Table1

Nature of pathology, number of patients treated with PDT method
in 1998 - 2001 and number of pathologic seats

Localization of tumour	Number of patients	Number of pathologic seats
Skin cancer	56	237
Skin melanoma	5	62
Lactic glands cancer	3	44
Cancer of mucous membrane, mouth cavity, tonque, lips	6	6
Larynx cancer	5	6
Lungs cancer	3	3
Gullet cancer	9	9
Ventricle cancer	2	2
Other	8	9
Total	97	378

 PDT method was applied for early stages of cancer with the purpose of complete recovery of patients with neoplasms of skin, lactic glands, big duodenal nipple, vulva, and PDT was applied as well  for the patients non liable to operations with palliative purpose – for rechannelling of hollow organs with stenosis caused by tumour, reduction of tumour mass volume, improvement of patients life quality. Patients with multiple intracutaneous metastases of lactic glands and melanoma were observed separately, and in the latter case PDT was applied with the aim to keep back metastases growth and prevent from further metastases-formation.

PDT method was applied to the patients aged from 35 to 92 years old. Many elderly patients had contra-indications to traditional methods of treatment, such as surgery and radiation therapy. Nevertheless after application of radical treatment with PDT method no grave systematic complications were detected.

Majority of treated patients had disease of relapse character after application of traditional methods of treatment. Only 27% of patients treated with PDT had primary malignant neoplasms, and in 4 cases PDT was applied to treat residual tumours after non-efficient treatment with radiation therapy and laser vaporization.

Patients with malignant neoplasms of skin (skin cancer, intracutaneous metastases) had prevailing multiple affections, the number of tumour seats of some patients reached 40 and more. Many patients with skin cancer had the seats of disease located in the face area, what resulted in high risk of unfavourable cosmetic consequences in case of radical surgery, and PDT in such cases was the method of choice.

As the result, therapeutical effect of PDT was recognized in 100% of cases, with complete tumour resorption for 61 patients (63%), and partial resorption – for 36 patients (37%) (Table 2).

Table 2

Results of PDT application (1998 - 2001)

Localization of tumour	Number of patients	PDT effect
		CR	PR
Skin cancer	56	48	8
Skin melanoma	5	2	3
Lactic glands cancer	3	0	3
Cancer of mucous membrane, mouth cavity, tonque, lips	6	3	3
Larynx cancer	5	4	1
Lungs cancer	3	0	3*
Gullet cancer	9	0	9*
Ventricle cancer	2	1	1*
Other	8	3	5
Total	97	61	36

CR – complete tumour resorption, PR – partial tumour resorption
   * - palliative PDT with purpose of rechannelling

Radical programme of PDT was applied to 64 patients. As result of the treatment complete tumour resorption was achieved for 52 patients (81% of cases), partial resorption – for 12 patients. PDT method was well accepted even by the patients with serious attendant diseases, and in many cases PDT proved to be the only possible method of treatment. Thus, PDT was applied for treatment of patient I.I. with cancer of big duodenal nipple (68 years old, case №3105), not liable for surgery because of pronounced attendant all-somatic pathology. Applied PDT allowed to achieve full recovery with duration of non-relapse observation of 33 months. It is necessary to point out that it was the first time in Russian medical practice that PDT was applied in the case with such pathology.

In treatment of skin cancer, even in cases with extensive and multiple affections PDT served as a good alternative to surgery, providing good and excellent cosmetic results and high efficiency. Also, the terms of hospitalization were reduced. Thus, patient A. (case №6192) came in for treatment in the Department with extensive infiltrating tumour of skin in right cheek (size of neoplasm 3,0 x 3,5 x 0,7 cm). After check-up the patient was treated with single PDT, what resulted in complete resorption of tumour with good cosmetic effect, and, considering the fact that total term of hospitalization was 18 days, the term starting from beginning of treatment until discharge was minimal –  3 days.

Organ-preserving nature of PDT allowed to apply this method for treatment of residual tumours and post-radiant relapses of cancer of mucous membrane of mouth cavity. Thus, patient I. with cancer of mucous membrane of bottom mouth cavity (case № 2528) received radical treatment of PDT with dosage of 75 Gr., which did not result in full recovery – there was a residual tumour. Further follow-up with radiation therapy was impossible, and post-radiation transformation of tissues created unfavourable conditions for surgery. Application of PDT led to complete recovery of the patient, and to the present the observation term without relapses is more than 2 years.

     Palliative PDT with the aim of rechannelling of hollow organs obturated by tumour was applied to treat 13 patients non-liable to surgery.

10 patients had cancer of gullet and cardial section of ventricle with extension to gullet. 7 patients had flat-cellular cancer, 3 had adenocartsinoma. 4 patients had  extent of section with gullet stenosis  from 2 to 6 cm, 6 patients had the extent from 7 to 12 cm. 4 patients had been submitted to rechannelling with YAG-Nd laser, 2 patients had 10 and 12 procedures with short-term effect. At the moment of the therapy application start the condition of all patients was aggravated with disphagia, cakhexia, development of systematic disorders.

3 patients had cancer of trachea and big bronchial tubes of IV stage (flat-cellular cancer with cornification) 1 patient with athelectasis of upper lobe of right lung, 1 patient with athelectasis of bottom lobe of right lung†; 1 patient with trachea stenosis and two main bronchial tubes, hypoventilation of both lungs and difficult breath.

The results of application of palliative PDT, aimed at rechannelling of hollow organs, obturated by tumour, are presented in Table 3.

Out of 10 patients with cancer of gullet and cardial section of ventricle 4 patients received 1 course of PDT, 4 patients received 2 courses of PDT, and 1 patient with cancer of gullet with extent of affection of middle- and bottom-pectoral part of gullet of 12 cm. received 5 course-treatment of PDT. As result of PDT application 9 patients showed pronounced effect of rechannelling with restored nutrition through mouth. 3 patients out of the group gained 15 - 20% of weight during the first month after PDT. Effect of rechannelling lasted for 3 - 7 months, after that with aggravation of symptoms of disphagia and detection of tumour stenosis come-back PDT was repeated.

Patient K. received with relapse of cancer of bottom part of gullet after surgery had extent of tumour stenosis of bottom gullet part of 12 cm. He had pronounced disphagia, difficulty with passing even liquid nutrition, the patient was emaciated and was liable only to symptomatic therapy. Application of course of endoscopic PDT lead to considerable extension of gullet space, in 2 days after the procedure passing of nutrition was resumed. The patient was discharged with considerable improvement and was under observation in satisfactory condition for 7 months. Considerable improvement of patient’s condition after PDT and absence of distant metastases-formation allowed him to undergo radical surgery, the patient died 1 day after surgery of thromboembolia of lung artery.

Only one patient with extent of gullet affection of 12 cm  with application of PDT for 5 times had short-term improvement of nutrition passing (and contrast mass during control x-ray researches), that was why the patient was put gastrostoma.

  Pronounced effect of rechannalling was detected for all 3 patients with lung cancer, with elimination of short-wind and difficult breath after 3 - 4 days of PDT application. During control bronchoscopy after first course of PDT application partial (50%) restoration of bronchi opening was detected, after 2 - 3 courses – full recovery of opening with X-ray detection of hypoventilation and athelectasis elimination and restoration of transparency (aireness) of lungs’ tissue.

   Table 3

Application of PDT for rechannelling of hollow organs, obturated by tumour
for patients not liable for surgery 

Nature of pathology	Number of patients	Rechannelling		Duration of effect
		Full	Partial
Gullet cancer	7	6	1	3 - 5 months
Ventricle cancer with extension to gullet	3	2	1	3 - 7 months
Bronchi cancer	3	3	0	3 - 7 months
Total	13	11	2

 One patient from that group (patient L., case №8240), had central cancer of right lung with tumour obturation of lengthwise bronchi and athelectasis of lobe, the patient was in a grave state, there were metastases in lymphatic knots of mediastinum, the case was defined as not liable to surgery. The patient was treated with PDT method. Thanks to PDT application full rechannelling of bronchi was achieved as well as smoothing out of athelectasis, improvement of lungs’ ventilation ability. General state of the patient considerably improved, and surgery-anaesthetic risk was reduced. It allowed to carry out radical surgery, the observation period from beginning of treatment is 17 months. Thus, in this case PDT application allowed to transfer the patient from not-liable to surgery state to liable to surgery state.

Among 4 patients who received palliative PDT in connection with multiple inracutaneous metastases of melanoma and cancer of lactic gland, pronounced therapeutical effect was detected in all cases. One patient (patient C., case №3705), who was received with multiple intacutaneous metastases of lactic gland cancer 2 years after radical mastectomy, had 25 metastases on the front pectoral side. After PDT course of treatment growth of intacutaneous metastases of lactic gland cancer was totally suppressed and duration of remission accounts to 21 months.