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PDT for Barrett's esophagus: Status and unsolved problems

机译：巴雷特食管的PDT：状态和未解决的问题

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PDT had been proposed in gastroenterology for various indications and the esophageal cancer treatment had been among the very first having been approved. However, PDT failed to be a real breakthrough. One reason for it was that although it had been approved for the palliative treatment of advanced tumors, PDT only has by nature a limited in-depth efficacy fitting better to the treatment and often the cure of "early cancers". For this reason PDT has also been proposed for the treatment of Barrett's esophagus (BE) with high-grade dysplasias. Barrett's mucosa (BM) is a field of a specialized metaplastic columnar epithelium replacing the normal stratified squamous epithelium or mucosa lining the distal esophagus. In this case, PDT has to destroy an area of thin tissues spread eventually over a wide area instead of a mass of tissues. Something important is that existing treatments allow the treatment of foci of dysplastic tissues but not the regression of the whole BM. BE is thus an unsolved medical problem having medical as well as economic consequences as BM being likely to transform into a cancer has to be carefully surveyed. The esophageal cancer, an adenocarcinoma, has to be surgically removed when it is possible something pretty heavy with a high morbidity. Economic burnt is also important with high survey costs independently to the additional surgical costs in case of diagnosed cancer. Treatments proposed for non or mild dysplastic BM regression have in common to have an inhomogenous impact on the target. Treatments for high-grade dysplasia (HGD, the ultimate pathological step before cancer) are based on mucosectomy and are limited to small areas of tissues. Recently circumferential mucosectomy had been proposed but at a higher risk making it suitable only to highly experienced hands in infrequent indications.
机译：在胃肠病学中已经提出了PDT用于各种适应症，并且食道癌治疗是最早被批准的治疗方法之一。但是，PDT并不是真正的突破。其原因之一是，尽管PDT已被批准用于晚期肿瘤的姑息治疗，但从本质上来说，PDT的深度疗效有限，更适合于“早期癌症”的治疗，并且通常可以治愈。由于这个原因，PDT也被提议用于治疗具有高度不典型增生的Barrett食道（BE）。 Barrett粘膜（BM）是专门化生的柱状上皮的领域，取代了正常的分层鳞状上皮或食管远端的粘膜。在这种情况下，PDT必须破坏薄薄的组织区域，该区域最终会散布在较宽的区域，而不是大量的组织。重要的是，现有的治疗方法可以治疗增生组织灶，但不能破坏整个BM。因此，BE是一个尚未解决的医学问题，具有医学和经济后果，因为必须仔细调查BM可能转化为癌症的可能性。食管癌，一种腺癌，必须在可能很重且发病率很高的情况下进行手术切除。经济烧伤也很重要，因为高昂的调查成本与诊断出的癌症的额外手术费用无关。提议用于非或轻度增生性BM退化的治疗方法通常会对目标产生不均匀的影响。高度不典型增生（HGD，癌症发生前的最终病理步骤）的治疗基于粘膜切除术，并且仅限于小面积组织。最近已经提出了圆周粘膜切除术，但是其风险较高，使其仅适用于经验很少的经验丰富的手。

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