1
|
Hua X, Li Y, Ma H, Zhang W, Qin J, Zhang J, Cao H. Photodynamic therapy versus endoscopic submucosal dissection for management of patients with early esophageal neoplasia: a retrospective study. J Thorac Dis 2017; 9:5046-5051. [PMID: 29312709 DOI: 10.21037/jtd.2017.11.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Photodynamic therapy (PDT) and endoscopic submucosal dissection (ESD) have been proposed as a treatment for early esophageal neoplasia. The objective of this study is to compare between the clinical outcome after ESD and PDT to reach the best management for early esophageal neoplasia. Methods All patients undergoing ESD or PDT for early esophageal neoplasia between 2014 and 2015 were eligible for the study. A retrospective analysis for comparison between the results of ESD and PDT was done. Results 36 patients underwent ESD and Thirty PDT. No significant difference was found between the two groups regarding the demographic or pathologic data. Also, there was no significant difference regarding the length of hospital stay, presence of hydrothorax, fever, and pain. Operative time was significantly longer in ESD than in PDT (72 vs. 8 minutes, P<0.001). In addition, bleeding was significantly lower in ESD than PDT (12 vs. 2, P<0.05). There was a significant difference regarding stricture and cost which were less in ESD (6 vs. 15, P<0.05). However, perforation was much more in ESD (6 vs. 0, P<0.05). There was no significant difference between the two groups regarding the disease free survival (DFS), but it was observed that patients who underwent PDT had more favorable 2-year DFS rates than patients received ESD. Conclusions The PDT may be comparable to the ESD. With the exception of esophageal stenosis, PDT could reduce many complications and have longer DFS in comparison with ESD. PDT is feasible for patients with early esophageal neoplasia confined to the mucosal layer without regional lymph nodal or distant metastasis.
Collapse
Affiliation(s)
- Xionghuai Hua
- Department of Thoracic Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou 450008, China
| | - Yin Li
- Department of Thoracic Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou 450008, China
| | - Haibo Ma
- Department of Thoracic Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou 450008, China
| | - Wei Zhang
- Department of Thoracic Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou 450008, China
| | - Jianjun Qin
- Department of Thoracic Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou 450008, China
| | - Jun Zhang
- Department of Thoracic Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou 450008, China
| | - Haixia Cao
- Department of Thoracic Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou 450008, China
| |
Collapse
|
2
|
Kunz-Schughart LA, Dubrovska A, Peitzsch C, Ewe A, Aigner A, Schellenburg S, Muders MH, Hampel S, Cirillo G, Iemma F, Tietze R, Alexiou C, Stephan H, Zarschler K, Vittorio O, Kavallaris M, Parak WJ, Mädler L, Pokhrel S. Nanoparticles for radiooncology: Mission, vision, challenges. Biomaterials 2016; 120:155-184. [PMID: 28063356 DOI: 10.1016/j.biomaterials.2016.12.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 12/29/2022]
Abstract
Cancer is one of the leading non-communicable diseases with highest mortality rates worldwide. About half of all cancer patients receive radiation treatment in the course of their disease. However, treatment outcome and curative potential of radiotherapy is often impeded by genetically and/or environmentally driven mechanisms of tumor radioresistance and normal tissue radiotoxicity. While nanomedicine-based tools for imaging, dosimetry and treatment are potential keys to the improvement of therapeutic efficacy and reducing side effects, radiotherapy is an established technique to eradicate the tumor cells. In order to progress the introduction of nanoparticles in radiooncology, due to the highly interdisciplinary nature, expertise in chemistry, radiobiology and translational research is needed. In this report recent insights and promising policies to design nanotechnology-based therapeutics for tumor radiosensitization will be discussed. An attempt is made to cover the entire field from preclinical development to clinical studies. Hence, this report illustrates (1) the radio- and tumor-biological rationales for combining nanostructures with radiotherapy, (2) tumor-site targeting strategies and mechanisms of cellular uptake, (3) biological response hypotheses for new nanomaterials of interest, and (4) challenges to translate the research findings into clinical trials.
Collapse
Affiliation(s)
- Leoni A Kunz-Schughart
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Anna Dubrovska
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Claudia Peitzsch
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Alexander Ewe
- Rudolf-Boehm-Institute for Pharmacology and Toxicology, Clinical Pharmacology, University of Leipzig, Germany
| | - Achim Aigner
- Rudolf-Boehm-Institute for Pharmacology and Toxicology, Clinical Pharmacology, University of Leipzig, Germany
| | - Samuel Schellenburg
- Institute of Pathology, University Hospital, Carl Gustav Carus, TU Dresden, Germany
| | - Michael H Muders
- Institute of Pathology, University Hospital, Carl Gustav Carus, TU Dresden, Germany
| | - Silke Hampel
- Leibniz Institute of Solid State and Material Research Dresden, 01171 Dresden, Germany
| | - Giuseppe Cirillo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, CS, Italy
| | - Francesca Iemma
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, CS, Italy
| | - Rainer Tietze
- ENT-Department, Section for Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Christoph Alexiou
- ENT-Department, Section for Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Holger Stephan
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, 01314 Dresden, Germany
| | - Kristof Zarschler
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, 01314 Dresden, Germany
| | - Orazio Vittorio
- Children's Cancer Institute Australia, ARC Centre of Excellence in Convergent Bio-Nano Science and Technology and Australian Centre for NanoMedicine, Sydney, UNSW, Australia
| | - Maria Kavallaris
- Children's Cancer Institute Australia, ARC Centre of Excellence in Convergent Bio-Nano Science and Technology and Australian Centre for NanoMedicine, Sydney, UNSW, Australia
| | - Wolfgang J Parak
- Fachbereich Physik, Philipps Universität Marburg, 35037 Marburg, Germany; CIC Biomagune, 20009 San Sebastian, Spain
| | - Lutz Mädler
- Foundation Institute of Materials Science (IWT), Department of Production Engineering, University of Bremen, 28359 Bremen, Germany
| | - Suman Pokhrel
- Foundation Institute of Materials Science (IWT), Department of Production Engineering, University of Bremen, 28359 Bremen, Germany.
| |
Collapse
|
3
|
Parameter-finding studies of photodynamic therapy for approval in Japan and the USA. Photodiagnosis Photodyn Ther 2013; 10:434-45. [DOI: 10.1016/j.pdpdt.2013.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 11/21/2022]
|
4
|
Wang KK. Ablation is in the eye of the beholder. Clin Gastroenterol Hepatol 2013; 11:643-4. [PMID: 23524127 PMCID: PMC3815674 DOI: 10.1016/j.cgh.2013.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/21/2013] [Accepted: 02/22/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Kenneth K. Wang
- Barrett’s Esophagus Unit Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, MN
| |
Collapse
|
5
|
Park JJ. Photodynamic therapy: establishing its role in palliation of advanced esophageal cancer. Korean J Intern Med 2012; 27:271-2. [PMID: 23019389 PMCID: PMC3443717 DOI: 10.3904/kjim.2012.27.3.271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 08/23/2012] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jong-Jae Park
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Nava HR, Allamaneni SS, Dougherty TJ, Cooper MT, Tan W, Wilding G, Henderson BW. Photodynamic therapy (PDT) using HPPH for the treatment of precancerous lesions associated with Barrett's esophagus. Lasers Surg Med 2011; 43:705-12. [PMID: 22057498 PMCID: PMC3218433 DOI: 10.1002/lsm.21112] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Photodynamic therapy (PDT) with porfimer sodium, FDA approved to treat premalignant lesions in Barrett's esophagus, causes photosensitivity for 6-8 weeks. HPPH (2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a) shows minimal photosensitization of short duration and promising efficacy in preclinical studies. Here we explore toxicity and optimal drug and light dose with endoscopic HPPH-PDT. We also want to know the efficacy of one time treatment with HPPH-PDT. STUDY DESIGN/MATERIALS AND METHODS Two nonrandomized dose escalation studies were performed (18 patients each) with biopsy-proven high grade dysplasia or early intramucosal adenocarcinoma of esophagus. HPPH doses ranged from 3 to 6 mg/m2 . At 24 or 48 hours after HPPH administration the lesions received one endoscopic exposure to 150, 175, or 200 J/cm of 665 nm light. RESULTS Most patients experienced mild to moderate chest pain requiring symptomatic treatment only. Six patients experienced grade 3 and 4 adverse events (16.6%). Three esophageal strictures were treated with dilatation. No clear pattern of dose dependence of toxicities emerged. In the drug dose ranging study (light dose of 150 J/cm at 48 hours), 3 and 4 mg/m2 of HPPH emerged as most effective. In the light dose ranging study (3 or 4 mg/m2 HPPH, light at 24 hours), complete response rates (disappearance of high grade dysplasia and early carcinoma) of 72% were achieved at 1 year, with all patients treated with 3 mg/m2 HPPH plus 175 J/cm and 4 mg/m2 HPPH plus 150 J/cm showing complete responses at 1 year. CONCLUSIONS HPPH-PDT for precancerous lesions in Barrett's esophagus appears to be safe and showing promising efficacy. Further clinical studies are required to establish the use of HPPH-PDT.
Collapse
Affiliation(s)
- Hector R Nava
- Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
Photodynamic therapy (PDT) is a photochemical process that uses a photosensitizer drug activated by laser light to produce mucosal ablation. Porfimer sodium PDT has proved long-term efficacy and durability in the treatment of Barrett's esophagus and high-grade dysplasia and early esophageal adenocarcinoma. Its use has been limited by serious side effects including prolonged cutaneous photosensitivity and stricture formation. Other photosensitizers with a better safety profile have been used mostly in Europe with limited experience. The future of PDT lies on a better understanding of dosimetry, tissue properties, and host genetic factors.
Collapse
Affiliation(s)
- Marta L Davila
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1466, Houston, TX 77030-4009, USA.
| |
Collapse
|
8
|
Abstract
Photodynamic therapy (PDT) is a promising new modality that utilizes the combination of a photosensitizing chemical and visible light for the management of various solid malignancies, including gastrointestinal (GI) cancer. PDT has some advantages over chemotherapy in terms of its greater safety and lower toxicity in the treatment of malignant lesions. However, PDT has not been used widely for treating upper GI cancer due to its relatively low cost-effectiveness and anatomical characteristics of the GI system. Nevertheless, PDT may be an effective alternative therapy for early upper-GI cancer patients who are at a high risk of curative surgical resection or systemic chemotherapy. In some clinical studies, PDT for various upper GI cancer showed positiveresults. To improve the efficacy of PDT for upper GI cancer, development of photosensitezer and light delivery system is needed.
Collapse
Affiliation(s)
- Key Hyeon Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | | |
Collapse
|
9
|
Spechler SJ, Fitzgerald RC, Prasad GA, Wang KK. History, molecular mechanisms, and endoscopic treatment of Barrett's esophagus. Gastroenterology 2010; 138:854-69. [PMID: 20080098 PMCID: PMC2853870 DOI: 10.1053/j.gastro.2010.01.002] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/11/2010] [Accepted: 01/11/2010] [Indexed: 02/06/2023]
Abstract
This report is an adjunct to the American Gastroenterological Association Institute's medical position statement and technical review on the management of Barrett's esophagus, which will be published in the near future. Those documents will consider a number of broad questions on the diagnosis, clinical features, and management of patients with Barrett's esophagus, and the reader is referred to the technical review for an in-depth discussion of those topics. In this report, we review historical, molecular, and endoscopic therapeutic aspects of Barrett's esophagus that are of interest to clinicians and researchers.
Collapse
Affiliation(s)
- Stuart Jon Spechler
- VA North Texas Healthcare System and The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | | | | | | |
Collapse
|
10
|
Wani S, Sayana H, Sharma P. Endoscopic eradication of Barrett's esophagus. Gastrointest Endosc 2010; 71:147-66. [PMID: 19879565 DOI: 10.1016/j.gie.2009.07.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 07/18/2009] [Indexed: 01/03/2023]
Affiliation(s)
- Sachin Wani
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri 64128-2295, USA
| | | | | |
Collapse
|
11
|
Friedberg JS. Photodynamic therapy as an innovative treatment for malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg 2009; 21:177-87. [PMID: 19822291 DOI: 10.1053/j.semtcvs.2009.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2009] [Indexed: 11/11/2022]
Abstract
Photodynamic therapy (PDT) of the pleura is an experimental treatment aimed at eradicating residual microscopic disease after macroscopic complete resection of malignant pleural mesothelioma (MPM) by means of intracavitary administration. A light-based treatment, PDT consists of 3 components: a nontoxic photosensitizing compound, oxygen, and visible light. The treatment is FDA-approved for several oncological targets, but remains experimental for MPM. PDT can be combined with lung-sparing pleurectomy and decortication and does not preclude other treatments such as adjuvant chemotherapy and/or radiation therapy. Additionally, PDT appears to bolster an immunologic effect by rendering the cancer cells that have been destroyed by the light-activated photosensitizer more presentable to the immune system. Local control and survival rates have been sufficiently rewarding to merit ongoing development of this combination of surgical technique and PDT.
Collapse
Affiliation(s)
- Joseph S Friedberg
- Department of Thoracic Surgery, University of Pennsylvania Medical Center-Presbyterian, Philadelphia, Pennsylvania 19104, USA.
| |
Collapse
|
12
|
Abstract
The management of Barrett esophagus is evolving with the emergence of new endoscopic technologies. Traditionally, patients with high-grade dysplasia or cancer were referred for esophagectomy. However, with the advent of endoscopic ablative therapies for Barrett esophagus, the treatment paradigm has shifted. Patients with high-grade dysplasia and intramucosal carcinoma are increasingly offered esophagus-sparing therapies. Endoscopic ablative therapies can be categorized into tissue-acquiring and non-tissue-acquiring modalities. Visible lesions in the setting of dysplasia should be treated with a tissue-acquiring modality to stage and resect the lesion appropriately. One or more modalities may be used to eradicate the entire region of affected esophagus totally. Total eradication treats all of the at-risk epithelium and, therefore, treats any metachronous or synchronous lesions. Success of treatment may be gauged by complete remission of cancer, dysplasia, or Barrett esophagus. In addition to procedure-related complications, the risk of residual Barrett esophagus or subsquamous Barrett esophagus remains to be addressed. Endoscopic surveillance and acid suppression is still currently required after ablation.
Collapse
Affiliation(s)
- Irving Waxman
- Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, University of Chicago Medical Center, Chicago, IL 60637, USA.
| | | |
Collapse
|