Abstract
Background: Surgery for cancer of the gastrointestinal tract is associated with high morbidity and mortality, especially in older patients. A significant proportion of patients cannot be cured and would be referred for palliative therapy. Others may have early cancer but are deemed unfit for surgery. Chemotherapy and external radiotherapy are suitable for only a proportion of patients. Therefore, photodynamic therapy may have a role in the management of these patients. It was the possibility of achieving selective tumour necrosis with sparing of normal tissue that made this treatment extremely appealing compared to other conventional tumour therapy. Method: The literature is reviewed (after an extensive Medline search 1975–1997) regarding the scientific basis of photodynamic therapy and the clinical experience to date with this therapy in the management of malignancies of the gastrointestinal tract. Results and Conclusions: Photodynamic therapy holds the promise of an eradication form of treatment for early cancer especially for patients deemed unfit for other treatment. It may also prove a useful supplement to other techniques in order to eliminate small residual areas of tumour left after the main bulk has been removed by other methods. The use of photodynamic therapy in the palliative management of gastrointestinal tract cancer is likely to be limited.
Journal Section:
Review
References
1.
Meyer-Betz F: Untersuchungen über die biologische (photodynamische) Wirkung des Hämatoporphyrins und anderer Derivative des Blut- und Gallenfarbstoffs. Dtsch Arch Klin Med 1913;112:476–503.
2.
Lipson RL, Blades EJ, Gray MJ: Hematoporphyrin derivative for the detection and management of cancer. Cancer 1967;20:2255–2257.
[PubMed]
3.
Raab GH, Schneilder AF, Eirmann W, et al: Response of human endometrium and ovarian carcinoma cell-lines to photodynamic therapy. Arch Gynecol Obstet 1990;248:13–20.
[PubMed]
4.
Byrne CJ, Marshallsay LV, Ward AD: The composition of photophyrin. J Photochem Photobiol B 1990;6:13–27.
[PubMed]
5.
Sindelar WF, DeLaney TF, Tochner Z, et al: Technique of photodynamic therapy for disseminated intraperitoneal malignant neoplasms. Arch Surg 1991;126:318–324.
[PubMed]
6.
Fromm D, Kessel D, Webber J: Feasibility of photodynamic therapy using endogenous photosensitization for colon cancer. Arch Surg 1996;131:667–669.
[PubMed]
7.
Bedwell J, MacRobert AJ, Phillips D, Bown SG: Fluorescence distribution and photodynamic effect of ALA-induced PP IX in DMH rat colonic tumour model. Br J Cancer 1992;65:818–824.
[PubMed]
8.
Loh CS, MacRobert AJ, Buonaccorsi G, Krasner N, Bown SG: Mucosal ablation using photodynamic therapy for the treatment of dysplasia: An experimental study in the normal rat stomach. Gut 1996;38:71–78.
[PubMed]
9.
Razum N, Balchum OJ, Profio AE, Carstens F: Skin photosensitivity: Duration and intensity following intravenous hematoporphyrin derivatives, HpD and DHE. Photochem Photobiol 1987;46:925–928.
[PubMed]
10.
Wooten RS, Ahlquist DA, Anderson RE, et al: Localisation of haematoporphyrin derivative to human colorectal cancer. Cancer 1989;64:1569–1576.
[PubMed]
11.
Margaron P, Madarnas P, Quellet R, Van Lier J: Biological activities of phthalocyanines. XVII: Histopathologic evidence for different mechanisms of EMT-6 tumour necrosis induced by photodynamic therapy with disulfonated aluminum phthalocyanine or photofrin. Anticancer Res 1996;16:613–620.
[PubMed]
12.
Barr H, Tralau CJ, MacRobert AJ, Krasner N, et al: PDT in the normal rat colon with phthalocynine sensitization. Br J Cancer 1987;56:111–118.
[PubMed]
13.
Nelson JS, Liaw LH, Orenstein A, Roberts WG, Berns MW: Mechanism of tumour destruction following photodynamic therapy with hematoporphyrin derivative, chlorin and phthalocyanine. J Natl Cancer Inst 1988;80:1599–1605.
[PubMed]
14.
Reddi E, Lo Castro G, Biolo R, Jori G: Pharmacokinetic studies with zinc (II)-phthalocyanines in tumour bearing mice. Br J Cancer 1987;56:597–600.
[PubMed]
15.
Reddi E, Zhou C, Menegaldo E, Jori G: Liposome- or LDL-administered zinc (II)-phthalocyanine as a photodynamic agent for tumours. I. Pharmacokinetic properties and phototherapeutic efficiency. Br J Cancer 1990;61:407–411.
[PubMed]
16.
Valduga G, Nonell S, Reddi E, Jori G, Braslavsky SE: The production of singlet molecular oxygen by zinc (II) phthalocyanine in ethanol and in unilamellar vesicles. Chemical quenching and phosphorescence studies. Photochem Photobiol 1988;48:1–5.
[PubMed]
17.
Zhou C, Shunji C, Jinsheng D, Junlin L, Jori G, Milanesi C: Apoptosis of mouse MS-2 fibrosarcoma cells induced by photodynamic therapy with Zn (II)-phthalocyanine. J Photochem Photobiol B 1996;33:219–223.
[PubMed]
18.
Ramington C: Prophyrin and haem biosynthesis and its control. Acta Med Scand 1966;179(suppl 445):11–24.
19.
Sima AAF, Kennedy JC, Balkeslee D, Robertson DM: Experimental porphyric neuropathy: A preliminary report. Can J Neurol Sci 1981;9:105–114.
20.
Loh CS, Bedwell J, MacRobert AJ, et al: Photodynamic therapy of the normal rat stomach: A comparative study between di-sulphonated aluminium phthalocyanine and 5-aminolaevulinic acid. Br J Cancer 1992;66:452–462.
[PubMed]
21.
Mlkvy P, Messmann H, Regula J, Conio M, Pauer M, Millson CE, MacRobert AJ, Bown SG: Sensitization and photodynamic therapy (PDT) of gastrointestinal tumors with 5-aminolaevulinic acid (ALA) induced protoporphyrin IX (PP IX). A pilot study. Neoplasma 1995;42:109–113.
[PubMed]
22.
Levy JG, Waterfield E, Richter A, et al: Photodynamic therapy of malignancies with benzoporphyrin derivative monoacid ring A. Proc Soc Photo-Optical Instr Eng 1994;2078:91–101.
23.
Potter WR: The theory of photodynamic dosimetry: Consequences of photodestruction of sensitizer. Proc SPIE. Lasers Med 1986;712:124–129.
24.
Ris HB, Altermat JH, Inderbitzi R, Hess R, Nachbur B, Stewart JCM, Wang Q, Lim CK, Bonnett R, Berenbaum MC, Althaus U: Photodynamic therapy with chlorins for diffuse malignant mesothelioma: Initial results. Br J Cancer 1991;64:1116–1120.
[PubMed]
25.
Roberts WG, Smith KM, McCullough JL, Berns MW: Skin photosensitivity and photodestruction of several potential photodynamic sensitizers. Photochem Photobiol 1989;49:431–438.
[PubMed]
26.
Nelson JS, Roberts WG, Berns JW: In vivo studies in the utilisation of mono-L-aspartate chlorin (NPe6) for photodynamic therapy. Cancer Res 1987;47:4681–4685.
[PubMed]
27.
Messnann H, Baumler W, Debl K, et al: Indocyanine green: A new photosensitizer for PDT in human colon carcinoma cells? Intracellular uptake and phototoxic effects. Gastroenterology 1997;112:A614.
28.
Messnann H, Baumler W, Debl K, et al: Phototherapy of colon, hepatoma and differently graded pancreatic carcinoma cell lines after sensitization with Indocyanine green. Gastroenterology 1997;112:A614.
29.
Weishaupt KR, Gomer CJ, Dougherty TJ: Identification of singlet oxygen as the cytotoxic agent in photoactivation of a murine tumour. Cancer Res 1976;36:2326–2329.
[PubMed]
30.
Foote CS: Mechanisms of photosensitized oxidation. Science 1968;162:963–967.
[PubMed]
31.
Robinson RS, Roberts AJ, Campbell ID: Photo oxidation on b-hydrobutyrate dehydrogenase: Studies on membrane fragments and intact mitochondria. Photochem Photobiol 1987;45:231–234.
[PubMed]
32.
Varnes ME, Bayne MT, Bright GR: Reduction in intracellular pH is not the mechanism for the synergistic interaction between photodynamic therapy and Nogericin. Photochem Photobiol 1996;64:853–858.
[PubMed]
33.
Dougherty TJ, Lawrence G, Kaufman JH, et al: Photoradiation in the treatment of recurrent breast carcinoma. J Natl Cancer Inst 1979;62:231–237.
[PubMed]
34.
Dougherty TJ, Kaufman JH, Goldfarb A, et al: Photoradiation therapy for the treatment of malignant tumours. Cancer Res 1978;38:2628–2635.
[PubMed]
35.
Chopp M, Derski MO, Madigan L, et al: Sensitivity of 9L gliosarcomas to photodynamic therapy. Radiat Res 1996;146:461–465.
[PubMed]
36.
Cairnduff F, Stringer MR, Hudson EJ, et al: Superficial photodynamic therapy with topical 5ALA for superficial primary and secondary skin cancer. Br J Cancer 1994;69:605–608.
[PubMed]
37.
Schmidt S, Wagner U, Oehr P, Krebs D: Clinical use of photodynamic therapy in gynecologic tumour (in German). Zentralbl Gynäkol 1992;114:307–311.
[PubMed]
38.
Tromberg BJ, Svaasand LO, Fehr MK, et al: A mathematical model for light dosimetry in photodynamic destruction of human endometrium. Phys Med Biol 1996;41:223–237.
[PubMed]
39.
Balchum OJ, Doiron DR, Huth GC: HpD photodynamic therapy for obstructing lung cancer. Prog Clin Biol Res 1984;170:727–745.
[PubMed]
40.
Fan KF, Hopper C, Speight PM, et al: Photodynamic therapy using 5-ALA for premalignant and malignant lesions of the oral cavity. Cancer 1996;78:1374–1383.
[PubMed]
41.
Overholt BR, Panjehpour M: Photodynamic therapy for Barrett’s oesophagus: Clinical update. Am J Gastroenterol 1996;91:9.
42.
Wang KK, Gutta K, Laukka MA: A prospective randomised trial of low dose PDT in the treatment of Barrett’s oesophagus. Gastroenterology 1994;106:A208.
43.
Berenson MM, Johnson TD, Markowitz NR, et al: Restoration of squamous mucosa after ablation of Barrett’s oesophageal epithelium. Gastroenterology 1993;104:1686–1691.
[PubMed]
44.
Nyamekye I, Buonaccorsi G, McEwan J, et al: Inhibition of intimal hyperplasia in balloon injured arteries with adjunctive phthalocyanine sensitized photodynamic therapy. Eur J Vasc Endovasc Surg 1996;11:19–28.
[PubMed]
45.
Garza OT, Abati A, Sindelar WF, et al: Cytologic effects of photodynamic therapy in body fluids. Diagn Cytopathol 1996;14:356–361.
[PubMed]
46.
Chan WS, Brasseur N, La Madeleine C, Van Lier JE: Evidence for different mechanisms of EMT-6 tumour necrosis by photodynamic therapy with disulfonated aluminum phthalocyanine or photofrin: Tumour cell survival and blood flow. Anticancer Res 1996;16:1887–1892.
[PubMed]
47.
Fiedler DM, Eckl PM, Krammer B: Does 5-aminolaevulinic acid induce genotoxic effects? J Photochem Photobiol B 1996;33:39–44.
[PubMed]
48.
Gibson SL, Murand RS, Chazen MD, et al: In vitro sensitization of tumour cell enzymes by photofrin II administered in vivo. Br J Cancer 1989;59:47–53.
[PubMed]
49.
Hayata Y, Kato H, Okitsu H, et al: Photodynamic therapy with hematoporphyrin derivative in cancer in the upper gastrointestinal tract. Semin Surg Oncol 1985;1:1–11.
[PubMed]
50.
Mitchell JB, McPhearson S, DeGraff W, et al: Oxygen dependence of hematoporphyrin derivative induced photoinactivation of Chinese hamster cells. Cancer Res 1985;45:2008–2011.
[PubMed]
51.
Moan J, Sommer S: Oxygen dependence of the photosensitizing effect of hematoporphyrin derivative in NHIK-3025 cells. Cancer Res 1985;45:1608–1610.
[PubMed]
52.
Henderson BW, Donovan JM: Release of prostaglandin E2 from cells by photodynamic treatment in vivo. Cancer Res 1989;49:6896–6900.
[PubMed]
53.
Fingar VH, Wieman TJ: Studies on the mechanism of photodynamic therapy induced tumour destruction. Proc SPIE Photodynamic Therapy: Mechanisms II 1990;1203:168–177.
54.
Van Geel IPJV, Oppelaar H, Rijken PFJW, et al: Vascular perfusion and hypoxic areas in RIF-1 tumours after photodynamic therapy. Br J Cancer 1996;73:288–293.
[PubMed]
55.
Chapman JD, McPhee MS, Walz N, et al: Nuclear magnetic resonance spectroscopy and sensitizer adduct measurements of photodynamic therapy induce ischaemia in solid tumors. J Natl Cancer Inst 1991;22:1650–1659.
56.
Overholt BF, Panjehpour M, DeNova RC, Peterson MG, Jenkins C: Balloon photodynamic therapy of esophageal cancer: Effect of increasing balloon size. Lasers Surg Med 1996;18:248–252.
[PubMed]
57.
Nseyo UO, Whalen RK, Duncan MR, Berman B, Lundahl SL: Urinary cytokines following photodynamic therapy for bladder cancer. A preliminary report. Urology 1990;36:167–171.
[PubMed]
58.
Jori G, Beltrami M, Reddi E, et al: Evidence for a major role of plasma lipoproteins as haematoporphyrin carriers in vivo. Cancer Lett 1984;24:291–297.
[PubMed]
59.
Korblik M: Low density lipoprotein receptor pathway in the delivery of photofrin. How much is it relevant for selective accumulation of the photosensitizer in tumours? J Photochem Photobiol 1992;12:107–109.
60.
Hamblin MR, Newman EL: On the mechanism of tumour localising effect in photodynamic therapy. J Photochem Photobiol B 1994;23:3–8.
[PubMed]
61.
Korbelik M, Krosl G, Chaplin DJ: Photofrin uptake by murine macrophages. Cancer Res 1991;51:2251–2255.
[PubMed]
62.
Allison BA, Waterfield E, Richter AM, Levy JG: The effects of plasma lipoprotein on in vitro tumour cell killing and in vivo tumour photosensitization with benzoporphyrin derivative. Photochem Photobiol 1991;54:709–714.
[PubMed]
63.
Puolakkainen P, Schroder T: Photodynamic therapy of gastrointestinal tumours: A review. Dig Dis 1992;10:53–60.
[PubMed]
64.
Overholt BF, Panjehpour M, De Novo RC, Peterson MG: Photodynamic therapy for esophageal cancer using a 180° windowed oesophageal balloon. Lasers Surg Med 1994;14:27–33.
[PubMed]
65.
Overholt BF, Panjehpour M, Denovo R, Peterson M: A centering balloon for PDT for oesophageal cancer tested in a canine model. Gastrointest Endosc 1993;39:782–787.
[PubMed]
66.
Kirschner RA, Unger M, Imber P: An introduction to dye lasers and photoradiation therapy. Surg Clin North Am 1984;64:939–940.
[PubMed]
67.
Kashtan H, Haddad R, Yossiphov Y, Bar-On S, Skornick Y: Photodynamic therapy of colorectal cancer using a new light source: From in vitro studies to a patient treatment. Dis Colon Rectum 1996;39:379–383.
[PubMed]
68.
Dougherty TJ, Marcus SL: Photodynamic therapy. Eur J Cancer 1992;28A:1734–1742.
69.
McCaughan JS, Hawley PC, Walker J: Management of endobronchial tumours: A comparative study. Semin Surg Oncol 1989;5:38–47.
[PubMed]
70.
Loh CS, MacRobert AJ, Bedwell J, et al: Oral versus intravenous administration of 5-aminolaevulinic acid for photodynamic therapy. Br J Cancer 1993;68:41–51.
[PubMed]
71.
Overholt BF, Panjehpour M: Barrett’s oesophagus: PDT for ablation of dysplasia, reduction of specialised mucosa and treatment of superficial oesophageal cancer. Gastrointest Endosc 1995;42:64–70.
[PubMed]
72.
Laukka MA, Wang KK: Initial results using low-dose photodynamic therapy in the treatment of Barrett’s oesophagus. Gastrointest Endosc 1995;42:59–63.
[PubMed]
73.
Gossner L, Hahn C: Oral administration of 5-aminolevulinic acid for photodynamic therapy in patients with gastrointestinal carcinomas: Preliminary results. Gastroenterology 1994;106:A387.
74.
Overholt BF, Panjehpour M: Photodynamic therapy for Barrett’s oesophagus: Clinical update. Am J Gastroenterol 1996;91:1719–1723.
[PubMed]
75.
Barr H, Shepherd NA, Dix A, Roberts DJH, Tan WC, Krasner N: Eradication of high-grade dysplasia in columnar-lined (Barrett’s) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX. Lancet 1996;348:584–585.
[PubMed]
76.
Verspaget HW, Torremans PAJ, Van Lerssel AJHM, et al: Photodynamic therapy affects spontaneous and NK cell mediated tumour cell lysis. Gastroenterology 1997;112:A674.
77.
Cohen S, Margalit R: Binding of porphyrin to human serum albumin. Structure-activity relationships. Biochem J 1990;270:325–330.
[PubMed]
78.
Amano T, Prout GR Jr, Lin CW: Intratumour injection as a more effective means of porphyrin administration for photodynamic therapy. J Urol 1988;139:392–395.
[PubMed]
79.
Veenhuizen RB, Marijnissen JPA, Kenemans P, et al: Intraperitoneal PDT of rat CC531 adenocarcinoma. Br J Cancer 1996;73:1387–1392.
[PubMed]
80.
WongKeeSong LM, Wang KK, Nourbaksh A: Intra-lesional administration of photosensitiser in photodynamic therapy: A novel approach. Gastrointest Endosc 1997;45:75.
81.
Rebeiz N, Rebeiz CC, Arkins S, et al: Photodestruction of tumor cells by induction of endogenous accumulation of protoporphyrin IX: Enhancement by 1,10-phenanthroline. Photochem Photobiol 1992;55:431–435.
[PubMed]
82.
Rebeiz N, Arkins S, Rebeiz C, et al: Induction of tumour necrosis by 5-ALA and 1,10-phenanthroline photodynamic therapy. Cancer Res 1996;56:339–344.
[PubMed]
83.
Kloek J, Akkermans W, Van Henegouwen GMJB: Derivative of 5-aminolaevulinic acid for photodynamic therapy: Enzymatic conversion into protoporphyrin. Photochem Photobiol 1998;67:150–154.
[PubMed]
84.
Watson A: A study of quality and duration of survival following resection, endoscopic intubation and surgical intubation in oesophageal carcinoma. Br J Surg 1985;69:585–588.
85.
Fein R, Kelson D, Geller N, et al: Adenocarcinoma of the oesophagus and gastroesophageal junction: Prognostic factors and results of therapy. Cancer 1985;56:2512–2518.
[PubMed]
86.
Kelsen D: Treatment of advanced oesophageal cancer. Cancer 1982;50(suppl 2):2576–2581.
87.
Overholt BF, Panjehpour M, Teffetellar E, Rose M: PDT for treatment of early adenocarcinoma in Barrett’s oesophagus. Gastrointest Endosc 1993;39:73–76.
[PubMed]
88.
Patrice T, Foultier MT, Yactayo S, et al: Endoscopic PDT with haematoporphyrin derivative for primary treatment of gastrointestinal neoplasm in inoperable patients. Dig Dis Sci 1990;35:545–552.
[PubMed]
89.
Calzavara F, Tomio L, Corti L, et al: Oesophageal cancer treated by PDT alone or followed by radiation therapy. J Photochem Photobiol B 1990;6:167–194.
[PubMed]
90.
Tajiri H, Daikuzono N, Joffe SN, Oguro Y: Photoradiation therapy in early gastro-intestinal cancer. Gastrointest Endosc 1987;33:88–90.
[PubMed]
91.
Fujimaki M, Nakayama K: Endoscopic laser treatment of superficial oesophageal cancer. Semin Surg Oncol 1986;2:248–256.
[PubMed]
92.
Monnier P, Savary M, Fontolliet C, et al: Photodetection and photodynamic therapy of early squamous cell carcinomas of the pharyns, oesophagus and tracheobronchial tree. Lasers Med Sci 1990;5:149–168.
93.
McCaughan J Jr, Ellison EC, Guy JT, et al: Photodynamic therapy for oesophageal malignancy: A prospective twelve-year study. Ann Thorac Surg 1991;62:1005–1010.
94.
Sugimachi K, Ikebe M, Kitamura K, et al: Long-term results of oesophagectomy for early oesophageal carcinoma. Hepatogastroenterology 1993;41:203–206.
95.
Vigneswaran WT, Trastek VF, Pairolero PC, et al: Transhiatal oesophagectomy for carcinoma of the oesophagus. Ann Thorac Surg 1993;56:838–846.
[PubMed]
96.
Skinner DB, Ferguson MK, Soriano A, et al: Selection of operation for oesophageal cancer based on staging. Ann Surg 1986;204:391–401.
[PubMed]
97.
Baba M, Aikou T, Yoshinaka H, et al: Long-term results of subtotal oesophagectomy with three field lymphadenectomy for carcinoma of the thoracic oesophagus. Ann Surg 1994;219:310–316.
[PubMed]
98.
Gertsch P, Vauthey JN, Lustenberger AA, Friedlander-Klar H: Long-term results of transhiatal oesophagectomy for oesophageal carcinoma. Cancer 1993;72:2312–2319.
[PubMed]
99.
Moghissi K: Surgical resection of stage I cancer of the oesophagus and cardia. Br J Surg 1992;79:935–937.
[PubMed]
100.
Hishikawa Y, Kamikonya N, Tanaka S, Miura T: Oesophageal stricture following high-dose-rate intracavitary irradiation for oesophageal cancer. Radiology 1986;159:715–716.
[PubMed]
101.
Hishikawa Y, Tanaka S, Miura T: Oesophageal fistula associated with intracavitary irradiation for oesophageal carcinoma. Radiology 1986;159:549–551.
[PubMed]
102.
Spinelli P, Mancini A, Fante MD: Endoscopic treatment of gastrointestinal tumours: Indications and results of laser photocoagulation and photodynamic therapy. Semin Surg Oncol 1995;11:307–318.
[PubMed]
103.
Sibille A, Lambert R, Souquet JC, Sabben G, Descos F: Long-term survival after photodynamic therapy for oesophageal cancer. Gastroenterology 1995;108:337–344.
[PubMed]
104.
Thomas RJ, Abbott M, Bhathal PS, et al: High dose photoirradiation of oesophageal cancer. Ann Surg 1987;206:193–199.
[PubMed]
105.
Tian ME, Qui SL, Ji Q: Preliminary results of haematoporphyrin derivative laser treatment for 13 cases of early oesophageal carcinoma. Adv Exp Med Biol 1985;193:21–25.
[PubMed]
106.
Regula J, MacRobert AJ, Gorchein A, Buonaccorsi GA, Thorpe SM, Spencer GM, Hatfield ARW, Bown SG: Photosensitisation and photodynamic therapy of oesophageal, duodenal and colorectal tumours using 5 aminolaevulinic acid induced protoporphyrin IX: A pilot study. Gut 1995;36:67–75.
[PubMed]
107.
Gossner L, Stolte M, Sroka R, et al: Photodynamic ablation of high grade dysplasia and early cancer in Barrett’s oesophagus by means of 5ALA. Gastroenterology 1998;114:448–455.
[PubMed]
108.
Wang KK, Geller A: PDT for early oesophageal cancer: Light versus surgical might. Gastroenterology 1995;108:593–607.
[PubMed]
109.
Kato H, Kito T, Furuse K: Photodynamic therapy in the early treatment of cancer (in Japanese). Gan To Kagaku Ryoho 1990;17:1833–1838.
[PubMed]
110.
Jin M, Yang B, Zhang W, Wang Y: Photodynamic therapy for upper gastrointestinal tumours over the past 10 years. Semin Surg Oncol 1994;10:111–113.
[PubMed]
111.
McCaughan JS, Williams TE, Bethel BH: Palliation of oesophageal malignancy with photodynamic therapy. Ann Thorac Surg 1985;40:113–119.
[PubMed]
112.
McCaughan JS, Nims A, Guy JT, et al: Photodynamic therapy for oesophageal tumours. Arch Surg 1989;124:74–80.
[PubMed]
113.
Cwikiel M, Cwikiel W, Albertson M: Palliation of dysphagia in patients with malignant oesophageal strictures. Acta Oncol 1996;35:75–79.
114.
Dallal HJ, Grieve D, Ghosh S, Penman I, Palmer KR: Expandable metallic stents versus Nd-YAG laser therapy for the palliative treatment of oesophageal cancer: A randomised trial. Gut 1998;42(suppl 1):TW265.
115.
Heier SK, Rothman KA, Heier LM, Rosenthal WS: Photodynamic therapy for obstructing oesophageal cancer: Light dosimetry and randomised comparison with Nd-YAG laser therapy. Gastroenterology 1995;109:63–72.
[PubMed]
116.
Schneider DM, Cirocco M, Haber GB, et al: Photodynamic therapy for the treatment of tumour ingrowth in expandable oesophageal stents. Endoscopy 1997;29:271–274.
[PubMed]
117.
Song SZ, Li JH, Zou J: Haematoporphyrin derivative and laser photodynamical reaction in the diagnosis and treatment of malignant tumours. Lasers Surg Med 1985;5:61–66.
[PubMed]
118.
Hu C, Li JY, Jin ML, Yang BQ: Pathologic study on the treatment-effect of hematoporphyrin derivative in carcinoma of the gastric cardia (in Chinese). Chung Hua Chung Liu Tsa Chih 1988;10:197–199.
119.
Kasugai T: Endoscopic treatment for gastric tumours: Long-term prognosis. Proc 48th Meet Japanese Research Society for Gastric Cancer, Nagoya, 1997.
120.
Dohmoto M, Hunerbein M, Schlag PM: Palliative endoscopic therapy of rectal carcinoma. Eur J Cancer 1996;32A:25–29.
121.
Panjehpour M, Overholt BF, Denovo R, Sneed R, Peterson M: Centering balloon to improve oesophageal PDT. Laser Surg Med 1992;12:631–638.
[PubMed]
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