Abstract:

Objective To observe the therapeutic effect of photodynamic therapy(PDT) for patients with perianal Paget’s disease guided by photodynamic fluorescence diagnosis. Methods　3 cases of 6 perianal Paget’s disease were treated by PDT alone, and the other 3 cases were treated by PDT guided by photodynamic fluorescence diagnosis. Routine PDT to utilize DIOMED 630nm diode laser as light source and Photofrin as photosensitizer. The patient’s focus was irradiated 48h after Photofrin 5mg/kg administration. The power density was 150～300J/cm2 and energy density was 100～150mW /cm2. PDT guided by photodynamic fluorescence diagnosis (FPDT group) was given the same dosage of Photofrin 48h before laser irradiation and 20% ALA local hydropathic compress 3h before laser irradiation. The laser dosage was the same as common PDT. The difference was that photodynamic fluorescence diagnosis guided to reassure the region of the cancer before laser irradiation. The observation of the reaction of the patients’ lesion change were taken in 48h, 72h, 1M, 3M and 6M after PDT and the follow up were continuing. Results The focus darkened and exudated apparently 48h after irradiation and formed a scar 120h gradually after irradiation. There were 1 case CR and 2 cases PR in common PDT, 2 cases CR and 1 case PR in FPDT 6 months after PDT. Conclusions Photodynamic therapy is an effective modality for perianal Paget’s disease, and fluorescence diagnosis is a key method to instruct clinical PDT by assurance the area of the lesion.