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Zhan PL, Canavan ME, Ermer T, Pichert MD, Li AX, Maduka RC, Kaminski MF, Johung KL, Boffa DJ. Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer. JTO Clin Res Rep 2022; 3:100429. [PMID: 36483656 PMCID: PMC9722471 DOI: 10.1016/j.jtocrr.2022.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction For patients with stage IV esophageal cancer, esophageal radiation may be used selectively for local control and palliation. We aimed to understand patterns of radiation administration among patients with stage IV esophageal cancer and any potential survival associations. Methods In this retrospective cohort study, the National Cancer Database was queried for patients with metastatic stage IV esophageal cancer diagnosed between 2016 and 2019. Patterns of radiation use were identified. Survival was determined through Kaplan-Meier analysis of propensity score-matched pairs of patients who did and did not receive radiotherapy and time-to-event models. Results Overall, 12,088 patients with stage IV esophageal cancer were identified, including 32.7% who received esophageal radiation. The median age was 65 (interquartile range [IQR]: 58-73) years, and 82.6% were male. Among the irradiated patients, the median total radiation dose was 35 (IQR: 30-50) Gy administered in a median of 14 (IQR: 10-25) fractions given in 22 (IQR: 14-39) days. Overall, esophageal radiation was not associated with better survival (log-rank p = 0.41). When stratified by radiation dose, a survival advantage (over no radiation) was found in the 1144 patients (29% of the irradiated patients) who received 45 to 59.9 Gy (time ratio = 1.28, 95% confidence interval: 1.20-1.37, p < 0.001) and the 88 patients (2.2%) who received 60 to 80 Gy (time ratio = 1.37, 95% confidence interval: 1.11-1.69, p = 0.003). Conclusions One-third of the patients with metastatic stage IV esophageal cancer in the National Cancer Database received esophageal radiation. Most received a radiation dose that, although consistent with palliative regimens, was not associated with a survival advantage. Further study is warranted to understand the indications for radiation in stage IV esophageal cancer and potentially reevaluate the most appropriate radiation dose for palliation.
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Affiliation(s)
- Peter Lee Zhan
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Maureen E. Canavan
- Cancer Outcomes Public Policy and Effectiveness Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Theresa Ermer
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew D. Pichert
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Andrew X. Li
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Richard C. Maduka
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Michael F. Kaminski
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Kimberly L. Johung
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Daniel J. Boffa
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
- Corresponding author Address for correspondence: Daniel J. Boffa, MD, MBA, P.O. Box 208062, New Haven, CT 06520-8062.
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Maurits E, van de Graaff MJ, Maiorana S, Wander DPA, Dekker PM, van der Zanden SY, Florea BI, Neefjes JJC, Overkleeft HS, van Kasteren SI. Immunoproteasome Inhibitor-Doxorubicin Conjugates Target Multiple Myeloma Cells and Release Doxorubicin upon Low-Dose Photon Irradiation. J Am Chem Soc 2020; 142:7250-7253. [PMID: 32275401 PMCID: PMC7181259 DOI: 10.1021/jacs.9b11969] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
![]()
Proteasome
inhibitors are established therapeutic agents for the
treatment of hematological cancers, as are anthracyclines such
as doxorubicin. We here present a new drug targeting approach that
combines both drug classes into a single molecule. Doxorubicin was
conjugated to an immunoproteasome-selective inhibitor via light-cleavable
linkers, yielding peptide epoxyketone–doxorubicin prodrugs
that remained selective and active toward immunoproteasomes.
Upon cellular uptake and immunoproteasome inhibition, doxorubicin
is released from the immunoproteasome inhibitor through photoirradiation.
Multiple myeloma cells in this way take a double hit: immunoproteasome
inhibition and doxorubicin-induced toxicity. Our strategy, which entails
targeting of a cytotoxic agent, through a covalent enzyme inhibitor
that is detrimental to tumor tissue in its own right, may find use
in the search for improved anticancer drugs.
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Affiliation(s)
- Elmer Maurits
- Gorlaeus Laboratories, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, The Netherlands
| | - Michel J van de Graaff
- Gorlaeus Laboratories, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, The Netherlands
| | - Santina Maiorana
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98122 Messina, Italy
| | - Dennis P A Wander
- Gorlaeus Laboratories, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, The Netherlands
| | - Patrick M Dekker
- Gorlaeus Laboratories, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, The Netherlands
| | | | - Bogdan I Florea
- Gorlaeus Laboratories, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, The Netherlands
| | - Jacques J C Neefjes
- ONCODE Institute, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Herman S Overkleeft
- Gorlaeus Laboratories, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, The Netherlands
| | - Sander I van Kasteren
- Gorlaeus Laboratories, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, The Netherlands
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Yano T, Wang KK. Photodynamic Therapy for Gastrointestinal Cancer. Photochem Photobiol 2020; 96:517-523. [DOI: 10.1111/php.13206] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Tomonori Yano
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Kashiwa Japan
| | - Kenneth K. Wang
- Division of Gastroenterology and Hepatology Mayo Clinic Rochester MN
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Malacarne MC, Banfi S, Alberton AS, Caruso E. Photodynamic activity of new photosensitizers obtained from 5,10,15,20-tetrapentafluorophenylporphyrin. J PORPHYR PHTHALOCYA 2019. [DOI: 10.1142/s1088424619500962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The commercially available tetrapentafluorophenylporphyrin has been used as parent compounds for the synthesis of six new tetraarylporphyrins. These new porphyrins were obtained following aromatic nucleophilic substitution of the para-position fluorine atoms by means of molecules bearing an oxygen or sulphur anion, providing either tri- or tetra-substituted derivatives which were isolated as pure compounds after a single step of column chromatography purification. These new porphyrins, first analyzed to determine the photobleaching stability and the octanol/water repartition values, were studied as photosensitizers against the HCT116 cancer cell line with irradiation by a blue LED device. The intrinsic toxicity of these compounds was negligible, whereas the photodynamic efficacy was found to be directly related to the cellular uptake of the photosensitizer that was correlated with the hydrophilicity of the substituent. In fact, the PSs lacking of any polar groups were found to be poorly efficient while the photosensitizer bearing four hydroxyl groups showed the greatest photodynamic activity, thus confirming the importance of the presence of polar appendixes to properly interact with the cells, thus exerting the desired photo-killing effect.
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Affiliation(s)
- Miryam C. Malacarne
- Department of Biotechnology and Life Sciences (DBSV). University of Insubria, via J.H. Dunant 3, 21100, Varese (VA), Italy
| | - Stefano Banfi
- Department of Biotechnology and Life Sciences (DBSV). University of Insubria, via J.H. Dunant 3, 21100, Varese (VA), Italy
| | - Anna S. Alberton
- Department of Biotechnology and Life Sciences (DBSV). University of Insubria, via J.H. Dunant 3, 21100, Varese (VA), Italy
| | - Enrico Caruso
- Department of Biotechnology and Life Sciences (DBSV). University of Insubria, via J.H. Dunant 3, 21100, Varese (VA), Italy
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Seah GL, Yu JH, Yang MY, Kim WJ, Kim JH, Park K, Cho JW, Kim JS, Nam YS. Low-power and low-drug-dose photodynamic chemotherapy via the breakdown of tumor-targeted micelles by reactive oxygen species. J Control Release 2018; 286:240-253. [PMID: 30071252 DOI: 10.1016/j.jconrel.2018.07.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 12/31/2022]
Abstract
Tumor-targeted delivery of anticancer agents using nanocarriers has been explored to increase the therapeutic index of cancer chemotherapy. However, only a few nanocarriers are clinically available because the physiological complexity often compromises their ability to target, penetrate, and control the release of drugs. Here, we report a method which dramatically increases in vivo therapeutic drug efficacy levels through the photodynamic degradation of tumor-targeted nanocarriers. Folate-decorated poly(ethylene glycol)-polythioketal micelles are prepared to encapsulate paclitaxel and porphyrins. Photo-excitation generates reactive oxygen species within the micelles to cleave the polythioketal backbone efficiently and facilitate drug release only at the illuminated tumor site. Intravenous injection of a murine xenograft model with a low dose of paclitaxel within the micelles, one-milligram drug per kg (mouse), corresponding to an amount less than that of Taxol by one order of magnitude, induces dramatic tumor regression without any acute systemic inflammation responses or organ toxicity under low-power irradiation (55 mW cm-2) at 650 nm.
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Affiliation(s)
- Geok Leng Seah
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Jeong Heon Yu
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Moon Young Yang
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Woo Jin Kim
- Pathology Research Center, Department of Jeonbuk Inhalation Research, Korea Institute of Toxicology, 30 Baekhak-1-gil, Jeongup, Jeonbuk 56212, Republic of Korea
| | - Jin-Ho Kim
- Samsung Medical Center, Samsung Biomedical Research Institute, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Keunchil Park
- Samsung Medical Center, Samsung Biomedical Research Institute, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea; Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jae-Woo Cho
- Pathology Research Center, Department of Jeonbuk Inhalation Research, Korea Institute of Toxicology, 30 Baekhak-1-gil, Jeongup, Jeonbuk 56212, Republic of Korea
| | - Jee Seon Kim
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea.
| | - Yoon Sung Nam
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea; KAIST Institute for the NanoCentury, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea.
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Ohtani K, Usuda J, Ogawa E, Maehara S, Imai K, Kudo Y, Ono S, Shigefuku S, Eriguchi D, Inoue T, Maeda J, Yoshida K, Hagiwara M, Kakihana M, Kajiwara N, Ohira T, Arai T, Ikeda N. Skin fluorescence following photodynamic therapy with NPe6 photosensitizer. Photodiagnosis Photodyn Ther 2017; 20:210-214. [DOI: 10.1016/j.pdpdt.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/19/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
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Kralova J, Kolar M, Kahle M, Truksa J, Lettlova S, Balusikova K, Bartunek P. Glycol porphyrin derivatives and temoporfin elicit resistance to photodynamic therapy by different mechanisms. Sci Rep 2017; 7:44497. [PMID: 28295025 PMCID: PMC5353759 DOI: 10.1038/srep44497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/08/2017] [Indexed: 12/14/2022] Open
Abstract
The development of drug resistance is a major problem which often occurs during anticancer chemotherapies. Photodynamic therapy (PDT) has been studied as an alternative treatment modality for drug-resistant tumors, however the question of resistance to PDT and potential cross-resistance with chemotherapy has yet to be fully answered. To investigate the mechanism of resistance to PDT, we developed an in vitro experimental model system in a mouse mammary carcinoma cell line 4T1. We used two ethylene glycol derivatives of tetraphenylporphyrin, and tetraphenylchlorin derivative, temoporfin, as photosensitizers (PS). PDT-resistant clones were obtained by exposure to a set concentration of PS followed by irradiation with increasing light doses. PDT resistance to soluble glycol porphyrins was mediated mainly by increased drug efflux through ABCB1 (P-glycoprotein) as we demonstrated by specific ABCB1 knockdown experiments, which in turn rescued the sensitivity of resistant cells to PDT. In contrast, resistance raised to temoporfin, which is generally more lipophilic than glycol porphyrins, elicited mechanism based on sequestration of the drug to lysosomes. The resistance that is acquired from a particular PS could be overcome by using a different PS, which is not susceptible to the same mechanism(s) of resistance. Elucidation of the underlying mechanisms in various types of resistance might facilitate improvements in PDT treatment design.
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Affiliation(s)
- Jarmila Kralova
- CZ-OPENSCREEN: National Infrastructure for Chemical Biology, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
| | - Michal Kolar
- CZ-OPENSCREEN: National Infrastructure for Chemical Biology, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
- Laboratory of Genomics and Bioinformatics, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
| | - Michal Kahle
- CZ-OPENSCREEN: National Infrastructure for Chemical Biology, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
| | - Jaroslav Truksa
- CZ-OPENSCREEN: National Infrastructure for Chemical Biology, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
- Laboratory of Tumor Resistance, Institute of Biotechnology of the ASCR, v. v. i., BIOCEV, Vestec, Prague-West, Czech Republic
| | - Sandra Lettlova
- CZ-OPENSCREEN: National Infrastructure for Chemical Biology, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
- Laboratory of Tumor Resistance, Institute of Biotechnology of the ASCR, v. v. i., BIOCEV, Vestec, Prague-West, Czech Republic
| | - Kamila Balusikova
- CZ-OPENSCREEN: National Infrastructure for Chemical Biology, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
- Division of Cell and Molecular Biology & Center for Research of Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Petr Bartunek
- CZ-OPENSCREEN: National Infrastructure for Chemical Biology, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
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8
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Photodynamic Therapy of Non-Small Cell Lung Cancer. Narrative Review and Future Directions. Ann Am Thorac Soc 2016; 13:265-75. [PMID: 26646726 DOI: 10.1513/annalsats.201509-650fr] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Photodynamic therapy (PDT) is an established treatment modality for non-small cell lung cancer. Phototoxicity, the primary adverse event, is expected to be minimized with the introduction of new photosensitizers that have shown promising results in phase I and II clinical studies. Early-stage and superficial endobronchial lesions less than 1 cm in thickness can be effectively treated with external light sources. Thicker lesions and peripheral lesions may be amenable to interstitial PDT, where the light is delivered intratumorally. The addition of PDT to standard-of-care surgery and chemotherapy can improve survival and outcomes in patients with pleural disease. Intraoperative PDT has shown promise in the treatment of non-small cell lung cancer with pleural spread. Recent preclinical and clinical data suggest that PDT can increase antitumor immunity. Crosslinking of signal transducer and activator of transcription-3 molecules is a reliable biomarker to quantify the photoreaction induced by PDT. Randomized studies are required to test the prognosis value of this biomarker, obtain approval for the new photosensitizers, and test the potential efficacy of interstitial and intraoperative PDT in the treatment of patients with non-small cell lung cancer.
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Rowe EA, Mathews KG, Linder KE, Tate LP. The effect of photodynamic therapy on cisterna chyli patency in rats. Vet Surg 2014; 43:642-9. [PMID: 24909350 DOI: 10.1111/j.1532-950x.2014.12222.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To radiographically and histologically evaluate the effects of photodynamic therapy on the cisterna chyli in rats. STUDY DESIGN Experimental study. ANIMALS Adult male Sprague-Dawley rats (n = 60). METHODS Cecal lymph nodes were injected with the photodynamic compound verteporfin. A 690 nm, 500 mW diode laser was then directed at the area of the cisterna chyli for either 0, 1.5, or 3 minutes. Cisterna chyli patency was evaluated using lymphography, and histologic changes were evaluated on postoperative Days 1, 3, 5, 7, and 14. RESULTS Histologically, minimal to marked injury to the cisternal and/or pericisternal tissues was present in all treated rats at all time periods. Radiographically, 8/20 cisternae were occluded in the 1.5-minute treatment group (including 1/4 on Day 1, 2/4 on Day 3, 3/4 on Day 5, 0/4 on Day 7, and 2/4 on Day 14), and 9/20 cisternae were occluded in the 3-minute treatment group (including 0/4 on Day 1, 1/4 on Day 3, 3/4 on Day 5, 3/4 on Day 7, and 2/4 on Day 14). There was minimal to no histologic evidence of tissue injury in control rats. All control cisternae were radiographically open. CONCLUSIONS Further investigations into the timing of laser application and light dose, or alternative photodynamic agents are required to limit injury to adjacent tissues and to improve the effectiveness of cisternal photoablation.
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Affiliation(s)
- Eric A Rowe
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina
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Stewart DJ, Balamurugan R, Everitt NJ, Ravi K. Ten-year experience of esophageal self-expanding metal stent insertion at a single institution. Dis Esophagus 2013; 26:276-81. [PMID: 22676427 DOI: 10.1111/j.1442-2050.2012.01364.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Palliation of malignant dysphagia can be achieved using self-expanding metal stents (SEMS). This study was conceived to confirm that the insertion of SEMS improved patient symptoms without serious complications and to allow comparison with recent national data. Retrospective case note review of all patients receiving SEMS over a 10-year period between March 1999 and February 2009 was used in this study. There were 138 consecutive patients (50 female), median age of 75 (range 46-90) years, 122 (88.5%) had primary malignant disease of the esophagus or gastroesophageal junction. In total, 250 endoscopic examinations were carried out, with 200 interventional procedures, including the insertion of 156 SEMS. Before stenting, 74.2% of patients had a dysphagia score of 2-3. Following stent insertion, dysphagia scores improved to 0-1 in 90.3% of patients (P < 0.0001, Wilcoxon signed ranks). No complications were encountered in 61 (44%) patients. Chest pain was the most frequent difficulty, encountered in 50 (36%) patients. Tumor overgrowth occurred in 17 (12.3%) patients and food bolus obstruction was seen in 7% of patients. There were no esophageal perforations attributable to SEMS insertion. Overall 30-day mortality for those with esophago-gastric malignancy was 11.6% (16 patients), although the SEMS-related mortality was 2.2% (3 patients). Median survival from SEMS insertion was 3 (IQR 1.5-7) months. Patients requiring re-intervention for tumor overgrowth had a significantly longer median survival of 9.2 months (P= 0.001, log rank). SEMS were well tolerated with overall mortality and complication rates comparable to national data. For the longer survivors, re-intervention for recurrent dysphagia was not unusual.
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Affiliation(s)
- D J Stewart
- Departments of General Surgery Radiology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
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Hiyama K, Matsui H, Tamura M, Shimokawa O, Hiyama M, Kaneko T, Nagano Y, Hyodo I, Tanaka J, Miwa Y, Ogawa T, Nakanishi T, Tamai I. Cancer cells uptake porphyrinsviaheme carrier protein 1. J PORPHYR PHTHALOCYA 2013. [DOI: 10.1142/s1088424612501192] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although exogenous porphyrin accumulation in cancer cells is important for the success of photodynamic therapies, the mechanism is not clear. We hypothesized that a newly reported transporter, heme carrier protein 1 (HCP1), is highly expressed in cancer cells, and transports porphyrins into the cells. We investigated the following three unknowns: whether cancer cells take up hematoporphyrin derivative via HCP1, whether HCP1 is involved in photodynamic therapies, and whether cancer cells highly express HCP1. First, when HCP1-overexpressed cells were treated with hematoporphyrin derivative and then exposed to an eximer laser beam, they emitted a significantly higher intensity of hematoporphyrin derivative fluorescence and became more susceptible to the laser beam than control. Second, when three other types of cancer cells with silenced HCP1 were treated with hematoporphyrin derivative and then exposed to the laser beam, they emitted a significantly lower intensity of hematoporphyrin derivative fluorescence. Third, non-cancer cells slightly expressed HCP1; on the other hand, the three other types of cancer cells clearly expressed HCP1. These results indicated that cancer cells uptake hematoporphyrin derivative via HCP1 and over-expression of HCP1 increases the efficacy of photodynamic therapies by increasing porphyrin accumulation in the cells. This is the first report about a transporter of porphyrin in cancer cells.
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Affiliation(s)
- Kazuhiro Hiyama
- Division of Gastroenterology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Hirofumi Matsui
- Division of Gastroenterology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Masato Tamura
- Division of Gastroenterology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Osamu Shimokawa
- Division of Gastroenterology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Mariko Hiyama
- Division of Gastroenterology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Tsuyoshi Kaneko
- Division of Gastroenterology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Yumiko Nagano
- Division of Gastroenterology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Ichinosuke Hyodo
- Division of Gastroenterology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Junko Tanaka
- Department of Molecular Pharmacology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Yoshihiro Miwa
- Department of Molecular Pharmacology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba 305-8575, Japan
| | - Tetsuo Ogawa
- Department of Membrane Transport and Biopharmaceutics, School of Pharmaceutical Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma, Kanazawa 920-1192, Japan
| | - Takeo Nakanishi
- Department of Membrane Transport and Biopharmaceutics, School of Pharmaceutical Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma, Kanazawa 920-1192, Japan
| | - Ikumi Tamai
- Department of Membrane Transport and Biopharmaceutics, School of Pharmaceutical Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma, Kanazawa 920-1192, Japan
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Perin B, Zaric B, Jovanovic S, Matijasevic J, Stanic J, Kopitovic I, Zvezdin B, Antonic M. Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer. Ann Thorac Med 2012; 7:233-7. [PMID: 23189101 PMCID: PMC3506104 DOI: 10.4103/1817-1737.102184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 07/07/2012] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer. METHODS In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment. RESULTS There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001). CONCLUSION Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD.
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Affiliation(s)
- Branislav Perin
- Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia
| | - Bojan Zaric
- Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia
| | - Svetlana Jovanovic
- Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia
| | - Jovan Matijasevic
- Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia
| | - Jelena Stanic
- Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia
| | - Ivan Kopitovic
- Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia
| | - Biljana Zvezdin
- Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia
| | - Milan Antonic
- Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia
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13
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Chen X, Zhao P, Chen F, Li L, Luo R. Effect and mechanism of 5-aminolevulinic acid-mediated photodynamic therapy in esophageal cancer. Lasers Med Sci 2010; 26:69-78. [PMID: 20676910 DOI: 10.1007/s10103-010-0810-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 06/14/2010] [Indexed: 12/14/2022]
Abstract
5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) provides a novel and promising treatment for esophageal cancer. However, its specific mechanism has not been fully elucidated and its efficacy is remarkably varied. This study investigated the effect of ALA-PDT on esophageal squamous carcinoma cell line Eca-109 in vitro and vivo to explore optimal parameters, and evaluated the significance of cell apoptosis, cell cycle, ALA-protoporphyrin IX (ALA-PpIX) subcellular localization, and expression of Bcl-2 and Bax mRNA in cells to understand the mechanism of ALA-PDT for esophageal cancer. How ALA concentration, incubation time, and laser irradiation dose influenced the cell proliferation was determined by MTT assay. ALA-PpIX subcellular localization was analyzed by confocal microscopy. The mRNA changes were detected by quantitative real-time polymerase chain reaction (QRT-PCR). Tumor models transplanted with Eca-109 cells in nude mice were established (n = 10) and killed (n = 4) at 24 h post-PDT for malondialdehyde (MDA) detection and histological study. The remaining mice were measured the tumor size for 3 weeks after treatment. Our data show that ALA-PDT significantly inhibits cell proliferation (p < 0.05), the PDT efficacy depends on the saturation of ALA concentration, incubation time, and laser irradiation dose, and the best effect in tumor destruction is at 7-14 days post-PDT. ALA-PpIX is localized in mitochondria and cytoplasm. ALA-PDT induces cell apoptosis and arrests cell cycle at G0/G1 phase. Bcl-2 is significantly down-regulated while Bax is up-regulated (p < 0.05). The results of this study provide references in choosing clinical optimal PDT parameters and help in better understanding the PDT mechanism for esophageal cancer.
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Affiliation(s)
- Xiaohua Chen
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
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14
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Shahbaz Sarwar CM, Luketich JD, Landreneau RJ, Abbas G. Esophageal cancer: an update. Int J Surg 2010; 8:417-422. [PMID: 20601255 DOI: 10.1016/j.ijsu.2010.06.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/24/2010] [Accepted: 06/25/2010] [Indexed: 02/08/2023]
Abstract
Esophageal cancer continues to be a lethal disease with the majority of patients presenting at an advanced stage. The incidence of adenocarcinoma is rising. Although Barrett's esophagus has been well characterized, specific pathways to the development of adenocarcinoma remain undefined. Current treatments for locoregional esophageal cancer include surgery, chemotherapy, radiation therapy, or a combination of these modalities. Optimal surgical treatment strategies include appropriate patient selection, accurate staging and risk assessment, selection of an appropriate surgical approach, and the use of multimodality treatment. This article provides an update on the myriad of options for managing esophageal cancer and outlines the surgical technique for minimally invasive esophagectomy used at our center.
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Affiliation(s)
- C M Shahbaz Sarwar
- Heart, Lung & Esopahgeal Surgery Institute, University of Pittsburgh Medical Center, C-800 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Katsanos K, Sabharwal T, Adam A. Stenting of the upper gastrointestinal tract: current status. Cardiovasc Intervent Radiol 2010; 33:690-705. [PMID: 20521050 DOI: 10.1007/s00270-010-9862-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 04/01/2010] [Indexed: 12/16/2022]
Abstract
Minimally invasive image-guided insertion of self-expanding metal stents in the upper gastrointestinal tract is the current treatment of choice for palliation of malignant esophageal or gastroduodenal outlet obstructions. A concise review is presented of contemporary stenting practice of the upper gastrointestinal tract, and the procedures in terms of appropriate patient evaluation, indications, and contraindications for treatment are analyzed, along with available stent designs, procedural steps, clinical outcomes, inadvertent complications, and future technology. Latest developments include biodegradable polymeric stents for benign disease and radioactive or drug-eluting stents for malignant obstructions.
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Affiliation(s)
- Konstantinos Katsanos
- Department of Interventional Radiology, School of Medicine, Patras University Hospital, 26500 Patras, Greece
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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: 29] [Impact Index Per Article: 1.8] [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.
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Affiliation(s)
- Joseph S Friedberg
- Department of Thoracic Surgery, University of Pennsylvania Medical Center-Presbyterian, Philadelphia, Pennsylvania 19104, USA.
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17
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A single-institutional brachytherapy experience in the management of esophageal cancer. Brachytherapy 2009; 9:185-91. [PMID: 19875341 DOI: 10.1016/j.brachy.2009.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 07/30/2009] [Accepted: 08/05/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this work was to analyze the efficacy of high-dose-rate brachytherapy in the management of patients with esophageal cancer. METHODS AND MATERIALS Between 2001 and 2008, 104 patients (88 males and 16 females) received a brachytherapy treatment as a part of a personalized multimodal approach. The median age was 72 years, and the median Karnofsky performance status was 60. Brachytherapy was used in different situations: to complete a primary treatment with radical intent in patients not suitable for surgery; to control local recurrences; or to obtain a rapid and durable palliation of dysphagia in patients with metastases or in poor general condition. In selected cases, endoscopic ultrasound images were integrated in treatment planning procedure to obtain a more accurate volume definition. Efficacy in controlling dysphagia was assessed 1 month after brachytherapy. RESULTS Fifty-one patients received a radical treatment, and 53 patients were treated to relieve the symptoms. The median overall survival was 20.8 months. Lymph node involvement was found to be a significant prognostic factor for overall survival and dysphagia. Dysphagia was controlled in 88 patients (84.6%), and the median dysphagia-free interval was 17.5 months. Early and late adverse events were generally mild to moderate. The most severe effects were esophagotracheal fistulas, observed in 3 patients. CONCLUSIONS Brachytherapy has an important role in the management of esophageal cancer with a low rate of complications. endoscopic ultrasound-assisted treatment planning can be useful for a better individualization of curative treatments.
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18
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Abstract
Oesophageal and gastric cancers are amongst the most frequent and lethal of cancers worldwide. In the US alone, some 13 000 individuals are affected each year, and mortality is particularly high in elderly patients with advanced stage disease and multiple co-morbidities. Patients usually do not present until later in the disease when symptoms occur, once the tumour is sufficiently large to cause obstruction or invasion of adjacent structures. Oesophageal cancer can metastasize to almost any organ, and widespread distant metastases are almost always present at the time of death. Overall mortality from this cancer is around 80-90%. Curative treatment of oesophageal cancer must achieve local control of the primary lesion as well as control and/or prevention of metastases. These are important contributors to overall results when therapy is undertaken in elderly patients, as are the significant risks of adverse effects such as morbidity from chemoradiation and the morbidity and mortality of oesophagectomy. Surgical resection affords the best chance for local control and the best means of palliation of dysphagia for most patients with localized disease, although both local and systemic recurrence of disease are common when surgery is used alone. Because of the low cure rates associated with the use of surgery alone, other modalities have been added to the treatment regimen. Elderly patients with significant cardiac and pulmonary co-morbidity are candidates for nonoperative therapy, even at an early disease stage. There are few data to support a survival advantage from adjuvant radiotherapy or chemotherapy following complete resection, in the absence of documented metastatic disease. Chemotherapy and radiotherapy have both been reported to improve survival when administered preoperatively in patients with oesophageal cancer, while current data using trimodal therapy show a trend towards increased treatment-related mortality with only a slight increase in overall survival. There is currently no completely reliable preoperative method for restaging patients following neoadjuvant chemoradiation in order to assess pathological complete response. Novel restaging techniques are therefore required, in addition to further study of the risks and benefits of neoadjuvant chemoradiotherapy for this disease.
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Affiliation(s)
- Mark J Krasna
- Saint Joseph Cancer Institute, St Joseph Medical Center, Towson, Maryland 21204, USA.
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Rendon A, Beck JC, Lilge L. Treatment planning using tailored and standard cylindrical light diffusers for photodynamic therapy of the prostate. Phys Med Biol 2008; 53:1131-49. [PMID: 18263963 PMCID: PMC2649773 DOI: 10.1088/0031-9155/53/4/021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interstitial photodynamic therapy (PDT) has seen a rebirth, partially prompted by the development of photosensitizers with longer absorption wavelengths that enable the treatment of larger tissue volumes. Here, we study whether using diffusers with customizable longitudinal emission profiles, rather than conventional ones with flat emission profiles, improves our ability to conform the light dose to the prostate. We present a modified Cimmino linear feasibility algorithm to solve the treatment planning problem, which improves upon previous algorithms by (1) correctly minimizing the cost function that penalizes deviations from the prescribed light dose, and (2) regularizing the inverse problem. Based on this algorithm, treatment plans were obtained under a variety of light delivery scenarios using 5-15 standard or tailored diffusers. The sensitivity of the resulting light dose distributions to uncertainties in the optical properties, and the placement of diffusers was also studied. We find that tailored diffusers only marginally outperform conventional ones in terms of prostate coverage and rectal sparing. Furthermore, it is shown that small perturbations in optical properties can lead to large changes in the light dose distribution, but that those changes can be largely corrected with a simple light dose re-normalization. Finally, we find that prostate coverage is only minimally affected by small changes in diffuser placement. Our results suggest that prostate PDT is not likely to benefit from the use of tailored diffusers. Other locations with more complex geometries might see a better improvement.
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Affiliation(s)
- Augusto Rendon
- Department of Medical Biophysics, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
- Ontario Cancer Institute, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - J. Christopher Beck
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, M5S 3G8, Canada, E-mail:
| | - Lothar Lilge
- Department of Medical Biophysics, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
- Ontario Cancer Institute, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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21
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Luketich JD, Pennathur A. How to keep the treatment of esophageal disease in the surgeon's hands. Ann Thorac Surg 2008; 85:S760-S763. [PMID: 18222212 DOI: 10.1016/j.athoracsur.2007.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 11/28/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Affiliation(s)
- James D Luketich
- The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-3221, USA.
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Giuliano EA, Ota J, Tucker SA. Photodynamic therapy: basic principles and potential uses for the veterinary ophthalmologist. Vet Ophthalmol 2007; 10:337-43. [PMID: 17970993 DOI: 10.1111/j.1463-5224.2007.00578.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Photodynamic therapy (PDT) involves the use of photochemical reactions mediated through the interaction of photosensitizing agents, light and oxygen. PDT, while now commonly used in physician ophthalmology and oncology, is uncommonly used for the veterinary ophthalmic patient. It is an emerging new therapy in veterinary ophthalmology for the treatment of periocular tumors. This article reviews the basic principles of PDT to provide the veterinary ophthalmologic community with a succinct reference for this emerging treatment modality in our field.
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Affiliation(s)
- Elizabeth A Giuliano
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO 65211, USA.
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Abstract
The sequelae of advanced malignancies of the chest, whether primary or metastatic, can be severely debilitating. In this review, we discuss the advances in palliative treatment for several intrathoracic complications of malignancy. The treatment of malignant pleural and pericardial effusions now includes a range of chemical sclerosants and percutaneous or surgical interventions. A new generation of promising stent and ablation technologies allows for the treatment of intrinsic or extrinsic airway obstruction. Similar techniques are being explored for esophageal obstruction, while the possible benefit of palliative radiation and chemotherapy continues to be investigated. Although their symptoms are often severe, patients with advanced thoracic malignancies have a growing number and variety of palliative treatment options to improve their quality of life.
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Affiliation(s)
- Warren J Gasper
- Department of Surgery, University of California San Francisco, 513 Parnassus Ave, Room S-321, San Francisco, CA 94143-0470, USA.
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Usuda J, Tsutsui H, Honda H, Ichinose S, Ishizumi T, Hirata T, Inoue T, Ohtani K, Maehara S, Imai K, Tsunoda Y, Kubota M, Ikeda N, Furukawa K, Okunaka T, Kato H. Photodynamic therapy for lung cancers based on novel photodynamic diagnosis using talaporfin sodium (NPe6) and autofluorescence bronchoscopy. Lung Cancer 2007; 58:317-23. [PMID: 17698240 DOI: 10.1016/j.lungcan.2007.06.026] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 06/15/2007] [Accepted: 06/23/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND We had previously developed the possibility of use of a photodynamic diagnosis (PDD) system using a tumor-selective photosensitizer and laser irradiation for the early detection and photodynamic therapy (PDT) for centrally located early lung cancers. Recently, we established the autofluorescence diagnosis system integrated into a videoendoscope (SAFE-3000) as a very useful technique for the early diagnosis of lung cancer. PATIENTS AND METHODS Twenty-nine patients (38 lesions) with centrally located early lung cancer received PDD and PDT using the second-generation photosensitizer, talaporfin sodium (NPe6). Just before the PDT, we defined the tumor margin accurately using the novel PDD system SAFE-3000 with NPe6 and a diode laser (408nm). RESULTS Red fluorescence emitted from the tumor by excitation of the photosensitizer by the diode laser (408nm) from SAFE-3000 allowed accurate determination of the tumor margin just before the PDT. The complete remission (CR) rate following NPe6-PDT in the cases with early lung cancer was 92.1% (35/38 lesions). We also confirmed the loss of red fluorescence from the tumors immediately after the PDT using SAFE-3000. We confirmed that all the NPe6 in the tumor had been excited and photobleached by the laser irradiation (664nm) and that no additional laser irradiation was needed for curative treatment. CONCLUSIONS This novel PDD system using SAFE-3000 and NPe6 improved the quality and efficacy of PDT and avoided misjudgement of the dose of the photosensitizer or laser irradiation in PDT. PDT using NPe6 will become a standard option of treatments for centrally located early lung cancer.
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Affiliation(s)
- Jitsuo Usuda
- Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo 160-0023, Japan.
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