Photodynamic therapy during second surgery for recurrent gliomas improves survival

The Implication of Photodynamic Therapy Applied to the Level of Tumor Resection on Postoperative Cerebral Edema and Intracranial Pressure Changes in Gliomas

AIM

The aim of our study was to explore the factors influencing cerebral edema and intracranial pressure in glioblastoma multiforme (GBM) patients who undergo photodynamic therapy (PDT) after resection.

APPROACH

This was a retrospective controlled study of GBM patients treated with PDT-assisted resections of varying scope from May 2021 to August 2023. The baseline clinical data, cerebral edema volumes, intracranial pressure values, and imaging data of the GBM patients were collected for statistical analysis.

RESULTS

A total of 56 GBM patients were included. Thirty of the patients underwent gross total resection (GTR), and the other 26 patients underwent subtotal resection (STR). We found that the cerebral edema volume and the mean intracranial pressure in patients who underwent GTR were lower than those in patients who underwent STR. Moreover, univariate analysis showed that the scope of tumor resection was an independent factor affecting cerebral edema and intracranial pressure after PDT.

CONCLUSIONS

Compared with STR, PDT combined with GTR significantly reduced postoperative brain edema volume and intracranial pressure in GBM patients.

Phototherapy for age-related brain diseases: Challenges, successes and future

Brain diseases present a significant obstacle to both global health and economic progress, owing to their elusive pathogenesis and the limited effectiveness of pharmaceutical interventions. Phototherapy has emerged as a promising non-invasive therapeutic modality for addressing age-related brain disorders, including stroke, Alzheimer's disease (AD), and Parkinson's disease (PD), among others. This review examines the recent progressions in phototherapeutic interventions. Firstly, the article elucidates the various wavelengths of visible light that possess the capability to penetrate the skin and skull, as well as the pathways of light stimulation, encompassing the eyes, skin, veins, and skull. Secondly, it deliberates on the molecular mechanisms of visible light on photosensitive proteins, within the context of brain disorders and other molecular pathways of light modulation. Lastly, the practical application of phototherapy in diverse clinical neurological disorders is indicated. Additionally, this review presents novel approaches that combine phototherapy and pharmacological interventions. Moreover, it outlines the limitations of phototherapeutics and proposes innovative strategies to improve the treatment of cerebral disorders.

Diagnostic performance of perfusion-weighted imaging combined with serum MMP-2 and -9 levels in tumor recurrence after postoperative concomitant chemoradiotherapy of glioblastoma

OBJECTIVE

To evaluate diagnostic accuracy of dynamic susceptibility contrast- perfusion weighted imaging (DSC-PWI) combined with serum MMP-2 and -9 levels in differentiating recurrent glioblastoma (GBM).

METHODS

We enrolled a total of 220 GBM patients, including recurrent cases (n = 150) and non-recurrent cases (n = 70) after postoperative concomitant chemoradiotherapy. All patients performed preoperative and follow-up DSC-PWI, and two parameters [normalized cerebral blood volume (nCBV) and cerebral blood flow (nCBF)] were obtained. Preoperative serum levels of MMP-2 and MMP-9 were detected using ELISA. The diagnostic performance was evaluated by analyzing receiver operating characteristic (ROC) and area under the curve (AUC).

RESULTS

At baseline, the recurrence patients had higher nCBF and nCBV than the non-recurrence patients, accompanying by the increased MMP-2 and MMP-9 levels in serum. Serum MMP-2 level were positively associated with MMP-9 in recurrent patients. In patients classified as recurrence, both MMP-9 and MMP-2 in serum had a significant correlation with nCBV and nCBF. A sensitivity and specificity of nCBF for recurrence vs. non-recurrence were 94.29% and 63.33%, respectively. nCBV also could provide high discrimination between recurrence and non-recurrence patients (sensitivity: 84.29%, specificity: 62.67%, AUC: 0.821). In ROC analyses, both MMP-2 and MMP-9 distinguished recurrence from non-recurrence with AUC values of 0.883 and 0.900, respectively. Finally, the combination of DSC-PWI parameters (nCBF and nCBV) and serum MMP-2 and -9 levels showed much better discrimination capacity between recurrence and non-recurrence patients with a sensitivity of 92.86%, specificity of 79.33% and AUC of 0.899.

CONCLUSION

The combination of DSC-PWI parameters together with serum MMP-2 and -9 levels offered an attractive approach to noninvasively distinguish recurrence after postoperative radiotherapy of GBM.

Targeted Drug/Gene/Photodynamic Therapy via a Stimuli-Responsive Dendritic-Polymer-Based Nanococktail for Treatment of EGFR-TKI-Resistant Non-Small-Cell Lung Cancer

Yes-associated protein (YAP) has been identified as a key driver for epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) resistance. Inhibition of YAP expression could be a potential therapeutic option for treating non-small-cell lung cancer (NSCLC). Herein, a nanococktail therapeutic strategy is proposed by employing amphiphilic and block-dendritic-polymer-based nanoparticles (NPs) for targeted co-delivery of EGFR-TKI gefitinib (Gef) and YAP-siRNA to achieve a targeted drug/gene/photodynamic therapy. The resulting NPs are effectively internalized into Gef-resistant NSCLC cells, successfully escape from late endosomes/lysosomes, and responsively release Gef and YAP-siRNA in an intracellular reductive environment. They preferentially accumulate at the tumor site after intravenous injection in both cell-line-derived xenograft (CDX) and patient-derived xenograft (PDX) models of Gef-resistant NSCLC, resulting in potent antitumor efficacy without distinct toxicity after laser irradiation. Mechanism studies reveal that the cocktail therapy could block the EGFR signaling pathway with Gef, inhibit activation of the EGFR bypass signaling pathway via YAP-siRNA, and induce tumor cell apoptosis through photodynamic therapy (PDT). Furthermore, this combination nanomedicine can sensitize PDT and impair glycolysis by downregulating HIF-1α. These results suggest that this stimuli-responsive dendritic-polymer-based nanococktail therapy may provide a promising approach for the treatment of EGFR-TKI resistant NSCLC.