Progress of photodynamic therapy (PDT) in gastric cancer and the clinical outcome are
described in this paper. (1) We included the whole lesion and a 5 mm margin in the field for
irradiation. Marking by injection of India-ink showing the irradiation field was performed
beforehand. (2) We established the standard light dose to be 90 J/cm2 for an argon dye
laser and 60 J/cm2 for a pulse wave laser. (3) The size of cancerous lesion curable by PDT
was expanded from 3 cm in diameter, i.e. 7 cm2 in area to 4 cm in diameter, i.e. 13 cm2 by
employing a new excimer dye laser model, which could emit 4mJ/pulse with 80 Hz pulse
frequency. (4) The depth of cancer invasion which could be treated by PDT was increased from
about 4 mm, i.e. the superficial part of the submucosal layer (SM-1) to more than 10 mm in
depth, i.e. the proper muscular layer. These improvements owe much to the pulse laser, the
photodynamic action induced by which permits deeper penetration than that of a continuous
wave laser. (5) We employed a side-viewing fiberscope for gastric PDT to irradiate the lesion
from an angle of 90°. (6) We designed a simple cut quartz fiber for photoradiation with a spiral spring thickened toward the end. (7) We developed an endoscopic device for photoradiation in
PDT which achieves accurate and efficient irradiation. As a result of these improvements a
higher cure rate was obtained even with a lower light dose of irradiation.