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Agostinis P, Berg K, Cengel KA, Foster TH, Girotti AW, Gollnick SO, Hahn SM, Hamblin MR, Juzeniene A, Kessel D, Korbelik M, Moan J, Mroz P, Nowis D, Piette J, Wilson BC, Golab J. Photodynamic therapy of cancer: an update. CA Cancer J Clin 2011; 61:250-81. [PMID: 21617154 PMCID: PMC3209659 DOI: 10.3322/caac.20114] [Citation(s) in RCA: 3319] [Impact Index Per Article: 255.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Photodynamic therapy (PDT) is a clinically approved, minimally invasive therapeutic procedure that can exert a selective cytotoxic activity toward malignant cells. The procedure involves administration of a photosensitizing agent followed by irradiation at a wavelength corresponding to an absorbance band of the sensitizer. In the presence of oxygen, a series of events lead to direct tumor cell death, damage to the microvasculature, and induction of a local inflammatory reaction. Clinical studies revealed that PDT can be curative, particularly in early stage tumors. It can prolong survival in patients with inoperable cancers and significantly improve quality of life. Minimal normal tissue toxicity, negligible systemic effects, greatly reduced long-term morbidity, lack of intrinsic or acquired resistance mechanisms, and excellent cosmetic as well as organ function-sparing effects of this treatment make it a valuable therapeutic option for combination treatments. With a number of recent technological improvements, PDT has the potential to become integrated into the mainstream of cancer treatment.
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Affiliation(s)
- Patrizia Agostinis
- Department of Molecular Cell Biology, Cell Death Research & Therapy Laboratory, Catholic University of Leuven, B-3000 Leuven, Belgium,
| | - Kristian Berg
- Department of Radiation Biology, Institute for Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Montebello, N-0310 Oslo, Norway, ;
| | - Keith A. Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19004, USA, ;
| | - Thomas H. Foster
- Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA,
| | - Albert W. Girotti
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, WI, 53226-3548, USA,
| | - Sandra O. Gollnick
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Elm and Carlton Sts, Buffalo, NY, 14263, USA,
| | - Stephen M. Hahn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19004, USA, ;
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114-2696, USA, ;
- Department of Dermatology, Harvard Medical School, Boston MA 02115
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Asta Juzeniene
- Department of Radiation Biology, Institute for Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Montebello, N-0310 Oslo, Norway, ;
| | - David Kessel
- Department of Pharmacology, Wayne State University School of Medicine, Detroit MI 48201, USA,
| | | | - Johan Moan
- Department of Radiation Biology, Institute for Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Montebello, N-0310 Oslo, Norway, ;
- Institute of Physics, University of Oslo, Blindern 0316 Oslo, Norway;
| | - Pawel Mroz
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114-2696, USA, ;
- Department of Dermatology, Harvard Medical School, Boston MA 02115
| | - Dominika Nowis
- Department of Immunology, Centre of Biostructure Research, Medical University of Warsaw, Poland, ;
| | - Jacques Piette
- GIGA-Research, Laboratory of Virology & Immunology, University of Liège, B-4000 Liège Belgium,
| | - Brian C. Wilson
- Ontario Cancer Institute/University of Toronto, Toronto, ON M5G 2M9, Canada,
| | - Jakub Golab
- Department of Immunology, Centre of Biostructure Research, Medical University of Warsaw, Poland, ;
- Institute of Physical Chemistry, Polish Academy of Sciences, Department 3, Warsaw, Poland
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Eichler J, Liebetruth J, London RA, Ziegenhagen L. Temperature distribution for combined laser hyperthermia-photodynamic therapy in the esophagus. Med Eng Phys 2000; 22:307-12. [PMID: 11018463 DOI: 10.1016/s1350-4533(00)00037-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In recent years photodynamic laser therapy (PDT) has been tested in animal and clinical studies for treatment of esophageal cancer. In several animal experiments a synergistic effect was found by simultaneously applying PDT and hyperthermia (HT). In this paper an optical fibre system is described which can be used in the esophagus for combined PDT with a 1 W dye laser and HT with a 15 W Nd:YAG laser. A phantom was built simulating the geometry of the esophagus using cow muscle. The spatial temperature field during HT was measured versus irradiation time. The results were compared with calculations using a coupled Monte Carlo laser transport/finite difference heat transport model using the LATIS computer program. Measurements and calculations yield a realistic description of the temperature distribution during HT under various experimental conditions. The LATIS program allows the prediction of the effects of blood perfusion for in vivo situations. The results show that perfusion has considerable influence on the temperature field, reducing the effective depth in tissue for HT.
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Affiliation(s)
- J Eichler
- TFH-University of Applied Science, Seestr. 64, 13347, Berlin, Germany
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Stender IM, Lock-Andersen J, Wulf HC. Recalcitrant hand and foot warts successfully treated with photodynamic therapy with topical 5-aminolaevulinic acid: a pilot study. Clin Exp Dermatol 1999; 24:154-9. [PMID: 10354167 DOI: 10.1046/j.1365-2230.1999.00441.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The purpose of this pilot study was to determine if photodynamic therapy with topical application of 5-aminolaevulinic acid followed by irradiation with incoherent filtered and unfiltered light (ALA-PDT) is an effective therapy for recalcitrant hand and foot warts. In 30 patients with recalcitrant warts, 49 regions with a total of 250 warts were randomized to one of the following five treatments: (i) ALA-PDT with white light applied three times within 10 days (W3); (ii) ALA-PDT with white light applied once (W1); (iii) ALA-PDT with red light applied three times within 10 days (R3); (iv) ALA-PDT with blue light applied three times within 10 days (B3), and (v) cryotherapy applied up to four times within 2 months (CRYO). The ALA-PDT treatment modality was repeated in case of partially responding warts. Significantly more warts were completely healed after W3 and W1 than after R3, B3 and CRYO (P < 0.01): 73% of the warts treated with W3 were completely healed, 71% after W1, 42% after R3, 23% after B3 and 20% after CRYO. No scars were observed in the ALA-PDT treated areas and patients treated for foot warts were all able to walk after the treatment. No recurrences in completely responding ALA-PDT treated warts were observed after 12 months of follow-up. In conclusion, photodynamic therapy with topical 5-aminolaevulinic acid followed by irradiation with white light is a promising treatment for recalcitrant hand and foot warts.
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Affiliation(s)
- I M Stender
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
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Kostron H, Obwegeser A, Jakober R. Photodynamic therapy in neurosurgery: a review. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 1996; 36:157-68. [PMID: 9002253 DOI: 10.1016/s1011-1344(96)07364-2] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Photodynamic therapy (PDT) has been investigated extensively, both experimentally and clinically, as an adjunctive treatment in the neuro-oncological field. It is based on the more selective accumulation of a photosensitizer in malignant than normal tissue with low systemic toxicity. Subsequent light activation induces photo-oxidation, followed by selective tumour destruction via vascular and direct cellular mechanisms. Malignant brain tumours carry a lethal prognosis with a median survival of 15 months despite surgery, radiotherapy and chemotherapy. PDT is therefore a logical therapeutic concept for brain tumours infiltrating into normal brain. In this review, all the available data on patients treated with haematoporphyrin derivative-mediated PDT are critically analysed. Over 310 patients have been reported in the literature suffering from primary or recurrent malignant brain tumours which were treated with PDT following tumour resection in open clinical phase I/II trials. This number includes 58 patients treated at our own institution. Variations in the treatment protocols make evaluation scientifically difficult; however, there is a clear trend of increased median survival after surgical resection and one single photodynamic treatment. PDT is generally well tolerated and side effects consist of moderate increased intracranial pressure and prolonged skin sensitivity to direct sunlight. The current available data indicate that PDT is a safe treatment, which is well tolerated by the patients and yields an improvement in survival of those with malignant brain tumours. Conclusive information can be expected from controlled clinical trials which are currently being designed. The results raise the hope that PDT will be a valuable addition to the armamentarium for the treatment of cerebral malignancies.
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Affiliation(s)
- H Kostron
- Department of Neurosurgery, University of Innsbruck, Austria
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Brasseur N, Lewis K, Rousseau J, van Lier JE. Measurement of tumor vascular damage in mice with 99mTc-MIBI following photodynamic therapy. Photochem Photobiol 1996; 64:702-6. [PMID: 8863477 DOI: 10.1111/j.1751-1097.1996.tb03127.x] [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: 02/02/2023]
Abstract
The clinical perfusion agent 99mTc-MIBI was used to monitor changes in tumor vascular perfusion (TVP) induced by Photofrin (PII)-mediated photodynamic therapy (PDT). BALB/c mice bearing an EMT-6 tumor on each hind thigh were given an intravenous injection of 1, 2 or 5 mg kg-1 PII. Twenty-four hours later, one tumor was illuminated (600-650 nm, 200 mW cm-2, 400 J cm-2) while the other served as a control. At various time intervals after PDT (0, 2 and 24 h) mice received an intravenous injection of 99mTc-hexakismethoxyisobutylisonitrile (MIBI) (0.18 MBq g-1) and were sacrificed 2 min later. The light-treated and the untreated tumors were then dissected, the radioactivity was counted and the percentage of the injected dose per gram of tumor (%ID g-1) was calculated as a measure of TVP. We observed that TVP is drug dose dependent, develops progressively with time post-PDT and is inversely related to PDT efficacy. Our data show that early tumor retention of 99mTc-MIBI is a simple method to assess TVP and vascular damage induced by PDT.
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Affiliation(s)
- N Brasseur
- MRC Group in the Radiation Sciences, University of Sherbrooke, Québec, Canada
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Lagerberg JW, Vanderwal J, Charlesworth P, Truscott TG, Van der Zee J, Schneckenburger H, Dubbelman TM. Influence of rhodamine 123 on the photosensitizing properties of porphyrins. Free Radic Biol Med 1996; 21:181-8. [PMID: 8818633 DOI: 10.1016/0891-5849(96)00026-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The photophysical and photochemical properties of porphyrins were profoundly changed upon addition of rhodamine 123. The Soret band of the porphyrins shifted to higher wavelengths, the fluorescence yield of the porphyrins decreased with unaltered decay rates, and their triplet state was quenched. These observations indicate a strong interaction between porphyrins and rhodamine 123 and formation of 1:1 nonfluorescent complexes, of which the binding constants were determined. Illumination of a porphyrin in the presence of rhodamine 123 resulted in the formation of a porphyrin radical cation, which could be detected with ESR spectroscopy. Quenching of the triplet state of the porphyrins by rhodamine 123 resulted in a decreased singlet oxygen yield and a decrease of the photooxidation of histidine, methionine, tyrosine, and tryptophan. However, the oxidation of thiol compounds was increased and the stoichiometry of the reaction between cysteine and oxygen changed from 2 to 3.8 mol cysteine/ mol oxygen. These results show that the presence of rhodamine 123 converted the for porphyrins prevalent energy transfer (type II) reaction to an electron transfer (type I) reaction.
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Affiliation(s)
- J W Lagerberg
- Department of Medical Biochemistry, Sylvius Laboratory, Leiden University, The Netherlands
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VanDerWal J, Lagerberg WM, Dubbelman TM, VanSteveninck J. Interaction of photodynamically induced cell killing and dark cytotoxicity of rhodamine 123. Photochem Photobiol 1995; 62:757-63. [PMID: 7480151 DOI: 10.1111/j.1751-1097.1995.tb08726.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Loss of clonogenicity of Chinese hamster ovary (CHO) cells, murine L929 fibroblasts and human bladder carcinoma T24 cells caused by photodynamic treatment (PDT) with hematoporphyrin derivative (HPD) is synergistically enhanced by subsequent incubation with rhodamine 123 in the dark. For CHO and L929 cells this synergistic interaction can be explained by an increased uptake of rhodamine 123 as the result of the photodynamic treatment. With aluminum phthalocyanine (AIPC) as photosensitizer only additive effects were observed in the three cell lines. Incubation in the dark with rhodamine 123, followed by a photodynamic treatment with HPD, resulted in an antagonistic interaction with regard to loss of colony formation. With AIPc the combination of treatments resulted in an additive effect with L929 and T24 cells, whereas with CHO cells a slight antagonistic interaction was observed. An antagonistic effect was also observed in model experiments, treating histidine photodynamically with HPD and measuring oxygen consumption. A possible explanation of these results could be an interaction or complex formation of rhodamine 123 with HPD resulting in a diminished singlet oxygen production. With AIPc this does not take place.
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Affiliation(s)
- J VanDerWal
- Department of Medical Biochemistry, State University of Leiden, The Netherlands
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Abstract
The blood supply to all solid tumours consists of parasitized normal vessels and new vessels which have been induced to grow by the presence of the tumour. These vessels are inadequate in many respects, being tortuous, thin-walled, chaotically arranged, lacking innervation and with no predetermined direction of flow. The walls consist of a basement membrane lined with rapidly proliferating immature endothelial cells, and are more permeable than normal vessels. The spacing of the vessels and their average diameters are not optimal for nutrient provision. This paper focuses on the evidence that many existing therapies may already have, as part of their action, a vascular mediated process of killing tumour cells. This may result from local changes within individual vessels or from systemic alterations in blood pressure, viscosity, coagulability etc. The hallmarks of vascular injury are identified and the dangers of discarding useful anticancer agent by failing to understand their mechanism of action are highlighted.
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Affiliation(s)
- J Denekamp
- CRC Gray Laboratory, Mount Vernon Hospital, Northwood, Middlesex, UK
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