Photodynamic therapy (PDT) is a therapeutic modality against cancers involving the use of a photosensitizer and the local application of laser. Photofrin (dihematoporphyrin ether and/or ester) is used as a photosensitizer in PDT. Photofrin retains selectively in the malignant tissue compared to normal tissue; destruction of normal tissue by PDT is minimal, therefore PDT is a good indication for patients with limited lung capacity and elderly patients. We treated 10 lesions in 8 patients from 1982 to 1993. We analyzed treatment results in these 8 patients. Complete response (CR) was achieved in 7 lesions and partial response (PR) was achieved in 3 lesions. 3 CR lesions relapsed afterward. After these analyses, we changed the method of laser radiation as follows because we considered that the dose of laser radiation was not enough in some of these patients. We decided to use 3 different fibers, cylindrical, lens diffuser and free cut fibers in combination, according to the shape and the location of the lesion. We changed the method of anesthesia from local anesthesia to ganeral anesthesia so that the patients could receive enough dose of laser without discomfort. After these alterations, we treated 13 lesions in 7 patients from 1999 to 2001. CR was achieved in 10 lesions. 3 lesions were considered as PR and 2 of these 3 lesins were treated by further PDT to achieve CR. However, bronchial stenosis was occurred in 3 patients ; one patient required stenting, one pneumonia and one pneumothorax were experienced. These were considered to be due to increased dosage of eximer dye laser radiation. PDT is a non-invasive method to treat bronchial malignancies however development of optimal method of treatment is still necessary.

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Our department perform laser therapy on ambulatory pediatric patients under general anesthesia. We have conducted a retrospective study on our status of laser therapy. The subjects were 749 children (248 boys and 501 girls; mean age, 2.9 ± 1.3 years; mean body weight, 16.3 ± 7.2 kg) who were subjected to laser treatment under general anesthesia at the Department of Plastic and Reconstructive Surgery, Tokyo Women' s Medical University between March 1993 and December 2001. The conditions treated were: simple hemangioma, 410 cases; Ota' s nevus, 132; pigmented nevus, 97; nevus spilus, 95; heterotopic Mongolian spots, 14; and strawberry hemangioma, 1. The average time required for surgery was 19.4 ± 14.1 minutes and the average time of anesthesia was 44.8 ± 29.7 minutes. Complications such as postoperative agitation and moderate fever were noted in 92 but no severe adverse effects of anesthesia or complications that might interfere with early discharge were recognized. The process was considered to be safe. These process were performed without major difficulties with the support of clearly performed informed consent with the aid of pamphlets and great team work of plastic surgeons and anesthesiologists. Laser treatment under general anesthesia conducted on pediatric outpatients contributes not only to reduce medical expenses and work load on the medical staff, but it also alleviates hospitalization-associated psychological stress on the patients and their families. The efficacy of this procedure should be highly appreciated.

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