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Cardoso M, Marto CM, Paula A, Coelho AS, Amaro I, Pineiro M, Pinho E Melo TMVD, Marques Ferreira M, Botelho MF, Carrilho E, Laranjo M. Effectiveness of photodynamic therapy on treatment response and survival in patients with recurrent oral squamous cell carcinoma: A systematic review. Photodiagnosis Photodyn Ther 2024; 48:104242. [PMID: 38857775 DOI: 10.1016/j.pdpdt.2024.104242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/06/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND This systematic review assessed the effectiveness of photodynamic therapy (PDT) in patients with recurrent oral squamous cell carcinoma (OSCC). METHODS Clinical studies on recurrent OSCC treated with PDT alone were included. Combined treatment strategies were excluded. The search was performed on Medline/Pubmed, Cochrane Library, Embase, Web of Science and ClinicalTrials.gov, manual search, and grey literature. RESULTS The eleven included studies were observational. The risk of bias and methodological quality were evaluated using the Newcastle-Ottawa Quality Assessment Scale. The studies reported the use of hematoporphyrin derivative, PhotofrinⓇ, FoscanⓇ and 5-aminolevulinic acid. Data on treatment response and survival was collected. Secondarily, postoperative courses and patient's quality of life/acceptance were reported whenever available. PhotofrinⓇ and FoscanⓇ were the most used photosensitisers, with more complete responses. Lesions responding less favourably were on posterior regions or deep-seated in the tissue. CONCLUSIONS Although treatment response differs between treatment protocols, PDT stands as a viable treatment option to be considered, as it can achieve therapeutic results and disease-free, long-lasting periods. Partial treatment responses may be of interest when achieving eligibility for other treatment strategies. Despite this study's limitations, which considered four photosensitisers, PhotofrinⓇ was the most used but more recent photosensitisers like FoscanⓇ have greater chemical stability, tissue penetration, and may be more efficacious on recurrent OSCC.
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Affiliation(s)
- Miguel Cardoso
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Biophysics, Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Coimbra Chemistry Centre - Institute of Molecular Sciences and Department of Chemistry, Rua Larga, Coimbra, 3004-535, Portugal.
| | - Carlos Miguel Marto
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Biophysics, Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Experimental Pathology, Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Integrated Clinical Practice and Laboratory for Evidence-based Science and Precision Dentistry, Faculty of Medicine, Av. Bissaya Barreto, Bloco de Celas, 3000-075 Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, Coimbra, 3004-504, Portugal; Clinical Academic Center of Coimbra (CACC), Praceta Professor Mota Pinto, Coimbra, 3004-561, Portugal; Univ Coimbra, CEMMPRE, ARISE, Pinhal de Marrocos, 3030-788 Coimbra, Portugal
| | - Anabela Paula
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Integrated Clinical Practice and Laboratory for Evidence-based Science and Precision Dentistry, Faculty of Medicine, Av. Bissaya Barreto, Bloco de Celas, 3000-075 Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, Coimbra, 3004-504, Portugal; Clinical Academic Center of Coimbra (CACC), Praceta Professor Mota Pinto, Coimbra, 3004-561, Portugal; Univ Coimbra, CEMMPRE, ARISE, Pinhal de Marrocos, 3030-788 Coimbra, Portugal
| | - Ana Sofia Coelho
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Integrated Clinical Practice and Laboratory for Evidence-based Science and Precision Dentistry, Faculty of Medicine, Av. Bissaya Barreto, Bloco de Celas, 3000-075 Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, Coimbra, 3004-504, Portugal; Clinical Academic Center of Coimbra (CACC), Praceta Professor Mota Pinto, Coimbra, 3004-561, Portugal; Univ Coimbra, CEMMPRE, ARISE, Pinhal de Marrocos, 3030-788 Coimbra, Portugal
| | - Inês Amaro
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Integrated Clinical Practice and Laboratory for Evidence-based Science and Precision Dentistry, Faculty of Medicine, Av. Bissaya Barreto, Bloco de Celas, 3000-075 Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, Coimbra, 3004-504, Portugal; Clinical Academic Center of Coimbra (CACC), Praceta Professor Mota Pinto, Coimbra, 3004-561, Portugal; Univ Coimbra, CEMMPRE, ARISE, Pinhal de Marrocos, 3030-788 Coimbra, Portugal
| | - Marta Pineiro
- Univ Coimbra, Coimbra Chemistry Centre - Institute of Molecular Sciences and Department of Chemistry, Rua Larga, Coimbra, 3004-535, Portugal
| | - Teresa M V D Pinho E Melo
- Univ Coimbra, Coimbra Chemistry Centre - Institute of Molecular Sciences and Department of Chemistry, Rua Larga, Coimbra, 3004-535, Portugal
| | - Manuel Marques Ferreira
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, Coimbra, 3004-504, Portugal; Clinical Academic Center of Coimbra (CACC), Praceta Professor Mota Pinto, Coimbra, 3004-561, Portugal; Univ Coimbra, CEMMPRE, ARISE, Pinhal de Marrocos, 3030-788 Coimbra, Portugal; Univ Coimbra, Institute of Endodontics, Faculty of Medicine, Av. Bissaya Barreto, Bloco de Celas, 3000-075 Coimbra, Portugal
| | - Maria Filomena Botelho
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Biophysics, Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, Coimbra, 3004-504, Portugal; Clinical Academic Center of Coimbra (CACC), Praceta Professor Mota Pinto, Coimbra, 3004-561, Portugal
| | - Eunice Carrilho
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Integrated Clinical Practice and Laboratory for Evidence-based Science and Precision Dentistry, Faculty of Medicine, Av. Bissaya Barreto, Bloco de Celas, 3000-075 Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, Coimbra, 3004-504, Portugal; Clinical Academic Center of Coimbra (CACC), Praceta Professor Mota Pinto, Coimbra, 3004-561, Portugal; Univ Coimbra, CEMMPRE, ARISE, Pinhal de Marrocos, 3030-788 Coimbra, Portugal
| | - Mafalda Laranjo
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Institute of Biophysics, Faculty of Medicine, Azinhaga de Santa Comba, Pólo III - Pólo das Ciências da Saúde, Coimbra, 3000-548, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, Coimbra, 3004-504, Portugal; Clinical Academic Center of Coimbra (CACC), Praceta Professor Mota Pinto, Coimbra, 3004-561, Portugal.
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Civantos FJ, Karakullukcu B, Biel M, Silver CE, Rinaldo A, Saba NF, Takes RP, Vander Poorten V, Ferlito A. A Review of Photodynamic Therapy for Neoplasms of the Head and Neck. Adv Ther 2018; 35:324-340. [PMID: 29417455 DOI: 10.1007/s12325-018-0659-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Indexed: 12/14/2022]
Abstract
Photodynamic therapy (PDT) involves the use of a phototoxic drug which is activated by low powered laser light to destroy neoplastic cells. Multiple photosensitizers have been studied and tumors have been treated in a variety of head and neck sites over the last 30 years. PDT can effectively treat head and neck tumors, particularly those of the superficial spreading type, and the classic application of this technology has been in the patient with a wide field of dysplastic change and superficial carcinomatosis. Interstitial treatment has been used to treat more invasive cancer. Data is available from case series and institutional experiences, but very little randomized data is available. We review the mechanisms of action, historical development, available data, and current knowledge regarding PDT for the various head and neck subsites, and discuss possible future directions, with an emphasis on clinical application.
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Affiliation(s)
- Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Barış Karakullukcu
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Merrill Biel
- University of Minnesota, Minneapolis, MN, USA
- Ear, Nose and Throat Specialty Care of Minnesota, Minneapolis, MN, USA
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Ahn PH, Quon H, O'Malley BW, Weinstein G, Chalian A, Malloy K, Atkins JH, Sollecito T, Greenberg M, McNulty S, Lin A, Zhu TC, Finlay JC, Cengel K, Livolsi V, Feldman M, Mick R, Busch TM. Toxicities and early outcomes in a phase 1 trial of photodynamic therapy for premalignant and early stage head and neck tumors. Oral Oncol 2016; 55:37-42. [PMID: 26865261 DOI: 10.1016/j.oraloncology.2016.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Management of early superficial lesions in the head and neck remains complex. We performed a phase 1 trial for high-grade premalignant and early superficial lesions of the head and neck using photodynamic therapy (PDT) with Levulan (ALA). MATERIALS AND METHODS Thirty-five subjects with high grade dysplasia, carcinoma in situ, or microinvasive (⩽1.5mm depth) squamous cell carcinoma were enrolled. Cohorts of 3-6 patients were given escalating intraoperative light doses of 50-200J/cm(2) 4-6h after oral administration of 60mg/kg ALA. Light at 629-635nm was delivered in a continuous (unfractionated) or fractionated (two-part) schema. RESULTS PDT was delivered to 30/35 subjects, with 29 evaluable. There was one death possibly due to the treatment. The regimen was otherwise tolerable, with a 52% rate of grade 3 mucositis which healed within several weeks. Other toxicities were generally grade 1 or 2, including odynophagia (one grade 4), voice alteration (one grade 3), and photosensitivity reactions. One patient developed grade 5 sepsis. With a median follow-up of 42months, 10 patients (34%) developed local recurrence; 4 of these received 50J/cm(2) and two each received 100, 150, and 200J/cm(2). Ten (34%) patients developed recurrence adjacent to the treated field. There was a 69% complete response rate at 3months. CONCLUSIONS ALA-PDT is well tolerated. Maximum Tolerated Dose appears to be higher than the highest dose used in this study. Longer followup is required to analyze effect of light dose on local recurrence. High marginal recurrence rates suggest use of larger treatment fields.
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Affiliation(s)
- Peter H Ahn
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
| | - Harry Quon
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States; Department of Radiation Oncology, Johns Hopkins University, 401 N. Broadway, Baltimore, MA 21231, United States
| | - Bert W O'Malley
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Gregory Weinstein
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Ara Chalian
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Kelly Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States; Department of Otolaryngology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, United States
| | - Joshua H Atkins
- Department of Anesthesiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Martin Greenberg
- Department of Oral Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Sally McNulty
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Keith Cengel
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Virginia Livolsi
- Department of Pathology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Michael Feldman
- Department of Pathology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Rosemarie Mick
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
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Photodynamic therapy in dentistry: a literature review. Clin Oral Investig 2012; 17:1113-25. [DOI: 10.1007/s00784-012-0845-7] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 09/17/2012] [Indexed: 01/25/2023]
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Liu W, Zhou A, Feng F, Zhang H, Zhou J, Huang W. Qualitative and quantitative studies on impurities in G004, a potential hypoglycaemic agent, using liquid chromatography, nuclear magnetic resonance and mass spectrometry. J Pharm Biomed Anal 2011; 56:627-32. [DOI: 10.1016/j.jpba.2011.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/20/2011] [Accepted: 06/21/2011] [Indexed: 10/18/2022]
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Abstract
Over 1,500 patients have been treated with PDT using Photofrin, HPD, ALA, or Foscan for head and neck cancers. These patients include a mixture of presentations including primary, recurrent, and metastatic lesions. The predominant histology is squamous cell carcinoma, but other histologies treated include mucosal melanoma, Kaposi's sarcoma, adenocarcinoma, metastatic breast carcinoma, and adenoid cystic carcinoma. Several multi-institutional phase II clinical trials evaluating PDT treatment of head and neck cancers have demonstrated the efficacy of this minimally invasive therapy in the treatment of early oropharyngeal primary and recurrent cancers as well as the palliative treatment of refractory head and neck cancers. Patients with early stage cancers or early recurrences in the oral cavity and larynx (Cis, T1, T2) tend to have an excellent response to PDT. Of 518 patients treated with Cis, T1, or T2 cancers of the oral cavity, larynx, pharynx, and nasopharynx, 462 (89.1%) obtained a complete clinical response after one PDT treatment. Laryngeal cancers, comprising 171 patients in this group, obtained a durable complete response rate of 89% with up to a 16-year follow-up. Photodynamic therapy is as effective as conventional therapies for the treatment of early (Cis, T1, T2) squamous cell cancers of the head and neck. It is also a promising therapy to be used in association with surgery to increase tumor-free margins and therefore increase cure rates.
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Nyst HJ, Tan IB, Stewart FA, Balm AJ. Is photodynamic therapy a good alternative to surgery and radiotherapy in the treatment of head and neck cancer? Photodiagnosis Photodyn Ther 2009; 6:3-11. [DOI: 10.1016/j.pdpdt.2009.03.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 03/13/2009] [Accepted: 03/16/2009] [Indexed: 02/03/2023]
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Abstract
Photodynamic therapy (PDT) is a nonsurgical, minimally invasive treatment that uses a light source to activate light-sensitive drugs or photosensitizers in the treatment of cancer and other diseases. PDT has been successfully employed to treat early carcinomas of the oral cavity and larynx preserving normal tissue and vital functions of speech and swallowing. Two hundred seventy-six patients with early carcinomas of the oral cavity and larynx were treated from 1990 to 2006. Cure rates with a single treatment for early laryngeal and oral cancers were 91% and 94%, respectively. PDT is an effective primary and alternative treatment modality for early oral cavity and laryngeal cancers.
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Affiliation(s)
- Merrill A Biel
- Ear, Nose and Throat Specialty Care of Minnesota, Minneapolis, MN, USA.
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Abstract
Photodynamic therapy (PDT) is an FDA-approved minimally invasive medical treatment modality that utilizes light in the presence of oxygen to activate photosensitizing agents that are relatively selectively concentrated in abnormal or neoplastic cells resulting in cell death. At the present time, PDT has been approved for clinical treatment in the United States, European Union, Canada, Russia, and Japan. In the United States, US Food and Drug administration approval has been given for the use of PDT in the treatment of Barrett's esophagus, obstructing esophageal carcinoma and early and obstructing tracheobronchial carcinoma using the photosensitizer Photofrin; actinic keratosis using the photosensitizer Levulan (aminolevulinic acid); and macular degeneration using the photosensitizer BPD. In the EU the above noted indications have also been approved in addition to the treatment of early head and neck cancers and palliative treatment of head and neck cancer using the photosensitizer Foscan; and treatment of basal and squamous cell skin cancers using the photosensitizer Metvix.
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Affiliation(s)
- M Biel
- Ear Nose and Throat Specialty Care of Minnesota, 2211 Park Ave, Minneapolis, Minnesota 55404, USA.
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Sadri M, McMahon J, Parker A. Management of laryngeal dysplasia: a review. Eur Arch Otorhinolaryngol 2006; 263:843-52. [PMID: 16823559 DOI: 10.1007/s00405-006-0078-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 05/04/2006] [Indexed: 10/24/2022]
Abstract
Laryngeal dysplasia is a common clinical concern. Despite major advancements in otolaryngology, a significant number of patients with the condition progress to invasive carcinoma. In the recent years, new diagnostic techniques such as autofluorescence and contact endoscopy have been applied to increase the accuracy of the laryngeal biopsies. Moreover, significant efforts have been made to correlate the histopathological appearance of the dysplastic samples to their clinical course. So far, a wide range of therapeutic strategies for different grades of dysplasia has been suggested by authors; however, there is a lack of outcome reviews. In the current review, the outcome of different therapeutic strategies for severe dysplasia and carcinoma in situ has been compared with statistical analysis. The paper also summarises the current knowledge of the alternative management methods as well as current areas of research in the chemoprevention of the condition. (1) Significant efforts have been made to develop new techniques to improve the accuracy of microlaryngoscopic assessment of laryngeal premalignancy. Comparative studies are required using microlaryngoscopy against the new techniques to evaluate their clinical utility. (2) The meta-analysis suggests a better local control rate with radiotherapy compared to other standard methods of management of dysplasia; however, functional impairment and complications associated with each of the standard treatments should be further evaluated.
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Affiliation(s)
- Maziar Sadri
- Head and Neck Centre, Royal Hallamshire Hospital, Sheffield, UK.
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Clinical photodynamic therapy of head and neck cancers-A review of applications and outcomes. Photodiagnosis Photodyn Ther 2005; 2:205-22. [PMID: 25048771 DOI: 10.1016/s1572-1000(05)00092-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 08/09/2005] [Accepted: 08/10/2005] [Indexed: 12/29/2022]
Abstract
As local control is tantamount to cure in head and neck cancer, an aggressive regimen of surgery and radiation remains the standard of care for most patients. Despite significant technical advances, these treatments are highly morbid. Further, patients who fail treatment have limited salvage options. Photodynamic therapy (PDT) and photodiagnosis (PD) of head and neck cancer offer significant potential for improved outcomes in a myriad of clinical indications ranging from in situ to recurrent disease. However, despite promising results, these modalities remain at the fringe of head and neck treatment options. Photofrin(®), Photosan and Foscan(®) are photosensitizers used clinically in head and neck PD/PDT. In addition, aminolevulinic acid (ALA), which gives origin to Protoporphyrin IX, an endogeneous photosensitizer, is also used for PD/PDT. We review the clinical literature on these photosensitizers to assist in the integration of these important modalities into the mainstream of head and neck oncological therapy.
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Bagnato V, Kurachi C, Ferreira J, Marcassa L, Sibata C, Allison R. PDT experience in Brazil: A regional profile. Photodiagnosis Photodyn Ther 2005; 2:107-18. [DOI: 10.1016/s1572-1000(05)00058-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 05/10/2005] [Accepted: 05/12/2005] [Indexed: 10/25/2022]
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Allison R, Mota H, Sibata C. Clinical PD/PDT in North America: An historical review. Photodiagnosis Photodyn Ther 2004; 1:263-77. [DOI: 10.1016/s1572-1000(04)00084-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 12/19/2004] [Indexed: 10/25/2022]
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Lou PJ, Jones L, Hopper C. Clinical outcomes of photodynamic therapy for head-and-neck cancer. Technol Cancer Res Treat 2003; 2:311-7. [PMID: 12892513 DOI: 10.1177/153303460300200405] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Head-and-neck cancers not only carry poor prognoses, but also reduced quality of life for the patients. Disease control is often achieved at the expense of substantial functional loss and disfigurement. Photodynamic therapy (PDT) is particularly well suited to the treatment of head-and-neck-tumors because it has little effect on underlying functional structures and has an excellent cosmetic outcome. Studies in the past decades have shown that PDT is of similar efficacy as traditional measures in the treatment of early-stage head-and-neck cancers with an overall response rate of 85%-100% with up to 75% of the complete responses sustained at 2 years after PDT. For advanced head-and-neck cancers, studies were also conducted to evaluate the palliative effects of PDT. Overall, 58%-70% palliative benefit can be observed in these patients. Using interstitial PDT, median survival of the patients with recurrent unresectable head-and-neck cancers can be improved to 14 months (cf. 226 days by using surface illumination PDT). PDT is thus a therapeutic option that may prove a useful addition to the armamentarium of the integrated head and neck oncology team.
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Affiliation(s)
- Pei-Jen Lou
- National Medical Laser Centre, Department of Surgery, University College London, London, United Kingdom
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Blant SA, Glanzmann TM, Ballini JP, Wagnières G, van den Bergh H, Monnier P. Uptake and localisation of mTHPC (Foscan) and its 14C-labelled form in normal and tumour tissues of the hamster squamous cell carcinoma model: a comparative study. Br J Cancer 2002; 87:1470-8. [PMID: 12454779 PMCID: PMC2376296 DOI: 10.1038/sj.bjc.6600651] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2002] [Revised: 09/02/2002] [Accepted: 09/16/2002] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate the pharmacokinetics of meta(tetrahydroxyphenyl)chlorin (mTHPC) on different tissues of interest in a hamster tumour model and to confirm our earlier animal studies on semi-quantitative fluorescence microscopy. The results obtained by three different evaluation methods were compared: in vivo spectrofluorometry, ex vivo fluorescence microscopy and chemical extraction of (14)C-labelled mTHPC. Following intracardiac injection of 0.5 mg kg(-1) mTHPC, groups of five tumour-bearing animals were used for in situ light-induced fluorescence spectroscopy. Afterwards, the biopsies were taken and snap frozen for fluorescence microscopy. The presence of radioactivity in serum and tissues was determined after chemical digestion in scintillation fluid using a scintillation counter. For each analysed tissue, a good correlation was observed between the three evaluation methods. The highest fluorescence intensity and quantities of mTHPC were observed between 12 and 24 h in liver, kidney, serum, vascular endothelium and advanced neoplasia. The majority of mTHPC was found at around 48 h in smooth muscle and at 96 h in healthy cheek pouch mucosa and early malignant lesions. The lowest level of mTHPC was noted in striated muscle at all times. No selectivity in dye localisation was observed between early squamous cell carcinoma and healthy mucosa. Soon after the injection, a significant selectivity was noted for advanced squamous cell carcinoma as compared to healthy cheek pouch mucosa or striated muscle. A significant difference in mTHPC localisation and quantity was also observed between striated and smooth muscle during the first 48 h following the injection. Finally, this study demonstrated the usefulness of non-invasive in situ spectroscopic measurements to be performed systematically prior to photodynamic therapy as a real-time monitoring for each treated patient in order to individualise and adapt the light dosimetry and avoid over or under treatments.
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Affiliation(s)
- S Andrejevic Blant
- Institute of Pathology, CHUV-Hospital, Bugnon 21, CH-1011 Lausanne, Switzerland.
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Affiliation(s)
- Ryan P Smith
- Radiation Oncology, The Hospital of the University of Pennsylvania, USA
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Abstract
Photodynamic therapy is a nonsurgical, minimally invasive technique that uses a light source to activate light-sensitive drugs or photosensitizers to treat cancer and other diseases. The effect on living organisms caused by light in the presence of a photosensitizer and oxygen is known as the photodynamic effect or photodynamic action.
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Affiliation(s)
- Merrill A Biel
- Ear, Nose and Throat Specialty Care of Minnestota, 2211 Park Avenue South, Minneapolis MN, 55404, USA.
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Andrejevic Blant S, Grosjean P, Ballini JP, Wagnières G, van den Bergh H, Fontolliet C, Monnier P. Localization of tetra(m-hydroxyphenyl)chlorin (Foscan) in human healthy tissues and squamous cell carcinomas of the upper aero-digestive tract, the esophagus and the bronchi: a fluorescence microscopy study. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2001; 61:1-9. [PMID: 11485842 DOI: 10.1016/s1011-1344(01)00148-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
To date, little is known about precise time-dependent distribution and histological localization of tetra(m-hydroxyphenyl)chlorin (mTHPC) in human healthy tissues and squamous cell malignancies in the upper aero-digestive tract. A fluorescence microscopy study was performed on 50 healthy tissue biopsies and on 13 tumors (graded from Tis to T1 SCC) from 30 patients. Tissue samples were taken between 4 h and 11 days following injection of 0.15 mg/kg mTHPC. A fairly comparable distribution pattern in various tissues was observed over time in different patients. Vascular localization of mTHPC fluorescence predominates at a short delay, whereas the dye is essentially located in the tumoral and healthy mucosa after longer delays. A much lower uptake and retention of mTHPC fluorescence was noted in striated muscle and cartilage as compared to neoplastic lesions. No significant selectivity was found between healthy and tumoral mucosa. The obtained data are important to confirm drug-light interval that have been selected for effective PDT for early SCC malignancies while minimizing the risks of over- or under-treatment. The low fluorescence level in striated muscle provides the opportunity to develop interstitial PDT as a treatment modality for invasive SCC of unfavorable locations in the oral cavity or pharynx, such as the base of the tongue.
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Affiliation(s)
- S Andrejevic Blant
- Institute of Pathology University of Lausanne, CH-1011 Lausanne, Switzerland.
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Allman R, Cowburn P, Mason M. Effect of photodynamic therapy in combination with ionizing radiation on human squamous cell carcinoma cell lines of the head and neck. Br J Cancer 2000; 83:655-61. [PMID: 10944608 PMCID: PMC2363519 DOI: 10.1054/bjoc.2000.1328] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Photodynamic therapy (PDT) is a promising treatment modality for head and neck, and other tumours, using drugs activated by light. A second generation drug, 5-aminolaevulinic acid (5-ALA), is a precursor of the active photosensitizer protoporphyrin IX (PpIX) and has fewer side-effects and much more transient phototoxicity than previous photosensitizers. We have investigated the effect of 5-ALA mediated PDT in combination with gamma-irradiation on the colony forming ability of several human head and neck tumour cell lines. The effect of treatments on the DNA cell cycle kinetics was also investigated. Our results indicate that the combination of 5-ALA mediated PDT and gamma-irradiation results in a level of cytotoxicity which is additive and not synergistic. 5-ALA mediated PDT had no discernible effect on DNA cell cycle distributions. gamma-irradiation-induced cell cycle arrest in G2 did not enhance the phototoxicity of 5-ALA.
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Affiliation(s)
- R Allman
- Research Department, Velindre Hospital, Whitchurch, Cardiff, CF14 2TL, Wales, UK
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21
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Belmont MJ, Marabelle N, Mang TS, Hall R, Wax MK. Effect of photodynamic therapy on revascularization of fasciocutaneous flaps. Laryngoscope 2000; 110:942-5. [PMID: 10852509 DOI: 10.1097/00005537-200006000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Photodynamic therapy (PDT) may be used as an adjuvant intraoperative treatment to improve locoregional control. PDT has been shown both to delay wound healing and to have a deleterious effect on flap survival after a primary ischemic insult. This delay in wound healing may make the flap dependent on its pedicled blood supply for a prolonged period. Long-term flap loss may be experienced. The effect of PDT on flap revascularization, with subsequent dependence on its vascular pedicle, is evaluated. STUDY DESIGN Randomized controlled trial using a rodent model. METHODS A rat fasciocutaneous flap was used. Study groups were as follows: group I received no treatment; group II received treatment with 630-nm light; groups IH and IV were given Photofrin (in group III, loupes without a fiberoptic light source were used for flap elevation, and in group IV, light source was employed); and group V was given Photofrin and 630-nm light. Primary ischemic times of 2 or 4 hours were used. Vascular pedicles were ligated on postoperative day (POD) 5, 6, or 7, and percentage of flap survival was evaluated 7 days later. RESULTS With 2 hours of ischemia, revascularization was decreased in the PDT group on POD 6 (P < .05) and on day 7 (P < .005) when compared with the other groups. With 4 hours of ischemia, revascularization was decreased in the PDT group on PODs 5 (P < .001), 6 (P < .01), and 7 (P < .005). CONCLUSION Intraoperative PDT decreases revascularization of a rat fasciocutaneous flap.
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Affiliation(s)
- M J Belmont
- Department of Otolaryngology--Head and Neck Surgery, University of Pennsylvania, Philadelphia 19104-4283, USA
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22
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Abstract
UNLABELLED The combination of light and chemicals to treat skin diseases is widely practiced in dermatology. Within this broad use of light and drugs, in recent years the concept of photodynamic therapy (PDT) has emerged. PDT is a promising modality for the management of various tumors and nonmalignant diseases, based on the combination of a photosensitizer that is selectively localized in the target tissue and illumination of the lesion with visible light, resulting in photodamage and subsequent cell death. Moreover, the fluorescence of photosensitizing compounds is also utilized as a helpful diagnostic tool for the detection of neoplastic tissue. Intensive basic and clinical research culminated in the worldwide approval of PDT for bladder, esophageal, and lung cancer. The expanding use of this relatively new therapeutic modality in dermatology at many centers around the world has revealed its efficacy for the treatment of cutaneous precancer and cancer, as well as selected benign skin disorders. The following article summarizes the main principles of PDT considering the most recent developments and provides a comprehensive synopsis of the present status of the use of PDT in dermatology. (J Am Acad Dermatol 2000;42:389-413.) LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be able to describe the basic concepts of PDT, including fundamental knowledge of the most relevant photosensitizers, the light sources, the mechanisms involved in PDT-mediated cell destruction, as well as the indications and limitations of photodynamic treatment of skin diseases.
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Affiliation(s)
- K Kalka
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
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Belmont MJ, Marabelle N, Mang TS, Wax MK. Effect of photodynamic therapy on the critical primary ischemic time of fasciocutaneous flaps. Laryngoscope 1999; 109:886-90. [PMID: 10369276 DOI: 10.1097/00005537-199906000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) may be used as an adjuvant intraoperative therapy to improve locoregional control. PDT has been shown to delay wound healing. This raises concern about PDTs effect on survival of fasciocutaneous flaps. OBJECTIVE Evaluate the effect of 1) PDT on the critical ischemic time in a rat fasciocutaneous flap model and 2) photosensitizer activation by the surgical light source. DESIGN A fasciocutaneous flap, based on the left inferior epigastric vessels, was used. Ischemic times of 2, 4, 6, 8, 10, and 12 hours were induced by clamping the vascular pedicle. Animals were randomly divided into five groups: ischemia only, group I; light treatment to wound bed, group II; Photofrin before surgery with the flap elevated without a fiber optic head light, group III, or with a headlight, group IV; Photofrin prior to surgery with light treatment to the wound bed, group V. Flap survival was assessed on postoperative day 7. RESULTS The critical primary ischemic time of group V (PDT) was significantly less (P < .05) than groups I, II, III, and IV. There was no statistical difference in the critical primary ischemic time when a fiber optic headlight was used (group III vs. group IV). CONCLUSION Intraoperative PDT significantly reduces the critical primary ischemic time of the rat fasciocutaneous flap. White light illumination of the operative field does not result in photosensitizer activation and has no effect on the critical primary ischemic time.
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Affiliation(s)
- M J Belmont
- Department of Otolaryngology-Head and Neck Surgery, State University of New York at Buffalo, USA
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24
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Photodynamic therapy in otolaryngology. Curr Opin Otolaryngol Head Neck Surg 1999. [DOI: 10.1097/00020840-199904000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To present the theory, technique, and results of photodynamic therapy for the treatment of oral, laryngeal, and head and neck cancers. STUDY DESIGN Retrospective review of the literature of more than 500 patients with head and neck cancer treated with photodynamic therapy, as well as a retrospective review of the author's 107 patients treated with photodynamic therapy for head and neck neoplasia between 1990 and 1997. METHODS The literature was retrospectively reviewed, as were patient records, and tabulated for age, sex, site, and staging of lesions, with special focus on post-photodynamic therapy treatment outcome, long-term disease-free survival, and complications. RESULTS Twenty-five patients with carcinoma in situ and T1 squamous cell carcinoma of the true vocal cord who underwent photodynamic therapy treatment for cure obtained a complete response after a single photodynamic therapy treatment. Only one patient has had recurrence to date, with a cure rate to 79-month follow-up of 95%. Twenty-nine patients with carcinoma in situ and T1 recurrent squamous cell carcinomas of the oral cavity and tongue were treated. All obtained a complete response after a single photodynamic therapy treatment; however, five patients developed local recurrence with follow-up to 70 months, for an 80% cure rate. A review of 217 patients with early squamous cell carcinomas of the head and neck treated with photodynamic therapy in the literature demonstrated an 89.5% complete response rate. The most common complication in these patients was limited prolonged skin photosensitivity without any permanent sequelae. CONCLUSIONS Photodynamic therapy is effective for treating carcinoma in situ and T1 squamous cell carcinoma of the larynx and oral cavity and may be of benefit as an adjuvant intraoperative treatment of stages III and IV tumors of the head and neck in conjunction with surgery and radiation therapy to improve cure rates. Further controlled studies need to be performed to further demonstrate the effectiveness of photodynamic therapy and the treatment of head and neck cancers.
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Affiliation(s)
- M A Biel
- Ear, Nose & Throat SpecialtyCare of Minnesota, Minneapolis 55404, USA
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26
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Andrejevic-Blant S, Woodtli A, Wagnieres G, Fontolliet C, van den Bergh H, Monnier P. Interstitial photodynamic therapy with tetra(m-hydroxyphenyl)chlorin: tumor versus striated muscle damage. Int J Radiat Oncol Biol Phys 1998; 42:403-12. [PMID: 9788423 DOI: 10.1016/s0360-3016(98)00221-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE The present study was initiated to determine the conditions under which a single photodynamic treatment would induce maximal damage to a tumor with no or at least minimal reversible damage to a normal striated muscle. METHODS AND MATERIALS The technique of interstitial light delivery was used after prior 0.5 mg/kg tetra(m-hydroxyphenyl)chlorin administration in a hamster model. After having estimated the threshold light doses required for minimal muscle damage, the same light doses were applied to squamous cell carcinomas to evaluate the efficiency of interstitial photodynamic therapy. Sixteen and 96 h after the injection, irradiation at 650 nm was performed on the thigh muscle of the left hind leg. The applied light doses ranged between 0.3-15 J and were delivered at an intensity of 44 mW per cm of diffuser length. RESULTS The threshold of muscle damage was obtained using light doses of 1.5-3 J at two drug-light intervals of 16 and 96 h, respectively. More than 85% of the tumor mass was destroyed when lesions were illuminated using these threshold conditions. In terms of immediate short-term tumor response, this means that for the given irradiation conditions, a relatively low threshold energy of only 1.5 or 3 J, depending on the drug-light interval, is sufficient to induce massive tumor destruction with minimal muscle damage. CONCLUSION These results have implications for evaluating interstitial PDT for squamous cell cancers in unfavorable localization in the oral cavity or pharynx, such as at the base of the tongue.
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Affiliation(s)
- S Andrejevic-Blant
- Department of Otolaryngology Head and Neck Surgery, CHUV Hospital, Lausanne, Switzerland.
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27
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Abstract
BACKGROUND AND OBJECTIVES Chest wall recurrence occurs in 5-20% of breast cancer patients. Until recently, the only treatments available were surgical resection or radiotherapy. Photodynamic therapy (PDT) is a new modality that uses a photosensitizer and light to destroy tumor cells selectively. We report here our experience with PDT as a treatment for chest wall recurrence. METHODS Seven patients with breast cancer who had chest wall recurrence despite previous therapy were treated with PDT. Four patients received one treatment, one received two treatments at the same site, one received two separate treatments at different sites, and one received three separate treatments at distinct sites. Response and adverse events were monitored. RESULTS The total response rate of 91% (10/11), with complete response (CR) in 73% (8/11) and partial response (PR) in 18% (2/11), was based on total number of treatments. The mean time to lesion healing was 73 days (range <30-99 days). One patient experienced a photosensitivity reaction after exposure to direct sunlight. No other adverse events were recorded. CONCLUSIONS PDT is an effective treatment for chest wall recurrence in patients with breast cancer in whom other treatments have failed. PDT is also well tolerated, especially when compared with traditional therapies.
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Affiliation(s)
- S W Taber
- Department of Surgery, University of Louisville, Kentucky 40202, USA.
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Viola A, Jeunet A, Decreau R, Chanon M, Julliard M. ESR studies of a series of phthalocyanines. Mechanism of phototoxicity. Comparative quantitation of O2-. using ESR spin-trapping and cytochrome c reduction techniques. Free Radic Res 1998; 28:517-32. [PMID: 9702532 DOI: 10.3109/10715769809066889] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ESR experiments with 2,2,6,6-tetramethyl-4-piperidone (4-oxo-TEMP) and the spin-trap 5,5-dimethyl pyrroline-N-oxide (DMPO) have been performed on a series of new phthalocyanines: the bis(tri-n-hexylsiloxy) silicon phthalocyanine ([(nhex)3SiO]2SiPc), the hexadecachloro zinc phthalocyanine (ZnPcCl16), the hexadecachloro aluminum phthalocyanine (AlPcCl16), the hexadecachloro aluminum phthalocyanine sulfate (HSO4AlPcCl16), whose photocytotoxicity has been studied against various leukemic and melanotic cell lines. Type I and Type II pathways occur simultaneously in DMF although the Type II seems to be prevalent. These results are not changed when the bis(tri-n-hexylsiloxy) silicon phthalocyanine is entrapped into liposomes. By contrast, the Type I process is favored in membrane models for all the perchlorinated phthalocyanines. This modified behavior may be accounted on a possible stacking of phthalocyanines in membranes and a preventing effect of axial ligands against aggregation in the case of the bis(tri-n-hexylsiloxy) silicon phthalocyanine. The photodynamic action of zinc perchlorinated phthalocyanine is not dependent on singlet oxygen, phototoxicity of this molecule being essentially mediated by oxygen free radicals. Quantitation of the superoxide radical was accomplished, with good agreement, by two techniques: the cytochrome c reduction and the ESR quantitation based on the double integration of the first derivative of the ESR signal. The disproportionation of the superoxide radical or degradation of the spin-trap seem to be avoided in aprotic solvents such as DMF.
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Affiliation(s)
- A Viola
- Laboratoire AM3-ESA 6009, Faculté des Sciences Saint-Jérôme, Marseille, France
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Viola A, Mannoni P, Chanon M, Julliard M, Mehta G, Maiya BG, Muthusamy S, Sambaiah T. Phototoxicity of some novel porphyrin hybrids against the human leukemic cell line TF-1. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 1997; 40:263-72. [PMID: 9372615 DOI: 10.1016/s1011-1344(97)00067-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Photodynamic induced cytotoxicity by porphyrin-DNA cross linker/intercalator hybrid diads and triads has been studied on the human leukemic cell line TF-1. Cells were incubated for 1 to 4 h with these new photosensitizers and irradiated with white light. Cell survival was assessed by the propidium iodide staining, using flow cytometry analysis. A comparison of the dark and light cell survival factor values suggests that irradiation has a significant effect on the toxicity at low concentrations for the porphyrin-chlorambucil diad and to a lesser extent at high concentrations for the porphyrin-acridone diad, the porphyrin-acridine diad and the porphyrin-cholic acid-chlorambucil triad. While the intrinsic antileukemic (via DNA cross-linking) activity of the chlorambucil moiety and the structural details may be responsible for the photoenhancement of the toxicity, the presence of acridine or acridone which are avid intercalators of DNA, is responsible for a similar effect seen for diads.
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Affiliation(s)
- A Viola
- Laboratoire AM3-ESA-CNRS 6009, Faculté des Sciences Saint-Jérôme, Marseille, France
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30
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Blant SA, Theumann JF, Forrer M, Wagnières G, Van Den Bergh H, Monnier P. Wavelength-dependent effect of tetra(m-hydroxyphenyl)chlorin for photodynamic therapy in an ‘early’ squamous cell carcinoma model. Lasers Med Sci 1997; 12:269-73. [DOI: 10.1007/bf02765108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/1996] [Accepted: 12/16/1996] [Indexed: 10/22/2022]
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31
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Andrejevic-Blant S, Hadjur C, Ballini JP, Wagnières G, Fontolliet C, van den Bergh H, Monnier P. Photodynamic therapy of early squamous cell carcinoma with tetra(m-hydroxyphenyl)chlorin: optimal drug-light interval. Br J Cancer 1997; 76:1021-8. [PMID: 9376261 PMCID: PMC2228103 DOI: 10.1038/bjc.1997.502] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The optimal drug-light interval for effective photodynamic therapy (PDT) of early squamous cell carcinomas was evaluated with tetra(m-hydroxyphenyl)chlorin (mTHPC) by means of two complementary modalities: irradiation tests and ex vivo fluorescence microscopy. A Syrian hamster cheek pouch tumour model was used in these experiments. Photodynamic therapy on both tumour-bearing and contralateral healthy cheek pouch mucosae was performed at 650 nm and 514 nm. Light doses of 12 J cm(-2) were delivered at a light dose rate of 150 mW cm(-2) and light doses of 80 J cm(-2) were delivered at a light dose rate of 100 mW cm(-2) respectively, at these two wavelengths, between 6 h and 12 days after the injection of 0.5 mg kg(-1) body weight mTHPC. Two histologically different types of tissue damage were observed: first, a non-selective and non-specific ischaemic vascular necrosis for the cases in which PDT took place during the first 48 h after the injection of the dye and, second, tissue-specific PDT damage, as a coagulation necrosis, when PDT took place more than 72 h after injection of the dye. The time-dependent biodistribution of mTHPC investigated by fluorescence microscopy shows a weak and non-significant difference in relative fluorescence intensities between early SCC and healthy mucosae. Up to 2 days after the injection, the drug is mainly localized in the endothelial cells of the blood vessels. After this period, the dye accumulates in the squamous epithelia with a concentration peaking at 4 days. At all time points, a weak fluorescence intensity is observed in the underlying lamina propria and striated muscle. The information obtained from these studies could well be relevant to clinical trials as it suggests that time delays between 4 and 8 days after i.v. injection should be optimal for PDT of early malignancies in hollow organs.
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Affiliation(s)
- S Andrejevic-Blant
- Department of Otolaryngology, Head and Neck Surgery-CHUV Hospital, Lausanne, Switzerland
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32
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Biel MA. Photodynamic therapy and the treatment of head and neck cancers. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1996; 14:239-44. [PMID: 9612189 DOI: 10.1089/clm.1996.14.239] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Photodynamic therapy is an effective curative treatment for early carcinomas of the head and neck and may be of benefit as an adjuvant intraoperative therapy to increase cure rates of large head and neck tumors. Eighty-seven patients with neoplastic diseases of the larynx, oral cavity, pharynx, and skin have been treated with photodynamic therapy (PDT) with follow-up to 66 months. Patients with carcinoma-in-situ and T1 carcinomas obtained a complete response after one PDT treatment. All but two have remained free of disease. Ten patients with massive neck recurrences of squamous cell carcinomas were treated with intraoperative adjuvant PDT following tumor resection. Only three developed recurrence with 40-month follow-up, but only one recurrence was in the field of surgery and PDT.
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Affiliation(s)
- M A Biel
- Photodynamic Therapy, Minneapolis Ear, Nose and Throat Clinic, Minnesota, USA
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Grosjean P, Savary JF, Mizeret J, Wagnieres G, Woodtli A, Theumann JF, Fontolliet C, Van den Bergh H, Monnier P. Photodynamic therapy for cancer of the upper aerodigestive tract using tetra(m-hydroxyphenyl)chlorin. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1996; 14:281-7. [PMID: 9612194 DOI: 10.1089/clm.1996.14.281] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A major step in the development of photodynamic therapy (PDT) is the clinical optimization and evaluation of new photosensitizers (PS). Ideally, new compounds should be more effective and/or induce fewer side effects than the first generation PS such as hematoporphyrin derivative and Photofrin. We report the results of our study of PDT applied in the human upper aerodigestive tract, using tetra(m-hydroxyphenyl)chlorin (mTHPC) as the photosensitizing drug. Twenty-seven patients with early (i.e., in situ or microinvasive) squamous cell carcinomas and 4 patients with T1 or T2 cancers were studied. In most cases, illumination of the tumor was performed 4 days after i.v. injection of 0.15 mg/kg of mTHPC using 652 or 514 nm laser light. Of the 36 early tumors evaluated 30 (83%) showed no recurrence after a mean disease-free follow-up of 15.3 months (3-35 months). Of the T1 and T2 cancers, only one achieved a complete response. Major complications, all following red light illuminations, included 1 bronchial stenosis, 1 esophagotracheal fistula, and 2 probable occult perforations of the esophagus. PDT in the esophagus with green light renders such perforations essentially impossible, without, however, reducing the efficacy of the treatment. Skin photosensitization, never observed later than the first week after injection, was seen in 12 patients. In conclusion, photodynamic therapy with mTHPC is a safe and effective technique for the treatment of early carcinomas of the upper aerodigestive tract. Its efficacy is much lower for more advanced cancers.
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Affiliation(s)
- P Grosjean
- Department of Otolaryngology, Head and Neck Surgery, CHUV Hospital, Lausanne, Switzerland
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Nauta JM, Van Leengoed HLLM, Witjes MJH, Roodenburg JLN, Nikkels PGJ, Thomsen SL, Marijnissen JPA, Star WM. Photofrin-mediated photodynamic therapy of rat palatal mucosa: Normal tissue effects and light dosimetry. Lasers Med Sci 1996. [DOI: 10.1007/bf02156758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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