1
|
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] [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.
Collapse
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.
| |
Collapse
|
2
|
Liu W, Zhang X, Shen X, Liu L. Evaluating photodynamic therapy for oral precancerous lesions: Highlighting outcome measure of malignant transformation. J Dent Sci 2024; 19:631-636. [PMID: 38303828 PMCID: PMC10829732 DOI: 10.1016/j.jds.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/12/2023] [Indexed: 02/03/2024] Open
Abstract
The main outcome measure assessed in previous studies on photodynamic therapy (PDT) for oral precancerous lesions (OPL) is clinical response based on the alteration in lesion size after treatment. However, the primary and secondary outcome measures of the interventions for OPL should be malignant transformation and recurrence. Thus, the objective of this short communication is to summarize the evidence on PDT in preventing the recurrence and malignant transformation of OPL. There were 16 eligible studies which addressed the issue of OPL patients who received PDT with recurrence outcome, and the pooled recurrence rate (95% confidence interval) was analyzed to be 20.1% (16.2-24.6%). Notably, only 1 study reported that 7.5% of malignant transformation rate for OPL received PDT. These should be interpreted with caution due to low-level evidence, such as differences in study design, clinical and pathological features of patients enrolled, limited sample size, short follow-up time. Given few evaluated the effect of PDT on malignant transformation, we highlight that this primary outcome measure of OPL needs to be investigated in further well-designed longitudinal studies with adequate follow-up periods.
Collapse
Affiliation(s)
- Wei Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Fengcheng Hospital of Fengxian District, Shanghai Ninth People’s Hospital Fengcheng Branch Hospital, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochen Zhang
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuemin Shen
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral Mucosal Diseases, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Liu
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Ibarra AMC, Aguiar EMG, Ferreira CBR, Siqueira JM, Corrêa L, Nunes FD, Franco ALDS, Cecatto RB, Hamblin MR, Rodrigues MFSD. Photodynamic therapy in cancer stem cells - state of the art. Lasers Med Sci 2023; 38:251. [PMID: 37919479 DOI: 10.1007/s10103-023-03911-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
Despite significant efforts to control cancer progression and to improve oncology treatment outcomes, recurrence and tumor resistance are frequently observed in cancer patients. These problems are partly related to the presence of cancer stem cells (CSCs). Photodynamic therapy (PDT) has been developed as a therapeutic approach for solid tumors; however, it remains unclear how this therapy can affect CSCs. In this review, we focus on the effects of PDT on CSCs and the possible changes in the CSC population after PDT exposure. Tumor response to PDT varies according to the photosensitizer and light parameters employed, but most studies have reported the successful elimination of CSCs after PDT. However, some studies have reported that CSCs were more resistant to PDT than non-CSCs due to the increased efflux of photosensitizer molecules and the action of autophagy. Additionally, using different PDT approaches to target the CSCs resulted in increased sensitivity, reduction of sphere formation, invasiveness, stem cell phenotype, and improved response to chemotherapy. Lastly, although mainly limited to in vitro studies, PDT, combined with targeted therapies and/or chemotherapy, could successfully target CSCs in different solid tumors and promote the reduction of stemness, suggesting a promising therapeutic approach requiring evaluation in robust pre-clinical studies.
Collapse
Affiliation(s)
- Ana Melissa C Ibarra
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University - UNINOVE, São Paulo, Brazil
| | | | - Cássia B R Ferreira
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University - UNINOVE, São Paulo, Brazil
| | | | - Luciana Corrêa
- School of Dentistry, University of São Paulo - FOUSP, São Paulo, Brazil
| | - Fabio D Nunes
- School of Dentistry, University of São Paulo - FOUSP, São Paulo, Brazil
| | | | - Rebeca B Cecatto
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University - UNINOVE, São Paulo, Brazil
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
| | - Maria Fernanda S D Rodrigues
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University - UNINOVE, São Paulo, Brazil.
| |
Collapse
|
4
|
Pavlíčková VS, Škubník J, Ruml T, Rimpelová S. A Trojan horse approach for efficient drug delivery in photodynamic therapy: focus on taxanes. J Mater Chem B 2023; 11:8622-8638. [PMID: 37615658 DOI: 10.1039/d2tb02147a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Photodynamic therapy is an effective method for the treatment of several types of cancerous and noncancerous diseases. The key to the success of this treatment method is effective drug delivery to the site of action, for instance, a tumor. This ensures not only the high effectiveness of the therapy but also the suppression of side effects. But how to achieve effective targeted delivery? Lately, much attention has been paid to systems based on the so-called Trojan horse model, which is gaining increasing popularity. The principle of this model is that the effective drug is hidden in the internal structure of a nanoparticle, liposome, or nanoemulsion and is released only at the site of action. In this review article, we focus on drugs from the group of mitotic poisons, taxanes, and their use with photosensitizers in combined therapy. Here, we discuss the possibilities of how to improve the paclitaxel and docetaxel bioavailability, as well as their specific targeting for use in combined photo- and chemotherapy. Moreover, we also present the state of the art multifunctional drugs based on cabazitaxel which, owing to a suitable combination with photosensitizers, can be used besides photodynamic therapy and also in photoacoustic imaging or sonodynamic therapy.
Collapse
Affiliation(s)
- Vladimíra Svobodová Pavlíčková
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Technická 3, 166 28 Prague 6, Czech Republic.
| | - Jan Škubník
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Technická 3, 166 28 Prague 6, Czech Republic.
| | - Tomáš Ruml
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Technická 3, 166 28 Prague 6, Czech Republic.
| | - Silvie Rimpelová
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Technická 3, 166 28 Prague 6, Czech Republic.
| |
Collapse
|
5
|
Domka W, Bartusik-Aebisher D, Mytych W, Dynarowicz K, Aebisher D. The Use of Photodynamic Therapy for Head, Neck, and Brain Diseases. Int J Mol Sci 2023; 24:11867. [PMID: 37511625 PMCID: PMC10380422 DOI: 10.3390/ijms241411867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/16/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
Head-neck cancers as a group have the 7th highest rate of incidence worldwide. The most often diagnosed disease of the head and neck is squamous cell carcinoma (90% of cases). Another specific group of tumors is brain tumors. These can be divided into primary tumors and secondary tumors associated with metastasis. Research shows that treating head and neck cancers continues to be problematic and challenging, and researchers are actively seeking new treatments that would improve survival rates and reduce side effects. Irradiation of tumor tissue with the optimal wavelength of light in photodynamic therapy (PDT) generates predominantly singlet oxygen in tissue-based photosensitizers (PSs) or reactive oxygen radicals in the case of vascular PSs leading to cellular apoptosis and necrosis. A very important feature of PDT is that cells cannot become immune to the effects of singlet oxygen or reactive oxygen radicals. However, photosensitizer (PS) transport is influenced by the specific structures of cancer tumors and the concentration of PS decreases in cells far from the vessel lumen. Therefore, PSs may not reach tumor interiors, which decreases therapy effectiveness. The use of drug carriers and 3rd generation PSs that contain biocompatible functional groups makes it possible to control transport. This review of the current literature on PDT was conducted through databases such as PubMed and Scopus. The types of publications considered included clinical studies and most of the articles included were published in English. Based on the publications collected, we conclude that researchers have demonstrated the potential of PDT as a therapeutic platform for head, neck, and brain diseases.
Collapse
Affiliation(s)
- Wojciech Domka
- Department of Otolaryngology, Medical College of The University of Rzeszów, 35-959 Rzeszów, Poland
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland
| | - Wiktoria Mytych
- Students English Division Science Club, Medical College of The University of Rzeszów, 35-959 Rzeszów, Poland
| | - Klaudia Dynarowicz
- Center for Innovative Research in Medical and Natural Sciences, Medical College of The University of Rzeszów, 35-310 Rzeszów, Poland
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland
| |
Collapse
|
6
|
Mosaddad SA, Namanloo RA, Aghili SS, Maskani P, Alam M, Abbasi K, Nouri F, Tahmasebi E, Yazdanian M, Tebyaniyan H. Photodynamic therapy in oral cancer: a review of clinical studies. Med Oncol 2023; 40:91. [PMID: 36749489 DOI: 10.1007/s12032-023-01949-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/08/2023] [Indexed: 02/08/2023]
Abstract
A significant mortality rate is associated with oral cancer, particularly in cases of late-stage diagnosis. Since the last decades, oral cancer survival rates have only gradually improved despite advances in treatment. This poor success rate is mainly due to the development of secondary tumors, local recurrence, and regional failure. Invasive treatments frequently have a negative impact on the aesthetic and functional outcomes of survivors. Novel approaches are thus needed to manage this deadly disease in light of these statistics. In photodynamic therapy (PDT), a light-sensitive medication called a photosensitizer is given first, followed by exposure to light of the proper wavelength that matches the absorbance band of the photosensitizer. The tissue oxygen-induced cytotoxic free radicals kill tumor cells directly, harm the microvascular structure, and cause inflammatory reactions at the targeted sites. In the case of early lesions, PDT can be used as a stand-alone therapy, and in the case of advanced lesions, it can be used as adjuvant therapy. The current review article discussed the uses of PDT in oral cancer therapy based on recent advances in this field.
Collapse
Affiliation(s)
- Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyedeh Sara Aghili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Poorya Maskani
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Alam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Abbasi
- Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Nouri
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Elahe Tahmasebi
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohsen Yazdanian
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Hamid Tebyaniyan
- Department of Science and Research, Islimic Azade University, Tehran, Iran.
| |
Collapse
|
7
|
Long-term effect of photodynamic therapy on oral squamous cell carcinoma and epithelial dysplasia. Photodiagnosis Photodyn Ther 2022; 41:103246. [PMID: 36535598 DOI: 10.1016/j.pdpdt.2022.103246] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) treatment consists mainly of surgery, chemotherapy, and radiotherapy, alone or in combination. Epithelial dysplasia (ED) is also treated with surgery. However, these treatments can induce functional and/or aesthetic disturbances. Photodynamic therapy (PDT) can preserve organs. Although short-term studies have shown good progress, long-term evaluations have not yet been conducted. This study aimed to clarify the long-term effects of PDT on OSCC and ED. METHODS Patients who underwent PDT with the first (porfimer sodium) or second generation photosensitizers (talaporfin sodium) for early OSCC (T1 and T2) and ED were included in this study. The long-term prognosis was assessed. RESULTS Twenty-three patients were included. Complete response (CR) was observed in 19 patients (82.6%) and partial response (PR) in 4 patients (17.4%) 4 weeks after PDT. Regarding long-term progress, local region recurrence occurred in 11 of 19 CR cases (57.9%), and the term of recurrence was 27.4 ± 30.4 months. Surgical resection was performed in all local recurrence and PR cases, and 3 patients died of the underlying disease. CONCLUSIONS PDT provides a good outcome in the short term, but its long-term effects are limited.
Collapse
|
8
|
Carigga Gutierrez NM, Pujol-Solé N, Arifi Q, Coll JL, le Clainche T, Broekgaarden M. Increasing cancer permeability by photodynamic priming: from microenvironment to mechanotransduction signaling. Cancer Metastasis Rev 2022; 41:899-934. [PMID: 36155874 DOI: 10.1007/s10555-022-10064-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
The dense cancer microenvironment is a significant barrier that limits the penetration of anticancer agents, thereby restraining the efficacy of molecular and nanoscale cancer therapeutics. Developing new strategies to enhance the permeability of cancer tissues is of major interest to overcome treatment resistance. Nonetheless, early strategies based on small molecule inhibitors or matrix-degrading enzymes have led to disappointing clinical outcomes by causing increased chemotherapy toxicity and promoting disease progression. In recent years, photodynamic therapy (PDT) has emerged as a novel approach to increase the permeability of cancer tissues. By producing excessive amounts of reactive oxygen species selectively in the cancer microenvironment, PDT increases the accumulation, penetration depth, and efficacy of chemotherapeutics. Importantly, the increased cancer permeability has not been associated to increased metastasis formation. In this review, we provide novel insights into the mechanisms by which this effect, called photodynamic priming, can increase cancer permeability without promoting cell migration and dissemination. This review demonstrates that PDT oxidizes and degrades extracellular matrix proteins, reduces the capacity of cancer cells to adhere to the altered matrix, and interferes with mechanotransduction pathways that promote cancer cell migration and differentiation. Significant knowledge gaps are identified regarding the involvement of critical signaling pathways, and to which extent these events are influenced by the complicated PDT dosimetry. Addressing these knowledge gaps will be vital to further develop PDT as an adjuvant approach to improve cancer permeability, demonstrate the safety and efficacy of this priming approach, and render more cancer patients eligible to receive life-extending treatments.
Collapse
Affiliation(s)
| | - Núria Pujol-Solé
- Université Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, 38000, Grenoble, France
| | - Qendresa Arifi
- Université Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, 38000, Grenoble, France
| | - Jean-Luc Coll
- Université Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, 38000, Grenoble, France
| | - Tristan le Clainche
- Université Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, 38000, Grenoble, France.
| | - Mans Broekgaarden
- Université Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, 38000, Grenoble, France.
| |
Collapse
|
9
|
Binnal DA, Tadakamadla DJ, Rajesh DG, Tadakamadla DSK. Photodynamic therapy for oral potentially malignant disorders: A Systematic Review and Meta-analysis. Photodiagnosis Photodyn Ther 2022; 37:102713. [PMID: 34999271 DOI: 10.1016/j.pdpdt.2022.102713] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of Photodynamic Therapy (PDT) in the treatment of Oral Potentially Malignant Disorders (OPMDs) patients. METHODOLOGY An electronic search was conducted to retrieve articles published until September 2021. Meta-analyses were conducted for the outcomes of complete response (CR) and any response (AR) after treatment with PDT using data from single-arm studies, case series and non-randomised controlled trials (NRCTs). RESULTS In total, 49 articles were included. RCTs revealed insignificant mean difference (MD) in efficacy index between PDT and comparison groups (MD: 1.32; 95% CI:-28.10-30.72, p=0.930). The likelihood of CR (OR:0.84; 95% CI: 0.42-1.71, p=0.637) or AR (OR:2.10; 95% CI: 0.31-14.25, p=0.448) was not different in PDT group when compared with any comparison treatments in NRCTs. CR/AR among single arm studies was 60.6% (95% CI: 50.5-70.7, P<0.001) and 93.7% (95% CI:91.5-95.8, P<0.001) respectively. Higher prevalence of CR and AR was observed for dysplasia or carcinoma insitu (CIS) (CR: 81%, 95% CI: 70.8-91.3, P<0.001; AR: 94.3%; 95% CI: 89-99.6, P<0.001) and actinic cheilitis (AC) (CR: 73.9%, 95% CI: 65.9-81.9, P<0.001; AR:97%; 95% CI:94.9-99, P<0.001). CONCLUSIONS More than half of the patients receiving PDT showed CR, with more than 90% responding to the treatment. PDT was most effective on oral dysplasias, followed by AC.
Collapse
Affiliation(s)
- Dr Almas Binnal
- Associate Professor, Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore - 575001, Manipal Academy of Higher Education, Manipal, Karnataka, India-576104.
| | | | - Dr Gururaghavendran Rajesh
- Professor and Head, Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore - 575001, Manipal Academy of Higher Education, Manipal, Karnataka, India-576104.
| | - Dr Santosh Kumar Tadakamadla
- Senior Research Fellow, National Health and Medical Research Council Early Career Fellow, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Australia.
| |
Collapse
|
10
|
Photodynamic therapy for squamous cell carcinoma of the head and neck: narrative review focusing on photosensitizers. Lasers Med Sci 2021; 37:1441-1470. [PMID: 34855034 DOI: 10.1007/s10103-021-03462-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
This narrative review aimed to evaluate the effectiveness of PDT in early or advanced squamous cell carcinoma of the head and neck (SCCHN). Scopus, MEDLINE/PubMed, and Embase were searched electronically following the PRISMA protocol. Quality assessment was performed according to JBI, NIH, and AMSTAR protocols. The main outcomes evaluated were treatment response, recurrence, survival, and adverse effects. A total of 49 articles met the search criteria: 43 case series, two cohort studies, two prospective before-after clinical trials, one systematic review, and one meta-analysis. Data from 2121 SCCHN patients were included. The response to PDT was variable according to the type of photosensitizer, tumor location, and tumor stage. In general, higher complete responses rated were observed in T1/T2 SCCHN, mainly with mTHPC-mediated PDT. With regard to T3/T4 or advanced SCCHN tumors, there is no compelling evidence suggesting the effectiveness of PDT. Any adverse effects reported were well tolerated by patients. The present review suggests that PDT is a promising treatment modality for early-stage SCCHN. Although there are limitations due to the low level of evidence of the included studies, we believe that the present review could help to design robust clinical trials to determine the efficacy of PDT in SCCHN.
Collapse
|
11
|
From Basic Mechanisms to Clinical Research: Photodynamic Therapy Applications in Head and Neck Malignancies and Vascular Anomalies. J Clin Med 2021; 10:jcm10194404. [PMID: 34640423 PMCID: PMC8509369 DOI: 10.3390/jcm10194404] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023] Open
Abstract
Head and neck cancers are largely squamous cell carcinomas derived from the epithelial lining of the structures in the region, and are often classified anatomically into oral, oropharyngeal, nasopharyngeal and laryngeal carcinomas. The region’s component structures serve complex and intricate functions, such as speaking, swallowing and breathing, which are often compromised by these neoplasms. Such lesions may also cause disfigurement, leading to distressing social and psychological issues. Conventional treatments of these neoplasms usually involve surgical intervention with or without chemoradiotherapy. These have shown to be efficacious; however, they can also cause damage to healthy as well as diseased tissue, exacerbating the aforementioned problems. Access to a given region to deliver the treatments is also often a problem, due to the complex anatomical structures involved. The use of photodynamic therapy in the head and neck region has been established for about two decades. In this review, we looked at the basic mechanisms of this intervention, examined its use in common head and neck malignancies and vascular anomalies, and reported on the most recent clinical studies. We further included a clinical guide which can help replicate the use of this technology by any unit. Based on this review, photodynamic therapy has been shown to be efficacious in the treatment of head and neck malignancies and vascular tumours. This therapy can be targeted to the diseased tissue and causes no damage to underlying structures. Recent studies have shown this therapy to be as effective as conventional therapies, without causing major adverse effects.
Collapse
|
12
|
Photodynamic Therapy for Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF PHOTOENERGY 2021. [DOI: 10.1155/2021/6641358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To assess the efficacy of photodynamic therapy (PDT) for oral squamous cell carcinoma (OSCC), literature on this topic from Embase, PubMed, and Web of Science were obtained and analyzed. The response and recurrence rates with 95% confidence intervals (CI) were calculated using the DerSimonia–Laird method. The pooled complete response (CR) rate from the included studies was 0.799 (95% CI: 0.708–0.867), while the overall response (OR) rate was 0.967 (95% CI: 0.902–0.989). The recurrence rate (RR) was 0.158 (95% CI: 0.090–0.264). A subgroup analysis of lesion site, photosensitizer, laser type, radiant exposure, and power density revealed no statistically significant differences. In general, PDT is effective for the treatment of early OSCC. Investigations on the influence of PDT on the survival of OSCC patients, optimization of the treatment regimen, and evaluation of response after treatment are still needed.
Collapse
|
13
|
Light stimulus responsive nanomedicine in the treatment of oral squamous cell carcinoma. Eur J Med Chem 2020; 199:112394. [DOI: 10.1016/j.ejmech.2020.112394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 12/13/2022]
|
14
|
Demir Duman F, Sebek M, Thanh NTK, Loizidou M, Shakib K, MacRobert AJ. Enhanced photodynamic therapy and fluorescence imaging using gold nanorods for porphyrin delivery in a novel in vitro squamous cell carcinoma 3D model. J Mater Chem B 2020; 8:5131-5142. [PMID: 32420578 DOI: 10.1039/d0tb00810a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nanocomposites of gold nanorods (Au NRs) with the cationic porphyrin TMPyP (5,10,15,20-tetrakis(1- methyl 4-pyridinio)porphyrin tetra(p-toluenesulfonate)) were investigated as a nanocarrier system for photodynamic therapy (PDT) and fluorescence imaging. To confer biocompatibility and facilitate the cellular uptake, the NRs were encapsulated with polyacrylic acid (PAA) and efficiently loaded with the cationic porphyrin by electrostatic interaction. The nanocomposites were tested with and without light exposure following incubation in 2D monolayer cultures and a 3D compressed collagen construct of head and neck squamous cell carcinoma (HNSCC). The results showed that Au NRs enhance the absorption and emission intensity of TMPyP and improve its photodynamic efficiency and fluorescence imaging capability in both 2D cultures and 3D cancer constructs. Au NRs are promising theranostic agents for delivery of photosensitisers for HNSCC treatment and imaging.
Collapse
Affiliation(s)
- Fatma Demir Duman
- Division of Surgery and Interventional Science, Centre for Nanomedicine and Surgical Theranostics, University College London, Royal Free Campus, Rowland Hill St, London, NW3 2PE, UK.
| | | | | | | | | | | |
Collapse
|
15
|
Peng W, de Bruijn HS, ten Hagen TLM, van Dam GM, Roodenburg JLN, Berg K, Witjes MJH, Robinson DJ. Targeted Photodynamic Therapy of Human Head and Neck Squamous Cell Carcinoma with Anti-epidermal Growth Factor Receptor Antibody Cetuximab and Photosensitizer IR700DX in the Mouse Skin-fold Window Chamber Model. Photochem Photobiol 2020; 96:708-717. [PMID: 32222965 PMCID: PMC7383977 DOI: 10.1111/php.13267] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/13/2020] [Indexed: 01/09/2023]
Abstract
Targeted photodynamic therapy (PDT) in head/neck cancer patients with a conjugate of the anti-epidermal growth factor receptor (EGFR) antibody, Cetuximab and a phthalocyanine photosensitizer IR700DX is under way, but the exact mechanisms of action are still not fully understood. In this study, the EGFR-overexpressing human head/neck OSC-19-luc2-cGFP tumor with transfected GFP gene was used in a skin-fold window chamber model in BALB/c nude mice. The uptake and localization of the conjugate in the tumor and its surrounding normal tissues were studied by an intravital confocal laser scanning microscopy with image analyses. The tumor was also irradiated with 690 nm laser light 24 h after conjugate administration. The vascular and tumor responses were examined by morphological evaluation and immunohistochemistry (IHC). The amount of conjugate in the tumor peaked at 24-48 h after injection. Image analyses of colocalization correlation parameters demonstrated a high fraction of the conjugate IR700DX colocalized in the GFP-expressing tumor cells. PDT-treated tumors showed extensive necrotic/apoptotic destruction with little vascular damage, while IHC showed no HIF-1α expression and decreased EGFR and Ki67 expression with activated caspase-3 overexpression, indicating a direct killing of tumor cells through both necrotic and apoptotic cell death.
Collapse
Affiliation(s)
- Wei Peng
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
- Centre for Optical Diagnostics and TherapyDepartment of Otorhinolaryngology and Head & Neck SurgeryErasmus University Medical Center RotterdamRotterdamThe Netherlands
- Department of Radiation BiologyInstitute for Cancer ResearchNorwegian Radium HospitalOslo University HospitalOsloNorway
| | - Henriette S. de Bruijn
- Centre for Optical Diagnostics and TherapyDepartment of Otorhinolaryngology and Head & Neck SurgeryErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Timo L. M. ten Hagen
- Laboratory of Experimental Oncology Department of PathologyErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Go M. van Dam
- Department of SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Jan L. N. Roodenburg
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Kristian Berg
- Department of Radiation BiologyInstitute for Cancer ResearchNorwegian Radium HospitalOslo University HospitalOsloNorway
| | - Max J. H. Witjes
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Dominic J. Robinson
- Centre for Optical Diagnostics and TherapyDepartment of Otorhinolaryngology and Head & Neck SurgeryErasmus University Medical Center RotterdamRotterdamThe Netherlands
| |
Collapse
|
16
|
Kim MM, Darafsheh A. Light Sources and Dosimetry Techniques for Photodynamic Therapy. Photochem Photobiol 2020; 96:280-294. [PMID: 32003006 DOI: 10.1111/php.13219] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/29/2019] [Indexed: 12/19/2022]
Abstract
Effective treatment delivery in photodynamic therapy (PDT) requires coordination of the light source, the photosensitizer, and the delivery device appropriate to the target tissue. Lasers, light-emitting diodes (LEDs), and lamps are the main types of light sources utilized for PDT applications. The choice of light source depends on the target location, photosensitizer used, and light dose to be delivered. Geometry of minimally accessible areas also plays a role in deciding light applicator type. Typically, optical fiber-based devices are used to deliver the treatment light close to the target. The optical properties of tissue also affect the distribution of the treatment light. Treatment light undergoes scattering and absorption in tissue. Most tissue will scatter light, but highly pigmented areas will absorb light, especially at short wavelengths. This review will summarize the basic physics of light sources, and describe methods for determining the dose delivered to the patient.
Collapse
Affiliation(s)
- Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Arash Darafsheh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
17
|
Jin X, Xu H, Deng J, Dan H, Ji P, Chen Q, Zeng X. Photodynamic therapy for oral potentially malignant disorders. Photodiagnosis Photodyn Ther 2019; 28:146-152. [PMID: 31394296 DOI: 10.1016/j.pdpdt.2019.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/30/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]
Abstract
To assess the impact of photodynamic therapy (PDT) parameters in the management of oral potentially malignant disorders (OPMDs). We conducted a systematic review and meta-analysis of studies that assessed the curative effect of PDT published in PubMed and Embase until Dec 2018. Random or fixed effects models for pooled estimates calculation were used. A pooled estimate calculation revealed that lesion size decreased by 1.38 cm2 (95% CI: 0.39-2.36) after PDT, and the overall complete response (CR) was 0.52 (95% CI: 0.36-0.68), while partial response (PR) reached 0.82 (95% CI: 0.74-0.88). Subgroup analyses revealed that the lesion response (CR: 0.21 [95% CI: 0.12-0.33]) of oral lichen planus was worse than that of other disease entities. 20% aminolevulinic acid was more effective than other photosensitizers, with the overall CR was 0.68 (95% CI: 0.42-0.86), while the PR was 0.88 (95% CI: 0.76-0.94). Topical use of photosensitizers can yield desirable results, while gargling methylene blue yields poor response (0.82 [95% CI: 0.75-0.88] vs. 0.59 [95% CI: 0.44-0.72], respectively). PDT is an effective treatment modality in the management of OPMDs, the overall efficacy of which is influenced by several factors.
Collapse
Affiliation(s)
- Xin Jin
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China
| | - Hao Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jing Deng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ping Ji
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
18
|
Photodynamic therapy in the treatment of oral leukoplakia: A systematic review. Photodiagnosis Photodyn Ther 2018; 25:17-22. [PMID: 30391342 DOI: 10.1016/j.pdpdt.2018.10.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/03/2018] [Accepted: 10/29/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the present study was to systematically review the efficacy of photodynamic therapy (PDT) in the management of oral leukoplakia (OLK). METHODS This systematic review aimed to address the following focused question: "Is photodynamic therapy effective in the management of oral leukoplakia?'' PubMed/Medline, EMBASE, ISI Web of Knowledge, OVID, CNKI, and WANFANG DATA were searched up to and including June 2018 using different combinations of the following keywords: photodynamic therapy, leukoplakia, oral dysplasia, oral precancers, and oral premalignant lesions. RESULTS Sixteen studies were included in the present study. A total of 352 patients was included in this review, with age ranging from 20 to 79 years. Photosensitizers used were aminolevulinic acid, Photofrin, methylene blue, and chlorine-e6. Laser wavelength, duration of irradiation, and power density were 420-660 nm, 60-1000 s, and 100-150 mW/cm2, respectively. On the whole, the rates of complete response and partial response were 32.9% and 43.2%, and the sum was 76.1%. The follow-up period ranged from 1 month to 119 months. The recurrence rate of OLK was 0-60%. CONCLUSION PDT appears to be a useful therapeutic strategy in the management of oral leukoplakia as a non-surgical treatment. Further RCTs with long follow-up period, standardized PDT parameters, and comparing efficacy of PDT with various other therapies are needed to acquire definite conclusions.
Collapse
|
19
|
Chang JE, Liu Y, Lee TH, Lee WK, Yoon I, Kim K. Tumor Size-Dependent Anticancer Efficacy of Chlorin Derivatives for Photodynamic Therapy. Int J Mol Sci 2018; 19:ijms19061596. [PMID: 29844257 PMCID: PMC6032057 DOI: 10.3390/ijms19061596] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/18/2018] [Accepted: 05/26/2018] [Indexed: 02/07/2023] Open
Abstract
Photodynamic therapy (PDT) with a suitable photosensitizer molecule is a promising anticancer treatment. We evaluated two chlorin molecules as potential photosensitizers, methyl pyropheophorbide a (MPPa) and N-methoxyl purpurinimide (NMPi), against A549 human lung adenocarcinoma cells in vitro as well as in A549 tumor-bearing mice in vivo. Cell viability, microscopy, and fluorescence-activated cell sorting (FACS) analyses were performed for the in vitro studies. MPPa and NMPi showed high phototoxicity in vitro, which was dependent on the concentration of the photosensitizers as well as the light irradiation time. In the animal study, tumor volume change, tumor surface alterations, and hematoxylin & eosin (H&E) and terminal deoxyribonucleotidyl transferse-mediated dUTP nick-end labelling (TUNEL) staining analyses were performed and compared between small (tumor volume of <50 mm3) and large (tumor volume of >50 mm3) size of initial tumors. MPPa and NMPi showed high anticancer efficacy against small-size tumors, indicating that early treatment with PDT is effective. Especially, repeated two times PDT with NMPi allowed almost complete eradication against small-size tumors. However, MPPa and NMPi were not effective against large-size tumors. In conclusion, the two chlorin derivatives, MPPa and NMPi, show good anticancer efficacy as promising photosensitizers for PDT in vitro and in vivo. Moreover, their activity in vivo was significantly dependent on the initial tumor size in mice, which confirms the importance of early cancer treatment.
Collapse
Affiliation(s)
- Ji-Eun Chang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 13620, Korea.
| | - Yang Liu
- Nano Manufacturing Institute, School of Nanoscience and Engineering, Inje University, Gimhae 50834, Korea.
| | - Tae Heon Lee
- Nano Manufacturing Institute, School of Nanoscience and Engineering, Inje University, Gimhae 50834, Korea.
| | - Woo Kyoung Lee
- Nano Manufacturing Institute, School of Nanoscience and Engineering, Inje University, Gimhae 50834, Korea.
| | - Il Yoon
- Nano Manufacturing Institute, School of Nanoscience and Engineering, Inje University, Gimhae 50834, Korea.
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 13620, Korea.
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul 03080, Korea.
| |
Collapse
|
20
|
Kofler B, Romani A, Pritz C, Steinbichler TB, Schartinger VH, Riechelmann H, Dudas J. Photodynamic Effect of Methylene Blue and Low Level Laser Radiation in Head and Neck Squamous Cell Carcinoma Cell Lines. Int J Mol Sci 2018; 19:ijms19041107. [PMID: 29642437 PMCID: PMC5979508 DOI: 10.3390/ijms19041107] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/20/2018] [Accepted: 04/04/2018] [Indexed: 12/29/2022] Open
Abstract
Photodynamic therapy (PDT) is suggested to have an impact on the treatment of early stage head and neck cancers (HNSCC). We investigated the effect of PDT with methylene blue (MB) and a diode laser (660 nm) as the laser source on HNSCC cell lines as an in vitro model of surface oral squamous cell carcinoma. Cell-cultures were exposed to 160 µM MB for 4 min and to laser light for 8 min. Viability was proven via cell viability assay and clonogenic survival via clone counting assay. The combination of MB and diode laser evidenced high efficient loss of cell viability by 5% of the control, while treatment with the same concentration of MB for 4 min alone showed a viability of 46% of the control. In both SCC-25 and Detroit 562 HNSCC cells, MB combined with the laser allowed a significant abrogation of clonogenic growth (p < 0.01), especially in the case of Detroit 562 cells less than 1% of the suspension plated cells were able to grow tumor cell nests. Multiresistant (Detroit 562) HNSCC cells expressing cancer stem cell markers are sensitive to MB/red laser combined PDT.
Collapse
Affiliation(s)
- Barbara Kofler
- Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | - Angela Romani
- Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | - Christian Pritz
- Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | | | - Volker Hans Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | - Jozsef Dudas
- Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| |
Collapse
|
21
|
van Straten D, Mashayekhi V, de Bruijn HS, Oliveira S, Robinson DJ. Oncologic Photodynamic Therapy: Basic Principles, Current Clinical Status and Future Directions. Cancers (Basel) 2017; 9:cancers9020019. [PMID: 28218708 PMCID: PMC5332942 DOI: 10.3390/cancers9020019] [Citation(s) in RCA: 561] [Impact Index Per Article: 80.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 12/12/2022] Open
Abstract
Photodynamic therapy (PDT) is a clinically approved cancer therapy, based on a photochemical reaction between a light activatable molecule or photosensitizer, light, and molecular oxygen. When these three harmless components are present together, reactive oxygen species are formed. These can directly damage cells and/or vasculature, and induce inflammatory and immune responses. PDT is a two-stage procedure, which starts with photosensitizer administration followed by a locally directed light exposure, with the aim of confined tumor destruction. Since its regulatory approval, over 30 years ago, PDT has been the subject of numerous studies and has proven to be an effective form of cancer therapy. This review provides an overview of the clinical trials conducted over the last 10 years, illustrating how PDT is applied in the clinic today. Furthermore, examples from ongoing clinical trials and the most recent preclinical studies are presented, to show the directions, in which PDT is headed, in the near and distant future. Despite the clinical success reported, PDT is still currently underutilized in the clinic. We also discuss the factors that hamper the exploration of this effective therapy and what should be changed to render it a more effective and more widely available option for patients.
Collapse
Affiliation(s)
- Demian van Straten
- Cell Biology, Department of Biology, Science Faculty, Utrecht University, Utrecht 3584 CH, The Netherlands.
| | - Vida Mashayekhi
- Cell Biology, Department of Biology, Science Faculty, Utrecht University, Utrecht 3584 CH, The Netherlands.
| | - Henriette S de Bruijn
- Center for Optical Diagnostics and Therapy, Department of Otolaryngology-Head and Neck Surgery, Erasmus Medical Center, Postbox 204, Rotterdam 3000 CA, The Netherlands.
| | - Sabrina Oliveira
- Cell Biology, Department of Biology, Science Faculty, Utrecht University, Utrecht 3584 CH, The Netherlands.
- Pharmaceutics, Department of Pharmaceutical Sciences, Science Faculty, Utrecht University, Utrecht 3584 CG, The Netherlands.
| | - Dominic J Robinson
- Center for Optical Diagnostics and Therapy, Department of Otolaryngology-Head and Neck Surgery, Erasmus Medical Center, Postbox 204, Rotterdam 3000 CA, The Netherlands.
| |
Collapse
|
22
|
Volgger V, Betz CS. Photodynamic therapy in the upper aerodigestive tract. Overview and outlook. JOURNAL OF BIOPHOTONICS 2016; 9:1302-1313. [PMID: 27010591 DOI: 10.1002/jbio.201600036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 02/28/2016] [Accepted: 03/01/2016] [Indexed: 06/05/2023]
Abstract
The gold standard in the treatment of (pre)malignancies of the upper aerodigestive tract (UADT) is either surgery or (chemo)radiotherapy. Nevertheless, there are special indications where an alternative treatment, such as photodynamic therapy (PDT), might be as effective for and better tolerated by the patients concerned. This article aims to present a contemporary and comprehensive review on the role of photodynamic therapy in the treatment of (pre)malignancies of the UADT. PubMed was searched for "photodynamic therapy larynx/oral cavity/oropharynx/head and neck" in 01/2016. PDT can be efficient in the treatment of recurrent, residual or multiple carcinomas of the UADT without other treatment options. It has also been used with success in the treatment of early oral or laryngeal carcinomas, widespread precancerous lesions or "difficult-to-treat" skin cancer, even though these treatments are off-label. For now, unsolved scientific and economical challenges hinder the methods spread. In special cases, PDT is a highly effective method to treat head and neck (pre)malignancies. Nevertheless, further clinical studies are needed to better define its true value in head and neck oncology.
Collapse
Affiliation(s)
- Veronika Volgger
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Großhadern, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Stephan Betz
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Großhadern, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
23
|
Andreadis D, Pavlou AM, Sotiriou E, Vrani F, Ioannides D, Kolokotronis A. Utility of photodynamic therapy for the management of oral potentially malignant disorders and oral cancer. TRANSLATIONAL RESEARCH IN ORAL ONCOLOGY 2016. [DOI: 10.1177/2057178x16669161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Photodynamic therapy (PDT), defined as “the light-induced inactivation of cells, microorganisms, or molecules,” combines the use of a photosensitive agent or photosensitizer (PS) activated by irradiation with a light source to produce reactive oxygen species and highly reactive singlet oxygen. PDT has been used for the treatment of different oral diseases with promising results. This review describes the basic principles of PDT, including the nature of PS and the light sources, and focuses on evaluating the efficacy of this method, according to the existing data, for the treatment of different oral diseases. PubMed was used as the source of the relevant literature, about the clinical application of PDT in actinic cheilitis (AC), leukoplakia, oral lichen planus, oral lichenoid lesions, and oral cancer. Complete response to PDT as high as 100% has been reported not only in cases of AC but also in dysplasias/carcinomas in situ, T1N0, and T2N0. According to the available data, PDT appears to be a safe, well-tolerated therapy with limited adverse effects and excellent cosmetic outcome. Although PDT is a very promising therapy, further research is needed in order to investigate the cases that fail to respond, to examine the long-term prognosis for cases of reported complete response and thus avoid the future recurrence of diseases.
Collapse
Affiliation(s)
- Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Achilleia-Maria Pavlou
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Sotiriou
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fani Vrani
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ioannides
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Kolokotronis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
24
|
Saini R, Lee NV, Liu KYP, Poh CF. Prospects in the Application of Photodynamic Therapy in Oral Cancer and Premalignant Lesions. Cancers (Basel) 2016; 8:cancers8090083. [PMID: 27598202 PMCID: PMC5040985 DOI: 10.3390/cancers8090083] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 12/16/2022] Open
Abstract
Oral cancer is a global health burden with significantly poor survival, especially when the diagnosis is at its late stage. Despite advances in current treatment modalities, there has been minimal improvement in survival rates over the last five decades. The development of local recurrence, regional failure, and the formation of second primary tumors accounts for this poor outcome. For survivors, cosmetic and functional compromises resulting from treatment are often devastating. These statistics underscore the need for novel approaches in the management of this deadly disease. Photodynamic therapy (PDT) is a treatment modality that involves administration of a light-sensitive drug, known as a photosensitizer, followed by light irradiation of an appropriate wavelength that corresponds to an absorbance band of the sensitizer. In the presence of tissue oxygen, cytotoxic free radicals that are produced cause direct tumor cell death, damage to the microvasculature, and induction of inflammatory reactions at the target sites. PDT offers a prospective new approach in controlling this disease at its various stages either as a stand-alone therapy for early lesions or as an adjuvant therapy for advanced cases. In this review, we aim to explore the applications of PDT in oral cancer therapy and to present an overview of the recent advances in PDT that can potentially reposition its utility for oral cancer treatment.
Collapse
Affiliation(s)
- Rajan Saini
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Nathan V Lee
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Kelly Y P Liu
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Catherine F Poh
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC V5Z 1L3, Canada.
| |
Collapse
|
25
|
Nimotuzumab increases the anti-tumor effect of photodynamic therapy in an oral tumor model. Oncotarget 2016; 6:13487-505. [PMID: 25918252 PMCID: PMC4537029 DOI: 10.18632/oncotarget.3622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/08/2015] [Indexed: 12/23/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) represents 90% of all oral cancers and is characterized with poor prognosis and low survival rate. Epidermal growth factor receptor (EGFR) is highly expressed in oral cancer and is a target for cancer therapy and prevention. In this present work, we evaluate the efficacy of photodynamic therapy (PDT) in combination with an EGFR inhibitor, nimotuzumab in oral cancer cell lines and OSCC xenograft tumor model. PDT is a promising and minimally invasive treatment modality that involves the interaction of a photosensitizer, molecular oxygen and light to destroy tumors. We demonstrated that EGFR inhibitors nimotuzumab and cetuximab exhibits anti-angiogenic properties by inhibiting the migration and invasion of oral cancer cell lines and human endothelial cells. The EGFR inhibitors also significantly reduced tube formation of endothelial cells. Chlorin e6-PDT in combination with nimotuzumab and cetuximab reduced cell proliferation in different oral cancer and endothelial cells. Furthermore, our in vivo studies showed that the combination therapy of PDT and nimotuzumab synergistically delayed tumor growth when compared with control and PDT treated tumors. Downregulation of EGFR, Ki-67 and CD31 was observed in the tumors treated with combination therapy. Analysis of the liver and kidney function markers showed no treatment related toxicity. In conclusion, PDT outcome of oral cancer can be improved when combined with EGFR inhibitor nimotuzumab.
Collapse
|
26
|
Rohrbach DJ, Rigual N, Arshad H, Tracy EC, Cooper MT, Shafirstein G, Wilding G, Merzianu M, Baumann H, Henderson BW, Sunar U. Intraoperative optical assessment of photodynamic therapy response of superficial oral squamous cell carcinoma. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:18002. [PMID: 26780226 PMCID: PMC5996863 DOI: 10.1117/1.jbo.21.1.018002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
This study investigated whether diffuse optical spectroscopy (DOS) measurements could assess clinical response to photodynamic therapy (PDT) in patients with head and neck squamous cell carcinoma (HNSCC). In addition, the correlation between parameters measured with DOS and the crosslinking of signal transducer and activator of transcription 3 (STAT3), a molecular marker for PDT-induced photoreaction, was investigated. Thirteen patients with early stage HNSCC received the photosensitizer 2-[1-hexyloxyethyl]-2-devinylpyropheophorbide-a (HPPH) and DOS measurements were performed before and after PDT in the operating room (OR). In addition, biopsies were acquired after PDT to assess the STAT3 crosslinking. Parameters measured with DOS, including blood volume fraction, blood oxygen saturation (StO2), HPPH concentration (cHPPH), HPPH fluorescence, and blood flow index (BFI), were compared to the pathologic response and the STAT3 crosslinking. The best individual predictor of pathological response was a change in cHPPH (sensitivity=60%, specificity=100%), while discrimination analysis using a two-parameter classifier (change in cHPPH and change in StO2) classified pathological response with 100% sensitivity and 100% specificity. BFI showed the best correlation with the crosslinking of STAT3. These results indicate that DOS-derived parameters can assess the clinical response in the OR, allowing for earlier reintervention if needed.
Collapse
Affiliation(s)
- Daniel J. Rohrbach
- Roswell Park Cancer Institute, Department of Cell Stress Biology, Elm and Carlton Streets, Buffalo, New York 14263, United States
- Wright State University, Department of Biomedical, Industrial and Human Factors Engineering, 207 Russ Center, Dayton, Ohio 45435, United States
| | - Nestor Rigual
- Roswell Park Cancer Institute, Department of Head and Neck Surgery, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Hassan Arshad
- Roswell Park Cancer Institute, Department of Head and Neck Surgery, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Erin C. Tracy
- Roswell Park Cancer Institute, Department of Cellular and Molecular Biology, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Michelle T. Cooper
- Roswell Park Cancer Institute, Department of Cell Stress Biology, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Gal Shafirstein
- Roswell Park Cancer Institute, Department of Cell Stress Biology, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Gregory Wilding
- Roswell Park Cancer Institute, Department of Biostatistics and Bioinformatics, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Mihai Merzianu
- Roswell Park Cancer Institute, Department of Pathology and Laboratory Medicine, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Heinz Baumann
- Roswell Park Cancer Institute, Department of Cellular and Molecular Biology, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Barbara W. Henderson
- Roswell Park Cancer Institute, Department of Cell Stress Biology, Elm and Carlton Streets, Buffalo, New York 14263, United States
| | - Ulas Sunar
- Roswell Park Cancer Institute, Department of Cell Stress Biology, Elm and Carlton Streets, Buffalo, New York 14263, United States
- Wright State University, Department of Biomedical, Industrial and Human Factors Engineering, 207 Russ Center, Dayton, Ohio 45435, United States
- State University of New York at Buffalo, Department of Biomedical Engineering, 332 Bonner Hall, Buffalo, New York 14228, United States
| |
Collapse
|
27
|
Moghissi K, Dixon K, Gibbins S. A Surgical View of Photodynamic Therapy in Oncology: A Review. Surg J (N Y) 2015; 1:e1-e15. [PMID: 28824964 PMCID: PMC5530619 DOI: 10.1055/s-0035-1565246] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/25/2015] [Indexed: 12/18/2022] Open
Abstract
Clinical photodynamic therapy (PDT) has existed for over 30 years, and its scientific basis has been known and investigated for well over 100 years. The scientific foundation of PDT is solid and its application to cancer treatment for many common neoplastic lesions has been the subject of a huge number of clinical trials and observational studies. Yet its acceptance by many clinicians has suffered from its absence from the undergraduate and/or postgraduate education curricula of surgeons, physicians, and oncologists. Surgeons in a variety of specialties many with years of experience who are familiar with PDT bear witness in many thousands of publications to its safety and efficacy as well as to the unique role that it can play in the treatment of cancer with its targeting precision, its lack of collateral damage to healthy structures surrounding the treated lesions, and its usage within minimal access therapy. PDT is closely related to the fluorescence phenomenon used in photodiagnosis. This review aspires both to inform and to present the clinical aspect of PDT as seen by a surgeon.
Collapse
Affiliation(s)
- K. Moghissi
- The Yorkshire Laser Centre, Goole and District Hospital, Goole, East Yorkshire, United Kingdom
| | - Kate Dixon
- The Yorkshire Laser Centre, Goole and District Hospital, Goole, East Yorkshire, United Kingdom
| | - Sally Gibbins
- The Yorkshire Laser Centre, Goole and District Hospital, Goole, East Yorkshire, United Kingdom
| |
Collapse
|