Evaluation of photodynamic therapy in advanced gastrointestinal cancer

Nanomedicine in Clinical Photodynamic Therapy for the Treatment of Brain Tumors

The current treatment for malignant brain tumors includes surgical resection, radiotherapy, and chemotherapy. Nevertheless, the survival rate for patients with glioblastoma multiforme (GBM) with a high grade of malignancy is less than one year. From a clinical point of view, effective treatment of GBM is limited by several challenges. First, the anatomical complexity of the brain influences the extent of resection because a fine balance must be struck between maximal removal of malignant tissue and minimal surgical risk. Second, the central nervous system has a distinct microenvironment that is protected by the blood–brain barrier, restricting systemically delivered drugs from accessing the brain. Additionally, GBM is characterized by high intra-tumor and inter-tumor heterogeneity at cellular and histological levels. This peculiarity of GBM-constituent tissues induces different responses to therapeutic agents, leading to failure of targeted therapies. Unlike surgical resection and radiotherapy, photodynamic therapy (PDT) can treat micro-invasive areas while protecting sensitive brain regions. PDT involves photoactivation of photosensitizers (PSs) that are selectively incorporated into tumor cells. Photo-irradiation activates the PS by transfer of energy, resulting in production of reactive oxygen species to induce cell death. Clinical outcomes of PDT-treated GBM can be advanced in terms of nanomedicine. This review discusses clinical PDT applications of nanomedicine for the treatment of GBM.

Clinical Efficacy of HiPorfin Photodynamic Therapy for Advanced Obstructive Esophageal Cancer

Objective:

To explore the clinical efficacy of HiPorfin photodynamic therapy for advanced esophageal cancer and evaluate its impact on survival.

Methods:

Retrospective analysis of 32 patients with advanced obstructive esophageal cancer at our institution from September 2013 to December 2016. HiPorfin was infused as the photosensitizer at a dose of 5 mg/kg, and after 48 hours, 630-nm laser irradiation was subsequently performed through an optical fiber that passed through the biopsy channel of a flexible endoscope.

Results:

The effectiveness rate was 78.1% (25/32), and the significant efficacy rate was 56.3% (18/32). The dysphagia score decreased from 3.43 ± 0.73 to 1.79 ± 0.53 (P < .05). There was no grade 3 or more toxicity. The median overall survival was estimated to be 16 months. Univariate analysis showed higher overall survival with a Karnofsky Performance Status score ≥80 compared with a Karnofsky Performance Status score <80 (hazard ratio: 2.626; 95% CI: 1.091-6.322; P = .024). Overall survival was higher in patients who had received radiation therapy than in patients who did not receive radiation therapy (hazard ratio: 3.574; 95% CI: 1.501-8.510; P = .002).

Conclusion:

Photodynamic therapy is an effective method for advanced esophageal cancer. The side effects are mild, and the short-term effect is good, especially in the relief of dysphagia. Photodynamic therapy can prolong the survival of patients with advanced esophageal cancer, and the Karnofsky Performance Status score and previous radiation therapy have a significant effect on the overall survival.

Photodynamic therapy for intractable bronchial lung cancer

OBJECTIVE

To investigate the effectiveness and side effects of photofrin-photodynamic therapy (PDT) for intractable bronchial lung cancer.

METHODS

Thirty patients were classified as stage II-IV intractable bronchial lung cancer with lumen obstruction after they failed previous treatment regimens such as surgery, radiotherapy and chemotherapy. PDT was performed with 630 nm laser light (Diomed) delivered through cylinder diffusing tip quartz fibers that was passed through the biopsy channel of a flexible endoscope 48 h after intravenous injection of the photosensitizer photofrin (2mg/kg body weight). 72 h after the first irradiation, the endoscopic procedure was repeated, necrotic tissues were mechanically removed and the deep original lesions and newly exposed cancer lesions were re-treated, and, if necessary, the areas were cleaned repeatedly.

RESULTS

The total response rate CR+PR was 86.7%, and the mean percentage of obstruction due to tumors at different treated sites decreased from 90% to 16.7% at discharge after PDT. The KPS score was significantly improved after PDT.

CONCLUSIONS

PDT of intractable bronchial lung cancer effectively reduces the amount of lumen obstruction, and improves the patient's quality of life. It may be an effective palliative treatment with minor side effects on patients with advanced bronchial lung cancer.

Photodynamic therapy combined with local chemotherapy for the treatment of advanced esophagocardiac carcinoma

BACKGROUND

Photodynamic therapy (PDT) is an effective palliative treatment for gastrointestinal tumors. The aim of this clinical study was to evaluate the efficacy of PDT combined with local chemotherapy for the treatment of advanced esophagocardiac cancer.

METHODS

A total of 140 patients with advanced esophagocardiac cancer were divided into two groups: 42 treated with PDT alone and 98 with combination of PDT and local injection of 5-fluorouracil (5-Fu). The light irradiation was carried out through a diffuser fiber at 24 and 48h after intravenous injection of a domestic photosensitizer PSD-007 (Photocarcinorin, 3-5mg/kg b.w.) at 200-400J/cm under endoscope guidance. Local chemotherapy group was carried out by local injection of 5-Fu (250-500mg) prior to PDT. Treatment was repeated 1-4 times. Short-term and long-term follow up were evaluated.

RESULTS

Short-term efficacy evaluation showed that the rate of significant remission in PDT combined with local chemotherapy group (41.8%) was significantly higher than that in PDT alone group (21.4%, P<0.05). Long-term follow up (up to 36 months) showed that the mean survival time of combined treatment group was longer than that of PDT group (P<0.01).

CONCLUSION

PDT is safe and effective for advanced esophagocardiac cancer. Its therapeutic effect can be further improved when combined with local chemotherapy.

Clinical study of Photofrin photodynamic therapy for the treatment of relapse nasopharyngeal carcinoma

OBJECTIVES

To evaluate the clinical response and adverse effects of Photofrin photodynamic therapy (PDT) in patients with relapse nasal pharyngeal cancer.

METHODS

Thirty patients with relapse nasal pharyngeal cancer were randomly divided into PDT group and chemotherapy group. In PDT group, patients received intravenous administration of Photofrin (2mg/kg b.w.) and 48h later light (200-300J/cm) was delivered by a 630nm diode laser through a cylinder diffuser under endoscopic assistance. Two days after PDT the necrotic tissues were removed and newly identified sites were subject to another round of light irradiation. In chemotherapy group, the routine cisplatin and 5-fluorouracil (DDP/5-FU) remedy was used. Endoscopic and radiological examinations were performed during 6 months follow-up. The Karnofsy Score was used to evaluate the quality of life.

RESULTS

The local response and nasal cavity obstruction remission rate in PDT group were better than that in chemotherapy group. The Karnofsy Score was also improved in PDT group.

CONCLUSION

This pilot study suggests that Photofrin PDT is effective and safe in treatment of advanced nasal pharyngeal cancer and management of nasal obstruction.

Evaluating the role of photodynamic therapy in the management of pancreatic cancer

BACKGROUND AND OBJECTIVE

Cancer of the pancreas constitutes one of the major causes of cancer related death throughout the world. A 5-year survival rate of only 2% and a maximum of 20 months median survival in multi modality treatment studies dealing with the most favorable patients only, has been demonstrated. This review analyzes the principal treatments and available experimental data in view of a clinical application of photodynamic therapy (PDT) for the treatment of pancreatic cancer.

STUDY DESIGN/MATERIALS AND METHODS

On the basis of published results, we examined the palliation of pancreatic cancer by chemotherapy alone; radiation alone and multimodality schedules (radiation and chemotherapy). Radical tumor resection was examined as attempted curative treatment.

RESULTS

In reported therapeutic procedures, palliative or potentially curative, median survival was below 2 years. The GTSG reported survival time increases from 10.9 to 21.0 months when surgery is followed by adjuvant chemotherapy and radiation. This combination postoperatively does not increase mortality, but adds 30% morbidity. Photodynamic therapy has been demonstrated in preclinical studies to have a selective effect on malignant versus the normal pancreas.

CONCLUSION

PDT is highly effective in eliciting the destruction of experimental pancreatic tumors with the lack of significant effect on the normal pancreas. The poor prognosis for patients with this disease, especially those patients with advanced disease, warrants closer examination of PDT for the treatment of pancreatic cancer.