka C. Photodynamic therapy with hematoporphyrin derivative in cancer of the upper gastrointestinal tract. Semin Surg Oncol 1985;1:1-11. https://doi.org/10.1002/ssu.2980010103
  6. Ha BW, Kim JI, Hwang Em, et al. A case of photodymanic therapy for early esophageal cancer recurred after esophagectomy. Korean J Gastroenterol 2007;49:331-335.
  7. Paik CN, Choi MG, Kim KW, et al. A case of photodynamic therapy as a curative treatment of early esophageal cancer. Korean J Gastrointest Endosc 2006;33:37-41.
  8. Thomas P, Doddoli C, Lienne P, et al. Changing patterns and surgical results in adenocarcinoma of the esophagus. Br J Surg 1997;84:119-125. https://doi.org/10.1002/bjs.1800840143
  9. Millwala F, Nguyen GC, Thuluvath PJ. Outcomes of patients with cirrhosis undergoing non-hepatic surgery: risk assessment and management. World J Gastroenterol 2007;13:4056-4063. https://doi.org/10.3748/wjg.v13.i30.4056
  10. Garrison RN, Cryer HM, Howard DA, Polk HC Jr. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg 1984;199:648-655. https://doi.org/10.1097/00000658-198406000-00003
  11. Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery 1997;122:730-735. https://doi.org/10.1016/S0039-6060(97)90080-5
  12. Takekoshi T, Baba Y, Ota H, et al. Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases. Endoscopy 1994;26:352-358. https://doi.org/10.1055/s-2007-1008990
  13. Karanov SI. Long-term results after photodynamic therapy (PDT) of T1N0M0 gastrointestinal (GI) tumors. Hepatogastroenterology 2002;49:1579-1581.
  14. Shaheen NJ. Advances in Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology 2005;128:1554-1566. https://doi.org/10.1053/j.gastro.2005.03.032
  15. Shim CS. Photodynamic therapy in gastroenterology. Korean J Gastroenterol 2005;45:153-161.
  16. Boyle RW, Dolphin D. Structure and biodistribution relationships of photodynamic sensitizers. Photochem Photobiol 1996;64:469-485. https://doi.org/10.1111/j.1751-1097.1996.tb03093.x
  17. Overholt BF, Panjehpour M, Haydek JM. Photodynamic therapy for Barrett's esophagus: follow-up in 100 patients. Gastrointest Endosc 1999;49:1-7. https://doi.org/10.1016/S0016-5107(99)70437-2
  18. Cheon YK, Han DH, Jung IS, et al. Photodynamic therapy in superficial gastrointestinal tumors. Korean J Gastrointest Endosc 2006;32:81-86.
  19. Hahn SM, Putt ME, Metz J, et al. Photofrin uptake in the tumor and normal tissues of patients receiving intraperitoneal photodynamic therapy. Clin Cancer Res 2006;12:5464-5470. https://doi.org/10.1158/1078-0432.CCR-06-0953
  20. Li CZ, Cheng LF, Wang ZQ, Gu Y. Attempt of photodynamic therapy on esophageal varices. Lasers Med Sci 2009;24:167-171. https://doi.org/10.1007/s10103-008-0542-6