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van Doeveren TEM, van Veen RLP, van den Boom F, Tan IB, Schreuder WH, Karakullukçu MB. Intra-cavity Photodynamic Therapy for malignant tumors of the paranasal sinuses: An in vivo light dosimetry study. Photodiagnosis Photodyn Ther 2020; 32:101972. [PMID: 32835881 DOI: 10.1016/j.pdpdt.2020.101972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is a promising treatment option for recurrent sinonasal malignancies. However, light administration in this area is challenging given the complex geometry, varying tissue optical properties and difficult accessibility. The goal of this study was to estimate the temporal and spatial variation in fluence and fluence rate during sinonasal mTHPC-mediated PDT. It was investigated whether the predetermined aim to illuminate with a fluence of 20 J⋅cm-2 and fluence rate of 100 mW⋅cm-2 was achieved. METHODS In eleven patients the fluence and fluence rates were measured using in vivo light dosimetry at the target location during real-time sinonasal PDT. There was a variance in sinonasal target location and type of light diffuser used. In four patients two isotropic detectors were used within the same cavity. RESULTS All measurements showed major fluence rate fluctuations within each single isotropic detector probe over time, as well as between probes within the same cavity. The largest fluence rate range measured was 328 mW⋅cm-2. Only one probe showed a mean fluence rate of ∼100 mW⋅cm-2. Taken all probes together, a fluence rate above 80 mW⋅cm-2 was measured in 31 % of the total light exposure; in 22 % it was less than 20 mW⋅cm-2. Thirty-three percent showed a fluence of at least 20 J⋅cm-2. CONCLUSIONS The current dosimetry approach for sinonasal intra-cavity PDT shows major temporal and spatial variations in fluence rate and a large variance in light exposure time. The results emphasize the need for improvement of in vivo light dosimetry and dosimetry planning.
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Affiliation(s)
- T E M van Doeveren
- Department of Head and Neck Oncology and Surgery, Verwelius lab, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Otolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - R L P van Veen
- Department of Head and Neck Oncology and Surgery, Verwelius lab, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - F van den Boom
- Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - I B Tan
- Department of Head and Neck Oncology and Surgery, Verwelius lab, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Otolaryngology and Head and Neck surgery, Gadjah Mada University, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - W H Schreuder
- Department of Head and Neck Oncology and Surgery, Verwelius lab, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre/Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - M B Karakullukçu
- Department of Head and Neck Oncology and Surgery, Verwelius lab, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre/Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands.
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Hohmann M, Lengenfelder B, Kanawade R, Klämpfl F, Douplik A, Albrecht H. Measurement of optical properties of pig esophagus by using a modified spectrometer set-up. JOURNAL OF BIOPHOTONICS 2018; 11. [PMID: 28464418 DOI: 10.1002/jbio.201600187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 05/14/2023]
Abstract
Optical properties (μa , μs and g) of certain human tissue types such as skin and blood have been very well investigated. However until today, for internal body organs such as the esophagus they are not well characterized. For ex-vivo measurements "Inverse Adding Doubling" (IAD) and Inverse Monte-Carlo-Simulation (IMCS) are state of the art. Both methods need the measurement of the collimated transmission. Current methods lack a proper way of measuring the collimated transmission. Hence, this measurement of the g-factor has a systematic error. Therefore, for the measurement of the collimated transmission, a new approach has been developed and evaluated with intralipid. Finally, the optical properties of mucosa, sub mucosa, muscularis and adventitia of pig esophagus tissue are calculated with IAD. The results are promising and in agreement with published literature.
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Affiliation(s)
- Martin Hohmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Institute of Photonic Technologies (LPT), Konrad-Zuse-Straße 3/5, 91052 Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052 Erlangen, Germany
- Ryerson University, Department of Physics, 350 Victoria Street Toronto, Ontario, M5B 2K3
| | - B Lengenfelder
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Institute of Photonic Technologies (LPT), Konrad-Zuse-Straße 3/5, 91052 Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052 Erlangen, Germany
| | - R Kanawade
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Institute of Photonic Technologies (LPT), Konrad-Zuse-Straße 3/5, 91052 Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052 Erlangen, Germany
| | - F Klämpfl
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Institute of Photonic Technologies (LPT), Konrad-Zuse-Straße 3/5, 91052 Erlangen, Germany
| | - A Douplik
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052 Erlangen, Germany
- Ryerson University, Department of Physics, 350 Victoria Street Toronto, Ontario, M5B 2K3
| | - H Albrecht
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Department of Internal Medicine 1, Ulmenweg 18, 91054 Erlangen, Germany
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Senge MO, Brandt JC. Temoporfin (Foscan®, 5,10,15,20-tetra(m-hydroxyphenyl)chlorin)--a second-generation photosensitizer. Photochem Photobiol 2011; 87:1240-96. [PMID: 21848905 DOI: 10.1111/j.1751-1097.2011.00986.x] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This review traces the development and study of the second-generation photosensitizer 5,10,15,20-tetra(m-hydroxyphenyl)chlorin through to its acceptance and clinical use in modern photodynamic (cancer) therapy. The literature has been covered up to early 2011.
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Affiliation(s)
- Mathias O Senge
- Medicinal Chemistry, Institute of Molecular Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland.
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4
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Glanzmann TM, Zellweger MP, Borle F, Conde R, Radu A, Ballini JP, Jaquet Y, Pilloud R, van den Bergh H, Monnier P, Andrejevic-Blant S, Wagnières GA. Assessment of a sheep animal model to optimise photodynamic therapy in the oesophagus. Lasers Surg Med 2009; 41:643-52. [DOI: 10.1002/lsm.20844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jones LR, Preyer NW, Wolfsen HC, Reynolds DM, Davis MA, Wallace MB. Monte carlo model of stricture formation in photodynamic therapy of normal pig esophagus. Photochem Photobiol 2009; 85:341-6. [PMID: 19161398 DOI: 10.1111/j.1751-1097.2008.00445.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Photodynamic therapy (PDT) is FDA-approved for use in patients with Barrett's esophagus using porfimer sodium (2 mg per kg) and a recommended light dose of 130 J cm(-1) for high grade dysplasia. Despite uniform drug and light doses, the clinical outcome of PDT is variable. A significant number of PDT cases result in esophageal strictures, a side effect related to excessive energy absorption. The purpose of this project was to model esophageal stricture formation with a Monte Carlo simulation. An original multilayer Monte Carlo computer simulation was developed for esophageal PDT. Optical absorption and scattering coefficients were derived for mucosal and muscle layers of normal porcine esophagus. Porfimer sodium was added to each layer by increasing the absorption coefficient by the appropriate amount. A threshold-absorbed light dose was assumed to be required for stricture formation and ablation. The simulation predicted irreversible damage to the mucosa with a 160 J cm(-1) light dose and damage to the muscle layer with an additional 160 J cm(-1) light dose for a tissue porfimer sodium content of 3.5 mg kg(-1). The simulation accurately modeled photodynamic stricture formation in normal pig in vivo esophageal tissue. This preliminary work suggests that the absorbed light threshold for stricture formation may be between 2 and 4 J per gram of tissue.
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Affiliation(s)
- Linda R Jones
- Department of Physics and Astronomy, College of Charleston, Charleston, SC, USA.
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Wagnieres G, Hadjur C, Grosjean P, Braichotte D, Savary JF, Monnier P, van den Bergh H. Clinical Evaluation of the Cutaneous Phototoxicity of 5,10,15,20-Tetra (m-hydroxyphenyl)chlorin. Photochem Photobiol 2008. [DOI: 10.1111/j.1751-1097.1998.tb09696.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zeng H, Korbelik M, McLean DI, MacAulay C, Lui H. Monitoring Photoproduct Formation and Photobleaching by Fluorescence Spectroscopy Has the Potential to Improve PDT Dosimetry with a Verteporfin-like Photosensitizer¶. Photochem Photobiol 2007. [DOI: 10.1562/0031-8655(2002)0750398mpfapb2.0.co2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Qin Y, Xing D, Luo S, Zhou J, Zhong X, Chen Q. Feasibility of using fluoresceinyl Cypridina luciferin analog in a novel chemiluminescence method for real-time photodynamic therapy dosimetry. Photochem Photobiol 2006; 81:1534-8. [PMID: 16149860 DOI: 10.1562/2005-05-20-ra-536] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Singlet oxygen ((1)O(2)) is the most important cytotoxic agent in photodynamic therapy (PDT). The feasibility of using a chemiluminescence (CL) probe, 3,7-dihydro-6-[4-(2-(N'-(5-fluoresceinyl)thioureido)ethoxy)phenyl]-2-methylimidazo{1,2-a}pyrazin-3-one sodium salt (fluoresceinyl Cypridina luciferin analog, FCLA), to monitor (1)O(2) production during PDT is evaluated in vitro. Lymphoma cells were treated with various protocols of PDT. The results show that the FCLA-CL production during PDT is linearly related to the corresponding cytotoxicity, regardless of the treatment protocol. With minimum cytotoxicity and interference to the PDT treatment outcome, the FCLA-CL system is an effective means to quantify PDT (1)O(2) production and may provide an alternative real-time dosimeter.
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Affiliation(s)
- Yanfang Qin
- Institute of Laser Life Science, South China Normal University, Guangzhou, 510631, PR China
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Stringer MR, Kelty CJ, Ackroyd R, Brown SB. Light dosimetry measurements during ALA-PDT of Barrett's oesophagus. Photodiagnosis Photodyn Ther 2006; 3:19-26. [PMID: 25049024 DOI: 10.1016/s1572-1000(05)00155-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 11/24/2005] [Accepted: 11/28/2005] [Indexed: 11/28/2022]
Abstract
A fibre optic probe and compact light detection system has been used to monitor the fluence-rate at the tissue surface during 5-aminolaevulinic acid based photodynamic therapy (PDT) of Barrett's oesophagous. The contributions from three specific wavelengths were recorded, corresponding to the combination of therapeutic laser light and fluorescence emission from protoporphyrin IX (635nm), the fluorescence from an oxidation product of the photosensitiser (670nm), and the protoporphyrin IX fluorescence alone (705nm). We have found that light scattering results in an enhancement of the therapeutic fluence-rate, and hence light dose, by approximately 70%. At the onset of therapy the fluorescence provides a 10% contribution to the overall fluence-rate at 635nm. The dynamics of photosensitiser bleaching could be extracted from the depletion in light signals. By defining a bleaching dose as the 635nm light fluence delivered over the period during which the photosensitiser fluorescence decays to 1/e(3) of its initial value, we find that the average ratio of bleaching to total dose is 33%. Further, the fluorescence contributes approximately 5% of the bleaching light dose. These results suggest that the prescribed period of therapeutic light exposure may be reduced with no loss in clinical efficacy, but with a consequent improvement in patient tolerance to this therapy.
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Affiliation(s)
- M R Stringer
- Institute of Microwaves and Photonics, School of Electronic and Electrical Engineering, University of Leeds, UK
| | - C J Kelty
- Department of Surgery, Royal Hallamshire Hospital, Sheffield, UK
| | - R Ackroyd
- Department of Surgery, Royal Hallamshire Hospital, Sheffield, UK
| | - S B Brown
- Centre for Photobiology and Photodynamic Therapy, School of Biochemistry and Microbiology, University of Leeds, UK
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Radu A, Grosjean P, Jaquet Y, Pilloud R, Wagnieres G, van den Bergh H, Monnier P. Photodynamic therapy and endoscopic mucosal resection as minimally invasive approaches for the treatment of early esophageal tumors: Pre-clinical and clinical experience in Lausanne. Photodiagnosis Photodyn Ther 2005; 2:35-44. [DOI: 10.1016/s1572-1000(05)00035-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 04/14/2005] [Accepted: 04/14/2005] [Indexed: 12/20/2022]
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11
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Photodynamic therapy and photodiagnosis for Barrett's oesophagus and early oesophageal carcinoma. Photodiagnosis Photodyn Ther 2004; 1:319-34. [DOI: 10.1016/s1572-1000(05)00009-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 02/07/2005] [Accepted: 02/07/2005] [Indexed: 01/14/2023]
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Nakamura T, Fukui H, Shirakawa K, Fujii Y, Fujimori T, Terano A. Photodynamic therapy of superficial esophageal cancer with a transparent hood. Gastrointest Endosc 2004; 60:120-4. [PMID: 15229444 DOI: 10.1016/s0016-5107(04)01525-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To improve the effectiveness of photodynamic therapy, the further development of endoscopic devices is essential. For photodynamic therapy of superficial esophageal cancer, a transparent hood was used to obtain precise laser irradiation. METHODS The transparent hood was attached to the tip of an upper endoscope. Forty-eight hours after the injection of porfimer sodium, cancerous lesions were irradiated with an excimer-dye laser (4 mJ, 80 Hz). Twenty-four hours later, additional irradiation was applied to lesions when the response to the initial irradiation appeared insufficient. Fifteen neoplastic lesions in 7 patients were treated. RESULTS The initial size of the lesions ranged from 5 to 30 mm in diameter. Histopathologically, there were 9 squamous-cell carcinomas and 6 high-grade squamous dysplastic lesions. All treated lesions disappeared after the first or the second laser irradiation (total energy range 39.1-193.5 J/cm(2)). During follow-up (range 4-51 months), there was no recurrence of the initial lesion in any patient. There was no severe photodynamic therapy related complication. CONCLUSIONS Photodynamic therapy with a transparent hood is an acceptable option for the treatment of superficial esophageal cancer.
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Affiliation(s)
- Tetsuya Nakamura
- Department of Endoscopy, Dokkyo University School of Medicine, Shimotsuga, Tochigi, Japan
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13
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Etienne J, Dorme N, Bourg-Heckly G, Raimbert P, Fléjou JF, Flijou JF. Photodynamic therapy with green light and m-tetrahydroxyphenyl chlorin for intramucosal adenocarcinoma and high-grade dysplasia in Barrett's esophagus. Gastrointest Endosc 2004; 59:880-9. [PMID: 15173809 DOI: 10.1016/s0016-5107(04)01271-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The eradication of early stage neoplastic lesions in Barrett's esophagus is imperative to prevent invasive adenocarcinoma. Early stage lesions have an extremely low risk of lymph node metastasis, thereby, making local treatment feasible. Photodynamic therapy destroys malignant cells by a photochemical effect. The aims of this study were to evaluate the efficacy and tolerance of photodynamic therapy with green light and a new photosensitizer, temoporfin or m-tetrahydroxyphenyl chlorin in patients with Barrett's esophagus and early stage neoplastic lesions. METHODS Four days after injection of m-tetrahydroxyphenyl chlorin, lesions were illuminated at a wavelength of 514 nm through non-circumferential windowed diffusers. Follow-up endoscopy with biopsies was performed at regular intervals. RESULTS Fourteen lesions (7 high-grade dysplasia, 7 intramucosal adenocarcinoma) in 12 patients were treated. For all lesions, efficacy was 100% and squamous re-epithelialization was complete. Side effects were of moderate severity (one stricture). Mean follow-up was 34 (15) months (range 12-68 months). CONCLUSIONS Green light photodynamic therapy with m-tetrahydroxyphenyl chlorin can eradicate early stage neoplastic lesions in Barrett's esophagus and may be proposed as an alternative first-line therapy or a second-line therapy after failure of other endoscopic treatments. The efficacy and patient tolerance of the procedure justify further studies of the method in larger groups of patients.
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Affiliation(s)
- Jacques Etienne
- Centre de Thérapie Photodynamique Pluridisciplinaire, Institut Mutualiste Montsouris, Paris, France
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14
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Radu A, Conde R, Fontolliet C, Wagnieres G, Van den Bergh H, Monnier P. Mucosal ablation with photodynamic therapy in the esophagus: optimization of light dosimetry in the sheep model. Gastrointest Endosc 2003; 57:897-905. [PMID: 12776039 DOI: 10.1016/s0016-5107(03)70027-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Photodynamic therapy is an attractive technique for mucosal ablation in patients with superficial squamous cell carcinoma of the esophagus, or high-grade dysplasia or early stage adenocarcinoma arising in Barrett's esophagus. Although illumination with green light is assumed to be safe, choice of the light has been empirical in clinical studies; light dose is often reduced to avoid potential complications. The present study assessed the safety of green and blue lights during photodynamic therapy in the esophagus by progressively administrating increasing doses in an attempt to standardize the dose and determine a safe upper limit. This would considerably simplify photodynamic therapy and improve therapeutic results. METHODS The sheep model was chosen because of similarities with humans regarding the thickness and histologic structure of the esophagus. Irradiation with a 180 degrees windowed cylindrical light distributor was performed in 19 sheep 4 days after injection of 0.15 mg/kg of tetra(m-hydroxyphenyl) chlorin. Light doses ranged from 10 to 500 J/cm(2) at 514 nm (argon ion laser) and from 5 to 250 J/cm(2) at 413 nm (krypton laser). RESULTS Follow-up endoscopies revealed a tissue response with a fibrinous area at almost all light doses, whereas application of extremely high light doses tended to induce circumferential necrosis with subsequent stenosis. Three months after irradiation with green light, histologic examination of the resected specimens revealed transmural scarring at doses higher than 100 J/cm(2). After illumination with blue light, partial or more extensive fibrosis of the muscular layer was observed only at light doses of 175 to 250 J/cm(2). CONCLUSIONS Application of high doses of green light after sensitization with tetra(m-hydroxyphenyl) chlorin led to severe complications in the esophagus of the sheep that are highly likely to occur in humans as well. Blue light causes significantly less damage than green light and may, therefore, be considered as an alternative for photodynamic therapy of early stage superficial esophageal cancer.
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Affiliation(s)
- Alexandre Radu
- Department of Otolaryngology, Head and Neck Surgery, CHUV Hospital, CH-1011 Lausanne, Switzerland
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van Veen RLP, Aalders MCG, Pasma KL, Siersema PD, Haringsma J, van de Vrie W, Gabeler EEE, Robinson DJ, Sterenborg HJCM. In situ light dosimetry during photodynamic therapy of Barrett's esophagus with 5-aminolevulinic acid. Lasers Surg Med 2003; 31:299-304. [PMID: 12430146 DOI: 10.1002/lsm.10129] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies with PhotoDynamic Therapy (PDT) in bladder and bronchi have shown that due to scattering and reflection, the actually delivered fluence rate on the surface in a hollow organ can be significantly higher than expected. In this pilot study, we investigated the differences between the primary calculated and the actual measured fluence rate during PDT of Barrett's Esophagus (BE) using 23 independent clinical measurements in 15 patients. STUDY DESIGN/MATERIALS AND METHODS A KTP-dye module laser at 630 nm was used as light source. Light delivery was performed using a cylindrical light diffuser inserted in the center of an inflatable transparent balloon with a length corresponding to the length of the Barrett's epithelium. The total light output power of the cylindrical diffuser was calibrated using an integrating sphere to deliver a primary fluence rate of 100 mW cm(-2). Two fiber-optic pseudo sphere isotropic detectors were placed on the balloon and were used to measure fluence rate at the surface of the esophageal wall during PDT. RESULTS AND CONCLUSIONS The actual fluence rate measured was 1.5-3.9 times higher than the primary fluence rate for 630 nm. In general, the fluence rate amplification factor decreased with increasing redness of the tissue and was less for shorter diffusers. Fluence rate variations in time were observed which coincided with patients coughing, movement, and esophageal spasms. These factors combined with inter patient variability of the fluence rate measured appears to justify the routine application of this technique in PDT of BE.
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Affiliation(s)
- Robert L P van Veen
- Photodynamic Therapy and Optical Spectroscopy Program, Erasmus MC, Rotterdam, The Netherlands
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Plaetzer K, Kiesslich T, Verwanger T, Krammer B. The Modes of Cell Death Induced by PDT: An Overview. ACTA ACUST UNITED AC 2003. [DOI: 10.1078/1615-1615-00082] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Zeng H, Korbelik M, McLean DI, MacAulay C, Lui H. Monitoring photoproduct formation and photobleaching by fluorescence spectroscopy has the potential to improve PDT dosimetry with a verteporfin-like photosensitizer. Photochem Photobiol 2002; 75:398-405. [PMID: 12003130 DOI: 10.1562/0031-8655(2002)075<0398:mpfapb>2.0.co;2] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In current clinical practice, photodynamic therapy (PDT) is carried out with prescribed drug doses and light doses as well as fixed drug-light intervals and illumination fluence rates. This approach can result in undesirable treatment outcomes of either overtreatment or undertreatment because of biological variations between different lesions and patients. In this study, we explore the possibility of improving PDT dosimetry by monitoring drug photobleaching and photoproduct formation. The study involved 60 mice receiving the same drug dose of a novel verteporfin-like photosensitizer, QLT0074, at 0.3 mg/kg body weight, followed by different light doses of 5, 10, 20, 30, 40 or 50 J/cm2 at 686 nm and a fluence rate of 70 mW/cm2. Photobleaching and photoproduct formation were measured simultaneously, using fluorescence spectroscopy. A ratio technique for data processing was introduced to reliably detect the photoproduct formed by PDT on mouse skin in vivo. The study showed that the QLT0074 photoproduct is stable and can be reliably quantified. Three new parameters, photoproduct score (PPS), photobleaching score (PBS) and percentage photobleaching score (PBS%), were introduced and tested together with the conventional dosimetry parameter, light dose, for performance on predicting PDT-induced outcome, skin necrosis. The statistical analysis of experimental results was performed with an ordinal logistic regression model. We demonstrated that both PPS and PBS improved the prediction of skin necrosis dramatically compared to light dose. PPS was identified as the best single parameter for predicting the PDT outcome.
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Affiliation(s)
- Haishan Zeng
- Cancer Imaging Department, British Columbia Cancer Agency, Vancouver, Canada.
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Pogue BW, Pitts JD, Mycek MA, Sloboda RD, Wilmot CM, Brandsema JF, O'Hara JA. In vivo NADH fluorescence monitoring as an assay for cellular damage in photodynamic therapy. Photochem Photobiol 2002. [PMID: 11783938 DOI: 10.1562/0031-8655(2001)0740817ivnfma2.0.co2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this study the endogenous fluorescence signal attributed to reduced nicotinamide adenine dinucleotide (NADH) has been measured in response to photodynamic therapy (PDT)-induced damage. Measurements on cells in vitro have shown that NADH fluorescence decreased relative to that of controls after treatment with a toxic dose of PDT, as measured within 30 min after treatment. Similarly, assays of cell viability indicated that mitochondrial function was reduced immediately after treatment in proportion to the dose delivered, and the proportion of this dose response did not degrade further over 24 h. Measurements in vivo were used to monitor the fluorescence emission spectrum and the excited state lifetime of NADH in PDT-treated tissue. The NADH signal was defined as the ratio of the integrated fluorescence intensity of the 450 +/- 25 nm emission band relative to the fluorescence intensity integrated over the entire 400-600 nm range of collection. Measurements in murine muscle tissue indicated a 22% reduction in the fluorescence signal immediately after treatment with verteporfin-based PDT, using a dose of 2 mg/kg injected 15 min before a 48 J/cm2 light dose at 690 nm. Control animals without photosensitizer injection had no significant change in the fluorescence signal from laser irradiation at the same doses. This signal was monotonically correlated to the deposited dose used here and could provide a direct dosimetric measure of PDT-induced cellular death in the tissue being treated.
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Affiliation(s)
- B W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA.
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Grosjean P, Wagnieres G, Fontolliet C, van den Bergh H, Monnier P. Clinical photodynamic therapy for superficial cancer in the oesophagus and the bronchi: 514 nm compared with 630 nm light irradiation after sensitization with Photofrin II. Br J Cancer 1998; 77:1989-95. [PMID: 9667680 PMCID: PMC2150371 DOI: 10.1038/bjc.1998.330] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Photodynamic therapy (PDT) for cancer in the oesophagus and bronchi with red (630 nm) light may occasionally lead to wall perforation and fistula. Therefore, we investigated the clinical use of a less penetrating wavelength (514 nm) for the curative treatment of nine superficial carcinomas in the oesophagus and bronchi after photosensitization with Photofrin II. Tumours without infiltration beyond the submucosa in the oesophagus and beyond the lamina propria in the bronchi were considered as superficial cancers. The outcome and complications were compared with those of 13 superficial cancers treated with PDT and 630 nm light. In addition, we evaluated histologically the extent of the long-term tissue damage and scarring following treatment of six oesophageal cancers with either green or red light. At first endoscopic control, 7-10 days after PDT, tissue necrosis simply matched the illuminated area, without evidence of selective tumour damage. Six of nine tumours treated with 514 nm light had a complete response compared with nine of 13 after 630 nm irradiation. No perforation or fistula occurred in either treatment group. However, severe chest pain and fever with or without pleural effusion, consistent with occult perforation, were observed in three patients after 630 nm illumination in the oesophagus. Histologically, fibrous scarring in the three distinct sites treated with green light was limited to the superficial layers of the oesophagus. After red light treatment, transmural fibrosis with marked thinning of the oesophageal wall was evident in two of the three specimens available for inspection. These results indicate that PDT with 514 nm light has the potential to cure superficial cancer in the oesophagus and bronchi with essentially the same probability of success as red light. In the oesophagus, green light prevents deep tissue damage, thus reducing the risk of perforation.
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Affiliation(s)
- P Grosjean
- Department of Otolaryngology, Head and Neck Surgery, CHUV Hospital, Lausanne, Switzerland
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