Photodynamic therapy for the treatment of periocular squamous cell carcinoma in horses: a pilot study

Squamous Cell Carcinomas in Horses: An Update of the Aetiopathogenesis and Treatment Options

Squamous cell carcinomas are a very common tumor type in horses, and are found in a variety of dermatologic and non-dermatologic locations. Metastasis is common, even at the first presentation of the disease, and a full staging workup is therefore strongly recommended to direct treatment and assist with prognostication. Wide surgical excision remains the treatment of choice in most cases, but recurrence is common, and adjunctive therapy may be indicated to improve the long-term prognosis.

Marginal resection and infracyanine green-mediated photodynamic therapy in the management of feline eyelid squamous cell carcinoma: Two cases

OBJECTIVE

Describe the presenting features, surgical procedure, and clinical outcomes of two cats managed with marginal resection and photodynamic therapy (PDT) for eyelid squamous cell carcinoma (SCC).

ANIMALS STUDIED

A 12-year-old female spayed domestic shorthair cat (case 1) and a 10-year-old female spayed domestic shorthair cat (case 2).

PROCEDURES

Following marginal resection of the eyelid neoplasm, hemostasis was achieved using a handheld cautery unit then 1 mL of infracyanine green was injected into the surgical wound bed. Photodynamic therapy was performed using an 810 nm diode laser in two consecutive steps: (i) six cycles at 500 mW for 30 s per cycle, using a rapid movement; then (ii) one (case 1) or two cycles (case 2) of 30 s at 2000 mW, using a slow deliberate movement to effect (charred surface).

RESULTS

Histopathology was consistent with SCC resected with incomplete margins in both cats. Follow-up duration was 416 and 161 days in case 1 and case 2, respectively. Consecutive exams and photo-documentation (in clinic or by owners) showed appropriate healing of the lower eyelid, with a smooth lid margin, and no evidence of tumor regrowth or ocular irritation. Subtle trichiasis was noted in case 1 on day 185, but not at the last follow-up.

CONCLUSIONS AND CLINICAL RELEVANCE

Marginal resection followed by PDT may be a valid alternative to complete surgical resection of periocular SCC in cats. The procedure was easy to perform, post-operative recovery was uncomplicated, and neither cat developed recurrent disease during the follow-up period.

Limbal Squamous Cell Carcinoma in a Black Baldy Cow: Case Report and Surgical Treatment

Objective

To document a case of limbal squamous cell carcinoma (SCC) in an adult Black Baldy cow treated with photodynamic therapy (PDT) as an adjunctive therapy following surgical excision. Animals Studied. One privately owned 8-year-old female, entire, Black Baldy cow. Procedures. A complete ophthalmic examination was performed on an adult Black Baldy cow for assessment of a mass affecting the left eye. Following a routine partial incision superficial lamellar keratectomy and conjunctivectomy under local analgesia using a Peterson retrobulbar block, photodynamic therapy was performed as an adjunctive treatment to lower the chance for recurrence and improve the prognosis for the globe.

Results

Histopathologic analysis of the limbal mass was reported to be consistent with a squamous cell carcinoma, removed with clean margins. The patient was comfortable and visual with no signs of tumor recurrence 11 months after surgery.

Conclusion

Superficial lamellar keratectomy and conjunctivectomy with adjunctive photodynamic therapy is an effective treatment for limbal squamous cell carcinoma and may be performed as an alternative to enucleation, exenteration, euthanasia, or slaughtering in cattle.

Current Therapeutics and Future Perspectives to Ocular Melanocytic Neoplasms in Dogs and Cats

Neoplasms of melanocytic origin are diseases relevant to dogs and cats' ophthalmic oncology due to their incidence, potential visual loss, and consequent decrease in life quality and expectancy. Despite its non-specific clinical presentation, melanocytic neoplasms can be histologically distinguished in melanocytomas, which present benign characteristics, and malignant melanomas. The diagnosis often occurs in advanced cases, limiting the therapeutic options. Surgery, cryotherapy, radiotherapy, photodynamic therapy (PDT), and laser are currently available therapeutic strategies. As no clinical guidelines are available, the treatment choice is primarily based on the clinician's preference, proficiency, and the owner's financial constraints. While surgery is curative in benign lesions, ocular melanomas present a variable response to treatments, besides the potential of tumour recurrences or metastatic disease. This review presents the currently available therapies for ocular melanocytic neoplasms in dogs and cats, describing the therapeutic, indications, and limitations. Additionally, new therapeutics being developed are presented and discussed, as they can improve the current treatment options.

Rhomboid blepharoplasty and cryotherapy for the treatment of a squamous cell carcinoma on the lower eyelid in a horse

A rhomboid blepharoplasty can be used to achieve functional and cosmetic eyelid reconstruction at the medial canthus in the horse. Combination of a rhomboid blepharoplasty with cryotherapy is a treatment option for eyelid ocular squamous cell carcinomas.

Avian Oncology: Diseases, Diagnostics, and Therapeutics

Companion birds are increasingly living longer due to improved husbandry, nutrition, and veterinary care. As a consequence, a growing number of geriatric disease conditions are diagnosed and managed by veterinarians. Awareness of bird owners of diagnostic and treatment options for neoplastic diseases in humans and domestic animals has led to increasing demand to provide advanced diagnostic and treatment modalities for companion birds diagnosed with neoplasia. Treatment remains challenging in many companion birds due to the lack of information regarding prognosis and efficacy of antineoplastic treatments in these species. There is no established standard of care for most tumors in companion birds.

Photo activation of HPPH encapsulated in "Pocket" liposomes triggers multiple drug release and tumor cell killing in mouse breast cancer xenografts

We recently reported laser-triggered release of photosensitive compounds from liposomes containing dipalmitoylphosphatidylcholine (DPPC) and 1,2 bis(tricosa-10,12-diynoyl)-sn-glycero-3-phosphocholine (DC(8,9)PC). We hypothesized that the permeation of photoactivated compounds occurs through domains of enhanced fluidity in the liposome membrane and have thus called them "Pocket" liposomes. In this study we have encapsulated the red light activatable anticancer photodynamic therapy drug 2-(1-Hexyloxyethyl)-2-devinyl pyropheophorbide-a (HPPH) (Ex/Em410/670 nm) together with calcein (Ex/Em490/517 nm) as a marker for drug release in Pocket liposomes. A mole ratio of 7.6:1 lipid:HPPH was found to be optimal, with >80% of HPPH being included in the liposomes. Exposure of liposomes with a cw-diode 660 nm laser (90 mW, 0-5 minutes) resulted in calcein release only when HPPH was included in the liposomes. Further analysis of the quenching ratios of liposome-entrapped calcein in the laser treated samples indicated that the laser-triggered release occurred via the graded mechanism. In vitro studies with MDA-MB-231-LM2 breast cancer cell line showed significant cell killing upon treatment of cell-liposome suspensions with the laser. To assess in vivo efficacy, we implanted MDA-MB-231-LM2 cells containing the luciferase gene along the mammary fat pads on the ribcage of mice. For biodistribution experiments, trace amounts of a near infrared lipid probe DiR (Ex/Em745/840 nm) were included in the liposomes. Liposomes were injected intravenously and laser treatments (90 mW, 0.9 cm diameter, for an exposure duration ranging from 5-8 minutes) were done 4 hours postinjection (only one tumor per mouse was treated, keeping the second flank tumor as control). Calcein release occurred as indicated by an increase in calcein fluorescence from laser treated tumors only. The animals were observed for up to 15 days postinjection and tumor volume and luciferase expression was measured. A significant decrease in luciferase expression and reduction in tumor volume was observed only in laser treated animal groups injected with liposomes containing HPPH. Histopathological examination of tumor tissues indicated tumor necrosis resulting from laser treatment of the HPPH-encapsulated liposomes that were taken up into the tumor area.

Veterinary photodynamic therapy: a review

Whereas in human medicine photodynamic therapy represents a well-known and recognized treatment option for diverse indications, it is still little known and unfortunately not yet established treatment option for pets. Various photosensitizers and light sources have been used and clinical results have been published. The main indication is a frequently occurring skin tumor in cats: in situ carcinoma/squamous cell carcinoma, mainly found in not or only slightly pigmented areas of the head. For early stages of this tumor, promising results have been published, partly using new, selective drugs to decrease light sensitivity after systemic administration and to increase response rates. Other possible indications are urinary tract neoplasia of dogs and equine sarcoids, the latter representing very common tumors in horses where no effective treatment is known so far. This review article summarizes the role of photodynamic therapy in veterinary medicine.

Modified Kuhnt-Szymanowski surgical procedure for secondary cicatricial ectropion in a horse

A 1-year-old Dutch Warmblood gelding was presented to the University of Florida's Large Animal Hospital (UF-LAH) for correction of ectropion of the right lower eyelid. The ectropion was the result of a lower eyelid laceration. A primary repair was performed by the referring veterinarian; however, the horse prematurely removed the sutures and the wound healed with inversion of the eyelid margin. Surgical correction of the entropion, with removal of tissue from the lower eyelid, resulted in cicatricial ectropion. During the initial evaluation at UF-LAH, a corneal ulcer was noted in the right eye because of exposure from the anatomically nonfunctional lower eyelid. A modified Kuhnt-Szymanowski procedure was performed to correct the ectropion and repair the eyelid margin. The surgical site healed appropriately with an acceptable cosmetic and functional result. No recurrences of corneal ulcers in the right eye were reported in the 18 months following surgical correction of the ectropion.

Equine periocular neoplasia: current concepts in aetiopathogenesis and emerging treatment modalities

Neoplastic adnexal disease represents one of the most frequently encountered and therapeutically challenging ophthalmic problems of horses. This paper reviews current concepts in equine periocular neoplasia. Specifically, a literature-based review of the aetiopathogenesis of the most common tumours to affect the equine eyelid (squamous cell carcinoma, sarcoid, melanoma and lymphosarcoma) is provided. Current and emerging treatment modalities, including photodynamic therapy, are reviewed.

Cellular localization of Visudyne as a function of time after local injection in an in vivo model of squamous cell carcinoma: an investigation into tumor cell death

OBJECTIVE

To evaluate the effects of time on cellular localization of Visudyne after local injection.

ANIMALS

Twenty athymic nude mice.

PROCEDURES

A squamous cell carcinoma (SCC) cell line (A-431) was injected into right and left dorsolumbar subcutaneous tissue of each mouse, representing treatment (T) and control (C) tumors. In experiment 1 (Exp 1; n = 10) and 2 (Exp 2; n = 10), the T tumors received a local injection of Visudyne (0.1 mg/cm(3)), and C tumors received an equal dose of 5% dextrose in water (D5W). Mice were randomly subdivided into two groups (A and B; n = 5 per group). Mice in Exp 1A and B were sacrificed 1 and 30 min after local injection, respectively. Experiment 1A and B tumors were evaluated by fluorescence microscopy to determine drug localization. Experiment 2A and B tumors were exposed to LED illumination 1 and 30 min after injection, respectively, and evaluated by transmission electron microscopy (TEM) to determine ultrastructural tumor cell damage.

RESULTS

Fluorescence was detected within the cytoplasm of T tumors in both Exp 1A and B. Significance was detected in fluorescence intensity between T1 min vs. T30 min (P = 0.03) and between T1 min and C1 min tumors (P = 0.01), respectively. Tumors in Exp 2A and B demonstrated evidence of apoptotic cell death.

CONCLUSIONS

Fluorescence microscopy demonstrated higher Visudyne concentration within SCC cytoplasm of 1 min compared with 30-min tumors. Transmission electron microscopy results revealed that tumors treated by photodynamic therapy (PDT) within 30 min of local injection undergo cellular apoptosis.