Biomedical Photonics (BMP - E-Journal)
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Комбинированная терапия экссудативной формы возрастной макулярной дегенерации сетчатки
Get PDFTreatment outcomes in patients with age-related vascular degeneration due to formation of subretinal neovascular membrane (SNM) of two groups: photodynamic therapy (PDT) with Photosens alone (18 patients) and in combination with anti-VEGF therapy with Lucentis (20 patients). For both groups Photosens was administrated i.v. in single dose of 0.05 mg/kg. The irradiation was performed on the 3rd day (the wave length 675 nm, light dose 120 J/cm2, total light dose did not exceed 500 J/cm2). The number of sessions accounted for 3 to 5 per week according to clinical manifestation of SNM. Patients with multimodality treatment had intravitreal administration of Lucensis in dose 0.05 ml (0.5 mg). The study showed that combination of PDT and anti-VEGF therapy improved vision better and with more stable effect then PDT alone. Thus vision improvement and decrease of SNM activity occurred in 50% of patients with PDT alone and in 60% of patients with multimodality treatment. For 2-year follow-up in the group of PDT alone the vision gradient gradually decreased compared with baseline vision (from 0.11 to 0.06), in the group of multimodality treatment gradual increase of vision gradient was noticed (from 0.03 to 0.155). The superior efficiency of PDT combined with anti-VEGF therapy compared with PDT alone in patients with age-related vascular degeneration was confirmed by study of vision, fundus angiography and average thickness of retina in foveola in both groups
Интраоперационная фотодинамическая терапия больных местнораспространенным раком молочной железы IIIb и IIIc стадий
Get PDFThe study of efficiency of intraoperative photodynamic therapy (PDT) with Photosens as the step of combined modality treatment in patients with IIIВ and IIIС stages of breast cancer was performed. The long-term outcomes were evaluated in two groups of patients: group 1 – after radical extended mastectomy combined with chemotherapy, radiotherapy and chemo- and hormonal therapy (138 patients), group 2 – the same treatment combined with intraoperative PDT (36 patients). For the patients with PDT photosens was administered i.v. in single dose 0.3 mg/kg for 2 h before surgery. The irradiation of operative field was performed single time (the light dose 30 J/cm2), with separate irradiation of subclavian, axillar and adjacent regions (the light dose 50 J/cm2). The results showed that intraoperative PDT was associated with better recurrence-free survival rates in patients with breast cancer: in the PDT group the average recurrence free survival was 44.9±3.4 months, in the group without PDT — 35.3±2.1 months. The obtained results confirm that intraoperative PDT for locally advanced breast cancer can be used successfully for devitalization of cancer cells on the wound superface and for prevention of intraoperative tumor dissemination and post-operative recurrence.
Обзор механизмов селективного накопления фотосенсибилизаторов различной химической структуры в опухолевой ткани
Get PDFThe review of available theories explaining mechanisms of photosensitizer selective accumulation in tumor tissue is represented in the article. Variants associated with both targeted delivery of compounds with different chemical structure to tumor and low elimination rate of photosensitizers in the tumor are described. Details of tumor cell up-take of photosensitizer bounded with lipoproteins due to increased expression of low solidity lipoproteins receptors comparing with normal cells; mechanisms of photosensitizer accumulation in tumor tissue due to phagocytosis by macrophages localized in this area; mechanisms of binding of porphyrin-based photosensitizer by collagen fibers, production of which is increased in tumor cells, and other mechanisms are reviewed. Perspectives of practical application of knowledge about mechanisms of selective accumulation for induced increase in selectiveness of photosensitizer accumulation in tumor through targeted delivery of agent to pathological tissues are shown. Analysis of world trends in the search of transport systems for photosensitizers is performed.
Поиск новых фотосенсибилизаторов для фотодинамической терапии
Get PDFThe review of photosensityzers for photodynamic therapy and fluorescent diagnosis, which are being developed, investigated and applied in clinical practice in Russia and other countries, is represented. Principal properties of photosensitizers based on derivatives of hematoporfirin, chlorines, phtalocyanines, naphthalocyanines, benzoporphyrins, pheophorbides, porphycenes etc are described. Main drugs based on these agents are listed, the field of clinical application is indicated. Special consideration is given to phtalocyanines derivatives and its structural analogues. In particular Russian photosensitizers developed in Research Institute of Organic Intermediates and Dyes under the Program for development and health care practical assimilation of new methods and means of prevention, diagnosis and treatment of cancer, infection and other hazardous diseases are traversed in the article. Methods of synthesis are described, spectral, physical and biological characteristics of synthesized compounds are shown. Представлен обзор разрабатываемых, исследуемых и применяемых в клинической практике в России и за рубежом фотосенсибилизаторов для фотодинамической терапии и флюоресцентной диагностики. Описаны основные свойства фотосенсибилизаторов на основе производных гематопорфирина, хлоринов, фталоцианинов, нафталоцианинов, бензопорфиринов, феофорбидов, порфиценов и др. Перечислены основные лекарственные препараты на их основе, указана область клинического применения. Особое внимание уделено производным фталоцианинов и его структурных аналогов. В частности, подробно освещены отечественные фотосенсиби- лизаторы, разработанные во ФГУП «ГНЦ «НИОПИК» в рамках Программы по разработке и практическому освоению в здравоохранении новых методов и средств профилактики, диагностики и лечения онкологических, инфекционных и других опасных заболеваний. Описаны методы синтеза, даны спектральные, физические и биологические характеристики синтезированных соединений.
Успешное комбинированное эндоскопическое лечение (фотодинамическая терапия + электро- коагуляция) больного ранним раком нижней трети пищевода (14-летнее клиническое наблюдение)
Get PDFThe case of successful use of photodynamic therapy (PDT) combined with electrocautery for treatment of patients with cancer or lower third esophagous is reported. The patient had well-differentiated adenocarcinoma with underlying intestinal metaplasia and I– III displasya. The organ-preserving endoscopic treatment was performed: PDT with phogem (2 courses) combined with electrocautery of tumor (3 sessions). Photogem was administered i.v. in dose 3.0 mg/kg 48 h prior to each session of irradiation (635 nm, light dose 150 J/cm2). Three months after treatment additional PDT in described regimen was performed for residual tumor. The followup accounted for 14 years, the complete regression of esophageal tumor with good functional result without scar deformation and stenosis was observed. Описан клинический случай успешного применения фотодинамической терапии (ФДТ) в сочетании с электрокоагуляцией для лечения больного ранним раком нижней трети пищевода. Морфологически у пациента диагностирована высокодифференцированная аденокарцинома на фоне кишечной метаплазии и дисплазии I–III степени. Пациенту было выполнено органосохраняющее эндоскопическое лечение: ФДТ с препаратом фотогем (2 курса) в сочетании с электрокоагуляцией опухоли (3 сеанса). Препарат фотогем вводили внутривенно капельно в дозе 3,0 мг/кг за 48 ч до проведения каждого сеанса облучения (635 нм, световая доза 150 Дж/см2). Через три мес после лечения из-за наличия остаточной опухоли проведен дополнительный курс ФДТ в описанном режиме. В течение 14 лет с момента проведения лечения пациент находится под динамическим наблюдением, у пациента диагностирована полная регрессия рака пищевода с хорошим функциональным результатом без рубцовой деформации и стеноза в зоне лечения.
Уникальное клиническое наблюдение метахронного опухолевого поражения головного мозга различной гистологической структуры
Get PDF The case of unusual course of brain tumor process – metachronous development of breast cancer brain metastasis and then development of malignant glioma is reported. The surgical treatment for both tumors were performed with intraoperative fluorescence diagnosis and photodynamic therapy. Due to multimodality treatment the patient was alive for 15 months from diagnosis of IV stage breast cancer (brain metastasis). Описан случай нестандартного с точки зрения нейроонкологии течения опухолевого поражения головного мозга – метахронного развития в головном мозге сначала метастатического поражения рака молочной железы, затем злокачественной глиомы. Хирургическое лечение обеих опухолей выполнено с применением интраоперационной флюоресцентной диагностики и фотодинамической терапии. Благодаря комплексному лечению больная прожила 15 месяцев с момента постановки диагноза рака молочной железы IV стадии (с метастатическим поражением головного мозга.
Материалы II всероссийской конференции с международным участием «Актуальные вопросы фотодинамической терапии и фотодиагностики»
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Спектроскопические методы и увеличительная эндоскопия в дифференциальной диагностике патологии толстой кишки
Get PDFThe review of recent development in diagnosis of premalignancy and early cancer in colon is represented. The results of several diagnostic methods which are supplemental for convenient colonoscopy, are described. Thus, NBI system (narrow spectrum endoscopy) and FICE combined with system for magnifying endoscopy significantly improve sensitivity and specifity of diagnostic method. However, the serious disadvantage is coloration of intestinal contents into different shades of red, impeding visualization of small structures and lesions. For detection of dysplasia of different degree in patients with colon polyps high levels of sensitivity and specifity were shown in the methods of magnifying and zoom-endoscopy (93.8% and 64.6%, respectively), confocal laser endomicroscopy (81% and 82%, perspectively), and optic coherent tomography (92% and 84%, respectively). The one of the most recent method – immunophotodiagnosis, showed high efficiency for detection of dysplasia and early cancer in patients with colon polyps: the sensitivity was 78.6%, specifity – 100%. Autofluorescence and fluorescence diagnostics with exogenous photosensitizers. The studies showed that autofluorescence diagnosis was valuable method for differential diagnosis of colon tumors (sensitivity was 85%, specifity – 81%).
Интраоперационная фотодинамическая терапия при неорганных забрюшинных опухолях
Get PDFThe results of treatment in 17 patients with morphologically confirmed resectable primary or recurrent retroperitoneal tumor using intraoperative photodynamic therapy with photogem (5 patients), radaсhlorin (7 patients) and photodithazine (5 patients). The drugs were administered intravenously in following regimen: photogem 48 h before surgery in dose 2.5–3.0 mg/kg, radaсhlorin and photodithazine – 0.7 and 0.7–1.0 mg/kg, respectively, 2–3 h before resection. Irradiation was performed to tumor bed after complete radical removal from one or several positions depending on tumor localization. The light dose accounted for 30 J/cm2, duration of treatment session depended on area of irradiation. Two patients with recurrent tumor had two reoperations with session of photodynamic therapy. One patient had repeated recurrence requiring third surgery with photodynamic therapy. Thus, 17 patients underwent 25 sessions of intraoperative photodynamic therapy. There were no intraoperative complications. One patient had an early post-operative complication in the form of pancreonecrosis which could be associated with extended resection. The recurrence rate was 17.6%. The results showed safety of the method and affinity of utilized photosensitizers to retroperitoneal tumors of different histological types (sarcoma, gastrointestinal stromal tumor and others).