Biomedical Photonics (BMP - E-Journal)
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Фотодинамическая терапия в лечении плоскоклеточного рака слизистой оболочки полости рта и нижней губы
Get PDFTreatment outcomes in 82 patients with primary and recurrent oral and lower lip cancer after photodynamic therapy with photosensitizer Photolon alone or combined with other methods of cancer treatment are represented. According to type and extent of the tumor the single dose of Photolon for intravenous administration accounted for 0.8–2.5 mg/kg, light dose – 100–400 J/cm2 (with wave length of 661 nm). 57 patients had PDT alone; 5 patients – in combination with distant radotherapy; 11 – with distant radiotherapy and polychemotherapy; 9 – with 252Cf interstitial therapy and polychemotherapy. For these patients 3-year overall survival rates were 85.1±4.8%, 3-year reccurence-free survival – 72.2±4.7%. The PDT for recurrent tumors, in cases when other methods were exhausted or impossible, allowed complete tumor response in 82.9% of patients, in 72.9% of them – 3-year disease free survivance. For PDT combined with distant radiotherapy (including concurrent polychemotherapy) the complete response was observed in 100% of patients with primary tumor and in 66.7% of patients with recurrent tumor. For PDT combined with interstitial neutron therapy all patients had complete tumor response. The study showed that this combination allowed decreasing the total radiation dose and radiation dose on adjacent normal tissue, thus, decreasing radiation injury.
Пример успешного применения интраоперационной фотодинамической терапии как этапа комбинированного лечения больной раком молочной железы IIIb cтадии
Get PDFThe case of successful combined modality treatment in patient with stage IIIB T4bN1M0 breast cancer is reported. The first step included 2 courses of neoadjuvant polychemotherapy in CAF regimen with decrease of tumor size. The second step was irradiation (total dose of 45 Gy) of breast and areas of regional metastasis. The third step was radical mastectomy by Madden with polypositional intraoperative photodynamic therapy with photosens (the output laser power 1500 mW, light dose 30 J/cm2, total time of irradiation – 25.6 min). The histological study of surgical specimen showed infiltrative ductal carcinoma with metastases in 3 nodes without fat invasion. In the post-operative period the patient had 3 courses of adjuvant chemotherapy in CAF regimen. Currently the duration of recurrence-free survival after treatment is 4 years. Описан клинический случай успешного комбинированного лечения больной раком молочной железы IIIB стадии T4bN1M0. На первом этапе лечения больной провели два курса неоадъювантной полихимиотерапии по схеме CAF. Вторым этапом терапии стало облучение (СОД 45 Гр) молочной железы и зон регионарного метастазирования. На третьем этапе больной была выполнена радикальная мастэктомия по Маддену и проведена полипозиционная интраоперационная фотодинамическая терапия с препаратом фотосенс (мощность лазера на выходе 1500 мВт, плотность энергии 30 Дж/см2, общее время облучения 25,6 мин.). Гистологическое исследование удаленного узла выявило инфильтративный протоковый рак с метастазами в трех лимфатических узлах без инвазии в клетчатку. В послеоперационном периоде дополнительно было проведено три курса адъювантного лекарственного лечения по схеме CAF. К настоящему моменту продолжительность безрецидивного периода после проведенного лечения составляет 4 года.
Отдаленные результаты хирургического лечения больных местнораспространенным и диссеминированным раком желудка в сочетании с интраоперационной фотодинамической терапией
Get PDFThis article represents the study of safety and efficiency of intraoperative photodynamic peritoneal therapy (IOPDT) developed in P.A. Herzen Moscow Cancer Research Institute. IPPDT was performed in 84 patients with locally advanced and disseminated gastric cancer. The control group included 100 patients with surgical treatment only. All patients underwent subradical or palliative subtotal distal gastroectomy or total gastrectomy with D2, D3 lymph node dissection. For IOPDT group Photohem was administrated intravenously in dose 2,5 mg/kg 48 h prior to operation, the session of peritoneal irradiation was performed after completion of the surgery (with laser device LFT-630-01 «Biospec», wavelength 630nm, light dose 6 J/cm2). IOPDT of peritoneum was associated with good tolerance, did not increase the rate and severity of post-operative complications. The efficiency of IOPDT was assessed with adjusted survival rates in study and control groups by Kaplan-Meier analysis. IOPDT significantly improved the prognosis in patients with subradical treatment, with metastasis in less then 15 lymph nodes. The use of IOPDT after surgery in this group of patients contributed to increase of median survival rate from 29.3 up to 43.6 months, annual survival rates from 80.0±5.7% to 93.7±4.2%, 3-year survival rates from 45.5±7.6% to 82.1±7.1%. Accordingly, IOPDT did not improved outcomes for palliative surgery R1–R2 and in patients with more than 15 involved lymph nodes. В работе представлены результаты исследования безопасности и эффективности методики интраоперационной фотодинамической терапии (ИОФДТ) брюшины, разработанной в МНИОИ им. П.А. Герцена. ИОФДТ проведена 84 пациентам с местнораспространенным и диссеминированным раком желудка. В контрольную группу включено 100 пациентов, которым хирургическое лечение было проведено в режиме монотерапии. Всем пациентам в ходе исследования была выполнена субтотальная дистальная резекция желудка или гастрэктомия с лимфаденэктомией Д2, Д3 с условно-радикальной или паллиативной целью. Пациентам из группы ИОФДТ за 48 ч до проведения операции однократно внутривенно вводили фотогем в дозе 2,5 мг/кг, сеанс облучения брюшины проводили после завершения хирургического этапа лечения (ЛФТ-630-01 «Биоспек», длина волны 630 нм, плотность энергии 6 Дж/см2). Проведение ИОФДТ брюшины сопровождалось хорошей переносимостью, не увеличивало частоту, характер и тяжесть послеоперационных осложнений. Эффективность ИОФДТ оценивали на основании сравнений скорректированной выживаемости в основной и контрольной группах методом Каплана-Майера. Показано, что ИОФДТ достоверно улучшила прогноз у больных с условно-радикальным лечением R0, при общем количестве пораженных лимфатических узлов менее 15. Применение ИОФДТ после хирургического вмешательства у этой группы пациентов позволило повысить медиану выживаемости пациентов с 29,3 до 43,6 мес, годичную выживаемость с 80,0±5,7% до 93,7±4,2%, 3-летнюю выживаемость с 45,5±7,6% до 82,1±7,1%. Вместе с тем, показано, что ИОФДТ не улучшает результаты лечения при паллиативных операциях R1-R2 и у больных при числе пораженных лимфатических узлов более 15.
Роль флюоресцентного исследования в выявлении рецидива рака кожи (клиническое наблюдение)
Get PDFThe case of diagnosis of recurrent skin cancer using fluorescence methods is reported. The patient who underwent multiple courses of treatment (surgical resection, cryotherapy and laser ablation) for multifocal basal cell carcinoma of head. trunk and extremities. The patient represented with multiple whitish scars in the region of surgery, cryotherapy and laser ablation (one of them was in the region of external ear) and with multiple foci of hyperemia and skin peeling. The patient underwent fluorescence diagnosis according to developed regimen: alasens was given per os at a dose of 30 mg/kg body weight 4 h before study. In the white light there were no features of recurrent tumor in scar areas. During fluorescence examination there was bright red fluorescence in the area of ear scar, which was intact visually, with no additional fluorescence foci in regions of surgical resection, cryotherapy and laser ablation and other regions. According to cytological study of shave biopsy from fluorescecnse area of ear scar the recurrence of basal cell skin carcinoma was diagnosed.
Спектрофотометрический интрадермальный анализ в дифференциальной диагностике пигментных новообразований кожи
Get PDFThe non-invasive diagnosis of pigmented skin lesions by spectrophotometric intracutaneous analysis (SIA-scopy) using device for dermatoscopy (SIAscope V by Astron Clinica, Ltd) was approved in P.A.Herzen Moscow Cancer Research Institute. The method is based on analysis of light interaction with wavelength of 440–960 nm anf human skin, which is recorded by change of image on scan. The comparative analysis of SIA-scopy and histological data in 327 pigmented skin lesions in 147 patients showed, that SIA had high diagnostic efficiency for cutaneous melanoma: the sensitivity was 96%, specifity – 94%, diagnostic accuracy – 94%. For study of malignant potential of pigmented lesions by SIA-scopy the most informative capacity was obtained for assessment of melanin in papillary dermis, status of blood vessels and collagen fibres (SIA-scans 3, 4, 5).В МНИОИ им. П.А. Герцена апробирована неинвазивная методика диагностики пигментных новообразований кожи методом спектрофотометрического интрадермального анализа (СИА-скопия) с использованием дерматоскопического диагностического оборудования (СИА-скоп V производства «Астрон Клиника Лтд»). Метод основан на анализе взаимодействия света с волнами излучения длиной от 440 до 960 нм и кожи человека, что фиксируется изменением цвета изображения на скане. Сравнительный анализ результатов СИА-скопии и гистологического исследования 327 пигментных новообразований кожи у 147 пациентов показал, что метод СИА обладает высокой диагностической эффективностью в отношении меланомы кожи: чувствительность метода составила 96%, специфичность – 94%, диагностическая точность – 94%. При исследовании характера злокачественности пигментных образований методом СИА-скопии наибольшая информативность была получена при оценке количества меланина в сосочковом слое дермы, состояния кровеносных сосудов и коллагеновых волокон (СИА-сканы 3, 4, 5).
Профессору Евгению Антоновичу Лукьянцу – 75 лет
Get PDF.21 июля 2013 года исполнилось 75 лет создателю препаратов фотосенс и аласенс профессору Евгению Антоновичу Лукьянцу
Эффективность флюоресцентной диагностики опухолевого поражения плевры с препаратом аласенс
Get PDFThe study of efficacy of thoracoscopy-assisted fluorescence diagnosis with Alasens is described in the article. The results of fluorescence diagnosis in 27 patients with suspicion on pleral tumor are represented. Before thoracoscopy-assisted fluorescence diagnosis in 21 patients according to radiological studies there was a fluid in pleural ca, in 19 patients of them tumor cells were found by cytological study of pleural fluid, in 10 patients differential diagnosis was performed between mesothelioma and adenogenic cancer. For fluorescence diagnosis fluorescence system by company Кarl Storz and xenon lamp with set of light filters was used: fluorescence study was performed by excitation at wavelength 380–460 nm. 3 h before investigation the patient received alasens per os in dose of 30 mg/kg body weight in 100 ml of water. For routine thoracoscopy tumor lesions were determined in 20 (87.0%) patients, other 3 (13.0%) patients had no tumors. In the group of patients with tumor lesions determined by routine thoracoscopy the fluorescence during fluorescence study was registered in all lesions determined in white light, besides this 24 additional foci of fluorescence were noticed, according to morphological study 21 of them had tumor nature, 3 lesions were inflammatory. In 1 of 3 patients with no lesion in white light there was one focus of fluorescence, morphological study proved the metastasis of adenocarcinoma in this area. According to morphological study of pleural biopsy specimens the true-positive results for fluorescence thoracoscopy accounted for 82, false-negative – 10, true-negative – 23, false-positive – 3. The sensitivity of the method was 89,1%, the specificity – 88,4%, the diagnostic accuracy – 88,9%.
Эндоскопическая хирургия и фотодинамическая терапия в лечении доброкачественных и малигнизированных новообразований толстой кишки
Get PDFThe review of literature for current methods of endoscopic treatment for colon epithelial neoplasms is represented. Such types of endoscopic interventions as loop electroresection, submucosal dissection, coagulation and destruction of tumors and combination of several options depending on efficiency of previous therapy is analyzed. Limitations of every method, its special aspects and possible complications are described. Special focus is on specifics of neoplasms for which selected methods may be the most effective. Thus, hot biopsy and destruction using high-energy laser is efficient for small flat neoplasms, endoscopic electroexcision – far small pedunculated lesions, and fragmentation is adequate for exophytic tumors more than 2.0 cm. Long-term results of endoscopic treatment, recurrence rates after different options are represented. The literature for photodynamic therapy consists mostly articles about development (on pre-clenecal stage) of new photosensitizers which are effective for colon cancer, new methods of treatment including combination with hyperthermia in low-dose light irradiation etc. The literature data shows the prospectivity of subsequent developments in this field.
Фотодинамическая терапия больных ранним центральным раком легкого
Get PDFThe results of photodynamic therapy (PDT) for early central lung cancer are represented in the article. The study included 37 patients (52 tumor lesions). For 52 lesions pre-invasive cancer (carcinoma in situ) was determined in 6 cases, squamous cell cancer with invasion within mucosal and submucosal layers of bronchial wall – in 46 cases. 51 tumors were primary lesion, 1 – residual after radiotherapy. 17 of 37 patients underwent previous surgical or combined modality treatment for cancer in other anatomical sites. For PDT we used photosensitizers photogem, photosens and radachlorine. The treatment response was assessed 1 months later by data of endoscopy and morphological study, CT, US and endosonography. Complete regression was achieved in 86,5% of cases, partial regression – in 13,5%. The efficacy of PDT was depended on tumor size. For lesion up to 1 cm in size complete regression was in 100% of cases, from 1.5 cm to 2.0 cm – in 28.6%, for tumors more than 2 cm the complete regression was not achieved. The recurrence of tumor was diagnosed in 2 patients in the period from 1 to 5 years with following successful repeated courses of PDT. Adverse effects included inflammation changes in mucosa at the PDT region with transient (up to 6-7 days) local fibrinous endobronchitis with obturation of segmental bronchial lumen by fibrin membranes (7 patients), scar stenosis of segmental bronchus (2 patients). All patients had increased sensitivity to sun exposure, mild skin burns at exposed areas of body were in 2 patients. The results showed that method was highly efficient and applicable for pre-invasive central lung cancer and in patients with multiple primary bronchial lesions and high risk of surgical complications.
Возможности флюоресцентного исследования в доморфологической эндоскопической диагностике малигнизации аденомы толстой кишки (клиническое наблюдение)
Get PDFThe results of fluorescence diagnosis with alasens in patient with sigmoid polyps are represented in the article. Fluorescence study gave a suspicion of malignant transformation in one of polyps. According to morphological data there was a well-differentiated colon adenocarcinoma with underlying tubular adenoma in suspicious region. Thus, fluorescence data showed malignant tumor prior to routine histological study, which was misdiagnosed for routine colonoscopy and biopsy without fluorescence diagnosis. В статье представлены результаты клинического применения флюоресцентной диагностики с препаратом аласенс у пациентки с полипами сигмовидной кишки. Проведенное флюоресцентное обследование позволило заподозрить малигнизацию одного из полипов. По данным морфологического исследования в подозрительном участке была выявлена высокодифференцированная аденокарцинома толстой кишки на фоне тубулярной аденомы. Таким образом, данные флюоресцентной диагностики свидетельствовали о злокачественном характере новообразования до проведения планового морфологического исследования, что не было диагностировано по данным рутинной колоноскопии и биопсии выполненной без флюоресцентного исследования.