Photodynamic therapy for premalignant lesions in DMBA-treated hamsters: a preliminary study

Quantitative differentiation of normal and scarred tissues using second-harmonic generation microscopy

The aim of this study was to differentiate normal and scarred hamster cheek pouch samples by applying a quantitative image analysis technique for determining collagen fiber direction and density in second-harmonic generation microscopy images. This paper presents a collagen tissue analysis of scarred cheek pouches of four adult male Golden Syrian hamsters as an animal model for vocal fold scarring. One cheek pouch was scarred using an electrocautery unit and the other cheek was used as a control for each hamster. A home-built upright microscope and a compact ultrafast fiber laser were used to acquire depth resolved epi-collected second-harmonic generation images of collagen fibers. To quantify the average fiber direction and fiber density in each image, we applied two-dimensional Fourier analysis and intensity thresholding at five different locations for each control and scarred tissue sample, respectively. The resultant depth-resolved average fiber direction variance for scarred hamster cheek pouches (0.61 ± 0.03) was significantly lower (p < 0.05) than control tissue (0.73 ± 0.04), indicating increased fiber alignment within the scar. Depth-resolved average voxel density measurements indicated scarred tissues contained greater (p < 0.005) fiber density (0.72 ± 0.09) compared to controls (0.18 ± 0.03). In the present study, image analysis of both fiber alignment and density from depth-resolved second-harmonic generation images in epi-detection mode enabled the quantification of the increased collagen fiber deposition and alignment typically observed in fibrosis. The epi-detection geometry is the only viable method for in vivo imaging as well as imaging thick turbid tissues. These quantitative endpoints, clearly differentiating between control and scarred hamster cheek pouches, provide an objective means to characterize the extent of vocal fold scarring in vivo in preclinical and clinical research. In particular, this non-invasive method offers advantages for monitoring scar treatments in live animals and following the effects of scarring-related treatments such as application of steroids or drugs targeting pathways involved in fibrosis. SCANNING 38:684-693, 2016. © 2016 Wiley Periodicals, Inc.

A preliminary study of the safety of red light phototherapy of tissues harboring cancer

OBJECTIVE

Red light phototherapy is known to stimulate cell proliferation in wound healing. This study investigated whether low-level light therapy (LLLT) would promote tumor growth when pre-existing malignancy is present.

BACKGROUND DATA

LLLT has been increasingly used for numerous conditions, but its use in cancer patients, including the treatment of lymphedema or various unrelated comorbidities, has been withheld by practitioners because of the fear that LLLT might result in initiation or promotion of metastatic lesions or new primary tumors. There has been little scientific study of oncologic outcomes after use of LLLT in cancer patients.

METHODS

A standard SKH mouse nonmelanoma UV-induced skin cancer model was used after visible squamous cell carcinomas were present, to study the effects of LLLT on tumor growth. The red light group (n=8) received automated full body 670 nm LLLT delivered twice a day at 5 J/cm(2) using an LED source. The control group (n=8) was handled similarly, but did not receive LLLT. Measurements on 330 tumors were conducted for 37 consecutive days, while the animals received daily LLLT.

RESULTS

Daily tumor measurements demonstrated no measurable effect of LLLT on tumor growth.

CONCLUSIONS

This experiment suggests that LLLT at these parameters may be safe even when malignant lesions are present. Further studies on the effects of photoirradiation on neoplasms are warranted.

Comparison of cryotherapy and photodynamic therapy in treatment of oral leukoplakia

Oral leukoplakia is a pre-malignant lesion of the oral mucosa. The aim of this study is to compare the curative effects of photodynamic therapy and cryotherapy in the treatment of oral leukoplakia. The first group, treated by photodynamic therapy (δ-aminolevulinic acid (ALA), 630-635 nm wavelength), consisted of 48 patients suffering from leukoplakia. The second group consisted of 37 patients treated using cryotherapy. Analyses and comparisons of the complete responses, recurrences, numbers of procedures and adverse effects after both PDT and cryotherapy were obtained. In the first group, a complete response was obtained in 35 patients (72.9%), with thirteen recurrences observed (27.1%) over a six-month period. In the second group, a complete response was obtained in 33 patients (89.2%), and recurrence was observed in nine patients (24.3%). Photodynamic therapy and cryotherapy appear to be comparative methods of treatment that may both serve as alternatives for the traditional surgical treatment of oral leukoplakia. The advantages of PDT are connected with minimally invasive and localized character of the treatment and with not damage of collagenous tissue structures, therefore normal cells will repopulate these arrangements. PDT is more convenient for patients, less painful, and more esthetic.

Pulsed potassium-titanyl-phosphate laser photoangiolytic treatment of mucosal squamous cell carcinoma in the hamster cheek pouch

OBJECTIVES/HYPOTHESIS

Early glottic cancer has been involuted by treatment with the 532 nm pulsed potassium-titanyl-phosphate (KTP) laser in initial clinical studies. Selective photoangiolysis of the sublesional circulation that allows for relative sparing of surrounding tissue is the presumed mechanism. No prior controlled animal-model study has analyzed the ability of selective coagulation of lesional microvasculature coagulation with the KTP laser to involute malignant lesions. This study tests the efficacy of photoangiolysis with the KTP laser in treating squamous cell carcinoma in an established animal model.

STUDY DESIGN

In vivo.

METHODS

Malignant lesions were induced unilaterally in the cheek pouches of 21 hamsters by applying 9,10-dimethyl-1,2-benzanthrancene. The contralateral cheek pouch served as a control. Weekly lesion photodocumentation and pulsed KTP laser (30 W, 15 msec pulse width, 2 pulses/sec) treatments were done. The endpoint of each treatment was a uniform white-blanching of the lesion. Hamsters were sacrificed 1 week after the last treatment and cheek pouches were analyzed histologically.

RESULTS

Carcinoma was confirmed in 19 hamsters, and lesions that were initially <2 mm were more effectively treated than lesions that were >2 mm (P = .0004). Every lesion (10/10) that initially measured <2 mm resolved completely after laser treatment with minimal scarring noted at the treatment site based on histology. Lesions measuring between 2 and 5 mm resolved 33% of the time (2/6), and none (0/3) of the lesions >5 mm resolved after completion of the treatment period.

CONCLUSIONS

Pulsed KTP laser photoangiolysis can effectively involute small malignant lesions, but may be less effective at involuting larger (>2 mm) lesions.

Selectivity of the photosensitiser Tookad for photodynamic therapy evaluated in the Syrian golden hamster cheek pouch tumour model

The response to photodynamic therapy (PDT) with the photosensitiser (PS) Tookad® was measured in the Syrian hamster cheek pouch model on normal mucosae and chemically induced squamous cell carcinoma. This PS is a palladium-bacteriopheophorbide presenting absorption peaks at 538 and 762 nm. The light dose, drug dose and drug injection-light irradiation times (DLI), ranging between 100 and 300 J cm⁻², 1–5 mg kg⁻¹ and 10–240 min respectively, were varied and the response to PDT was analysed by staging the macroscopic response and by the histological examination of the sections of the irradiated cheek pouch. A fast time decay of the tissular response with drug dose of 1–5 mg kg⁻¹ was observed for DLI ranging from 10 to 240 min and for light doses of 100–300 J cm⁻² delivered at a light dose rate of 150 mW cm⁻². A significantly higher level of tissular response was observed for squamous cell carcinoma compared to normal tissue. Nevertheless, the threshold level of the drug–light dose for a detectable response was not significantly different in the tumoral vs normal tissue. The highest response at the shortest DLIs and the absence of measurable response at DLI larger than 240 min at light dose of 300 J cm⁻² and drug dose of 5 mg kg⁻¹ reveals the predominantly vascular effect of Tookad®. This observation suggests that Tookad® could be effective in PDT of vascularised lesions.

Evaluation of the photosensitizer Tookad for photodynamic therapy on the Syrian golden hamster cheek pouch model: light dose, drug dose and drug-light interval effects

We have evaluated the efficacy of the new photosensitizer (PS) Tookad in photodynamic therapy (PDT) in vivo. This PS is a palladium-bacteriopheophorbide presenting absorption peaks at 762 and 538 nm. The light dose, drug dose and drug injection-light irradiation interval (DLI), ranging between 100 and 300 J/cm2, 1 and 5 mg/kg and from 10 to 240 min, respectively, were varied, and the response to PDT was analyzed by staging the macroscopic response and by the histological examination of the sections of the irradiated cheek pouch. The level of PDT response, macroscopically and histologically, shows a strong dependence on the DLI, light dose and drug dose at the applied conditions in the normal hamster cheek pouch. A decay of the tissular response with increasing DLI is observed corresponding to a time of half-maximum response ranging from 10 to 120 min, depending on drug dose and light dose. The tissues affected at the lowest doses are predominantly the vascularized diffuse connective tissue situated between the inner and outer striated muscle (SM) layers as well as these muscle layers themselves. The highest response at the shortest DLI and the absence of a measurable response at DLI longer than 240 min at 300 J/cm2 and drug dose of 5 mg/kg are characteristics of a predominantly vascular effect of this PS. This observation suggests that Tookad could be effective in PDT of vascularized lesions or pathologies associated with the proliferation of neovessels.

Photodynamic therapy (PDT) using topically applied delta-aminolevulinic acid (ALA) for the treatment of oral leukoplakia

BACKGROUND

Photodynamic therapy (PDT) is a non-invasive method for topical and selective treatment of pre-malignant lesions of oral cavity. The aim of our study was to determine therapeutic response to PDT in patients with oral leukoplakia.

METHODS

Twelve patients participated in our study. Lesions affected a variety of intraoral sites. The most common location was buccal, gingival and mandibular mucosa. Patients were treated with topically applied 10% delta-aminolevulinic acid (ALA) and light from an argon-pumped dye laser. Irradiation was performed in several (6-8) sessions using light at 635 nm wavelength, delivering a total dose of 100 J/cm2 per session.

RESULTS

A complete response was obtained in 10 out of 12 treated patients. One recurrence was observed during 6 months.

CONCLUSION

Photodynamic therapy appears to be a feasible alternative to conventional therapy of pre-malignant lesions of oral cavity.

Promotional effects of CO(2) laser and scalpel incision on 4-NQO-induced premalignant lesions of mouse tongue

BACKGROUND AND OBJECTIVES

CO(2) laser and scalpel incision have been demonstrated to have promotional effects on oral neoplastic lesions. However, a precise understanding has not been achieved as to which modality has a more significant effect on cancer promotion. The purpose of this study was to determine the histological and biological changes after CO(2) laser surgery and scalpel incision in oral premalignant lesions.

STUDY DESIGN/MATERIALS AND METHODS

Premalignant lesions of mouse tongue induced by 4-nitroquinoline-1-oxide (4NQO) in drinking water for 4 months were used in this study. A 2-mm incision was made on the right margin of each mouse tongue, using either a CO(2) laser (group A) or a scalpel (group B). Mice without incisional treatment were used as controls (group C). Seven months after laser and scalpel treatments, hematoxylin-eosin staining and proliferating cell nuclear antigen (PCNA), epidermal growth factor receptor (EGFR), and p53 immunostaining were performed for tongue specimens.

RESULTS

The epithelia of right tongue margins showed more severe dysplasia than those of left tongue margins in both group A and group B. The PCNA labeling indices (LIs) and EGFR expression for right tongue margins were also higher than for left margins in both group A and group B. There was no obvious difference between these two groups. Almost no p53-positive staining was found in either group.

CONCLUSION

CO(2) laser surgery and scalpel incision seem to have similar promotional effects on oral premalignant lesions.

Telomerase activation and cell proliferation during 7,12-dimethylbenz[a]anthracene-induced hamster cheek pouch carcinogenesis

Telomerase is a ribonucleoprotein complex intimately involved in cell immortalization and carcinogenesis. This enzyme is activated and stabilizes telomere length in almost all types of cancer. Telomerase may be necessary for continuous cell proliferation. In this study, we analyzed telomerase activity in hamster experimental oral lesions (starting from epithelial hyperplasia through dysplasia, carcinoma in situ, and invasive carcinoma) evoked by 7,12-dimethylbenz[a]anthracene, and in normal mucosa. We also analyzed proliferative activity in these lesions by using immunohistochemical analysis and flow cytometry. Histologically normal epithelium expressed weak telomerase activity. The telomerase activity count increased rapidly in the early stage of carcinogenesis and gradually in the late stage. Cell-proliferative activity closely correlated with progression of disease. These findings indicate that telomerase activation is an early event and that increases in telomerase activity upregulate cell proliferation in chemically induced hamster oral carcinogenesis.

Effect of photodynamic therapy using 5-aminolevulinic acid on 4-nitroquinoline-1-oxide-induced premalignant and malignant lesions of mouse tongue

A new photosensitizing agent 5-aminolevulinic acid (ALA)-based photodynamic therapy (PDT) has been demonstrated as a useful method for treatment of superficial neoplastic lesions. The aim of this study was to determine the effects of topically and systemically ALA-based PDT in neoplastic lesions of the oral cavity. Premalignant and malignant lesions of mouse tongue induced by 4-nitroquinoline-l-oxide (4NQO) were used in this study. At 1, 2 and 3 h after topical application of ALA or 3 h after systemic administration of ALA (250 or 1000 mg/kg), the lesions were irradiated with Nd: YAG dye laser at 630 nm (200 J/cm2). Both premalignant and early malignant lesions showed complete response to systemically ALA-based PDT. In an invasive nodular malignant lesion, however, only the superficial portion was affected. There was no apparent difference in the PDT effect between 250 and 1000 mg/kg doses of ALA. In contrast, topically ALA-based PDT had virtually no effect on most lesions. It was concluded that systemically ALA-based PDT is a useful method for treating premalignant and early malignant lesions in the oral cavity, while topically ALA-based PDT using this preparation may be unsuitable for treatment of oral lesions.