1
|
Hsia T, Small JL, Yekula A, Batool SM, Escobedo AK, Ekanayake E, You DG, Lee H, Carter BS, Balaj L. Systematic Review of Photodynamic Therapy in Gliomas. Cancers (Basel) 2023; 15:3918. [PMID: 37568734 PMCID: PMC10417382 DOI: 10.3390/cancers15153918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Over the last 20 years, gliomas have made up over 89% of malignant CNS tumor cases in the American population (NIH SEER). Within this, glioblastoma is the most common subtype, comprising 57% of all glioma cases. Being highly aggressive, this deadly disease is known for its high genetic and phenotypic heterogeneity, rendering a complicated disease course. The current standard of care consists of maximally safe tumor resection concurrent with chemoradiotherapy. However, despite advances in technology and therapeutic modalities, rates of disease recurrence are still high and survivability remains low. Given the delicate nature of the tumor location, remaining margins following resection often initiate disease recurrence. Photodynamic therapy (PDT) is a therapeutic modality that, following the administration of a non-toxic photosensitizer, induces tumor-specific anti-cancer effects after localized, wavelength-specific illumination. Its effect against malignant glioma has been studied extensively over the last 30 years, in pre-clinical and clinical trials. Here, we provide a comprehensive review of the three generations of photosensitizers alongside their mechanisms of action, limitations, and future directions.
Collapse
Affiliation(s)
- Tiffaney Hsia
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Julia L. Small
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Chan Medical School, University of Massachusetts, Worcester, MA 01605, USA
| | - Anudeep Yekula
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN 554414, USA
| | - Syeda M. Batool
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ana K. Escobedo
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Emil Ekanayake
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dong Gil You
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA 02114, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bob S. Carter
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02215, USA
| | - Leonora Balaj
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02215, USA
| |
Collapse
|
2
|
First Clinical Report of the Intraoperative Macro- and Micro-Photodiagnosis and Photodynamic Therapy Using Talaporfin Sodium for a Patient with Disseminated Lumbar Medulloblastoma. J Clin Med 2023; 12:jcm12020432. [PMID: 36675360 PMCID: PMC9867022 DOI: 10.3390/jcm12020432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023] Open
Abstract
Photodiagnosis (PD) and photodynamic therapy (PDT) using the second-generation photosensitizer talaporfin sodium together with an exciting laser for primary intracranial malignant tumors is well recognized in Japan, and many medical institutions are introducing this new therapeutic option. In particular, intraoperative PDT using talaporfin sodium for infiltrating tumor cells in the cavity walls after the resection of malignant glioma is now covered by health insurance after receiving governmental approvement, and this method has been recommended in therapeutic guidelines for primary malignant brain tumors in Japan. On the other hand, experimental and clinical studies on the development of novel therapeutic strategies for malignant spinal cord tumors have not been reported to date, although their histological features are almost identical to those of intracranial malignant tumors. Therefore, the clinical outcomes of malignant spinal cord tumors have been less favorable than those of malignant brain tumors. In this report, we performed the PD and PDT using talaporfin sodium on a patient with a metastatic lumbar lesion that was detected on magnetic resonance image (MRI) 50 months after the resection of cerebellar medulloblastoma who presented with lumbago and sciatica. We were able to detect the target lesion in the conus medullaris using a surgical microscope, and detected the disseminated medulloblastoma cells floating in the cerebrospinal fluid using a compact fluorescence microscope. Furthermore, we performed PDT to the resected lumbar lesion with the adjuvant platinum-based chemotherapy, and the patient survived a meaningful life for more than 2 years after the lumbar surgery. This report describes the first case of a human patient in whom the efficacy of PD and PDT was demonstrated for a malignant spinal cord tumor.
Collapse
|
3
|
Reinhardt A, Neundorf I. Design and Application of Antimicrobial Peptide Conjugates. Int J Mol Sci 2016; 17:E701. [PMID: 27187357 PMCID: PMC4881524 DOI: 10.3390/ijms17050701] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/25/2016] [Accepted: 05/04/2016] [Indexed: 12/17/2022] Open
Abstract
Antimicrobial peptides (AMPs) are an interesting class of antibiotics characterized by their unique antibiotic activity and lower propensity for developing resistance compared to common antibiotics. They belong to the class of membrane-active peptides and usually act selectively against bacteria, fungi and protozoans. AMPs, but also peptide conjugates containing AMPs, have come more and more into the focus of research during the last few years. Within this article, recent work on AMP conjugates is reviewed. Different aspects will be highlighted as a combination of AMPs with antibiotics or organometallic compounds aiming to increase antibacterial activity or target selectivity, conjugation with photosensitizers for improving photodynamic therapy (PDT) or the attachment to particles, to name only a few. Owing to the enormous resonance of antimicrobial conjugates in the literature so far, this research topic seems to be very attractive to different scientific fields, like medicine, biology, biochemistry or chemistry.
Collapse
Affiliation(s)
- Andre Reinhardt
- Department of Chemistry, Institute of Biochemistry, University of Cologne, Zuelpicher Str. 47, D-50674 Cologne, Germany.
| | - Ines Neundorf
- Department of Chemistry, Institute of Biochemistry, University of Cologne, Zuelpicher Str. 47, D-50674 Cologne, Germany.
| |
Collapse
|
4
|
Concomitant treatment with temozolomide enhances apoptotic cell death in glioma cells induced by photodynamic therapy with talaporfin sodium. Photodiagnosis Photodyn Ther 2014; 11:556-64. [PMID: 25262961 DOI: 10.1016/j.pdpdt.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) induces selective cell death of neoplastic tissue and connecting vasculature by combining photosensitizers with light. We have previously reported that PDT induces apoptotic cell death in glioma cells when the photosensitizer talaporfin sodium (NPe6) is used. Here, we investigated the combined effect of NPe6-PDT with temozolomide, a DNA-alkylating drug used in glioma therapy. METHODS Human glioblastoma T98G cells and human glioma U251 cells were used as glioma cells. Cell viability was evaluated by WST-8 assay. Apoptosis was evaluated by measurement of caspase-3 activity and DNA-fragmentation. Intracellular reactive oxygen species were evaluated by dihydrorhodamine assay. RESULTS While the degree of NPe6-PDT induced cell death unchanged in T98G and U251 cells when temozolomide treatment was adjuvant, it was dose-dependently increased by concomitant treatment with temozolomide. Further, concomitantly administered temozolomide dose-dependently increased caspase-3 activity and DNA-fragmentation, while adjuvant-temozolomide did not. These results are suggesting that concomitantly administered temozolomide potentiates the effect of NPe6-PDT to facilitate apoptotic cell death. Additionally, concomitantly administered temozolomide increased intracellular NPe6-fluorescence and reactive oxygen species, suggesting that the augmentation effect of combined treatment may be due to increased intracellular accumulation of NPe6. CONCLUSION These results suggest that concomitant treatment with NPe6-PDT and temozolomide is a potentially useful therapy for glioma.
Collapse
|
5
|
The effects of PDT in primary malignant brain tumours could be improved by intraoperative radiotherapy. Photodiagnosis Photodyn Ther 2012; 9:40-5. [DOI: 10.1016/j.pdpdt.2011.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/01/2011] [Accepted: 12/02/2011] [Indexed: 11/17/2022]
|
6
|
Bourré L, Giuntini F, Eggleston IM, Mosse CA, MacRobert AJ, Wilson M. Effective photoinactivation of Gram-positive and Gram-negative bacterial strains using an HIV-1 Tat peptide–porphyrin conjugate. Photochem Photobiol Sci 2010; 9:1613-20. [DOI: 10.1039/c0pp00146e] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
7
|
Alves E, Costa L, Carvalho CMB, Tomé JPC, Faustino MA, Neves MGPMS, Tomé AC, Cavaleiro JAS, Cunha A, Almeida A. Charge effect on the photoinactivation of Gram-negative and Gram-positive bacteria by cationic meso-substituted porphyrins. BMC Microbiol 2009; 9:70. [PMID: 19368706 PMCID: PMC2672088 DOI: 10.1186/1471-2180-9-70] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 04/15/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent times photodynamic antimicrobial therapy has been used to efficiently destroy Gram (+) and Gram (-) bacteria using cationic porphyrins as photosensitizers. There is an increasing interest in this approach, namely in the search of photosensitizers with adequate structural features for an efficient photoinactivation process. In this study we propose to compare the efficiency of seven cationic porphyrins differing in meso-substituent groups, charge number and charge distribution, on the photodynamic inactivation of a Gram (+) bacterium (Enterococcus faecalis) and of a Gram (-) bacterium (Escherichia coli). The present study complements our previous work on the search for photosensitizers that might be considered good candidates for the photoinactivation of a large spectrum of environmental microorganisms. RESULTS Bacterial suspension (10(7) CFU mL(-1)) treated with different photosensitizers concentrations (0.5, 1.0 and 5.0 microM) were exposed to white light (40 W m(-2)) for a total light dose of 64.8 J cm(-2). The most effective photosensitizers against both bacterial strains were the Tri-Py+-Me-PF and Tri-Py+-Me-CO2Me at 5.0 microM with a light fluence of 64.8 J cm(-2), leading to > 7.0 log (> 99,999%) of photoinactivation. The tetracationic porphyrin also proved to be a good photosensitizer against both bacterial strains. Both di-cationic and the monocationic porphyrins were the least effective ones. CONCLUSION The number of positive charges, the charge distribution in the porphyrins' structure and the meso-substituent groups seem to have different effects on the photoinactivation of both bacteria. As the Tri-Py+-Me-PF porphyrin provides the highest log reduction using lower light doses, this photosensitizer can efficiently photoinactivate a large spectrum of environmental bacteria. The complete inactivation of both bacterial strains with low light fluence (40 W m(-2)) means that the photodynamic approach can be applied to wastewater treatment under natural light conditions which makes this technology cheap and feasible in terms of the light source.
Collapse
Affiliation(s)
- Eliana Alves
- Department of Biology & CESAM, University of Aveiro, 3810-193 Aveiro, Portugal.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Namatame H, Akimoto J, Matsumura H, Haraoka J, Aizawa K. Photodynamic therapy of C6-implanted glioma cells in the rat brain employing second-generation photosensitizer talaporfin sodium. Photodiagnosis Photodyn Ther 2008; 5:198-209. [DOI: 10.1016/j.pdpdt.2008.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 08/04/2008] [Accepted: 08/07/2008] [Indexed: 11/15/2022]
|
9
|
Varma AK, Muller PJ. Cranial neuropathies after intracranial Photofrin-photodynamic therapy for malignant supratentorial gliomas—a report on 3 cases. ACTA ACUST UNITED AC 2008; 70:190-3. [DOI: 10.1016/j.surneu.2007.01.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 01/11/2007] [Indexed: 11/16/2022]
|
10
|
Matsumura H, Akimoto J, Haraoka J, Aizawa K. Uptake and retention of the photosensitizer mono-l-asparthyl chlorine e6 in experimental malignant glioma. Lasers Med Sci 2007; 23:237-45. [PMID: 17703335 DOI: 10.1007/s10103-007-0469-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 04/27/2007] [Indexed: 10/22/2022]
Abstract
The objective of the study was to investigate the potential of mono-L-aspartyl chlorine e6 (NPe6), a water-soluble photosensitizer derived from chlorophyll, for use in photodynamic diagnosis (PDD) of malignant brain tumor. A C6 glioma cell line was transplanted in the SD rat brain to create a brain tumor model. Five days after transplantation, NPe6 was administrated via the tail vein at concentrations ranging from 1.25 to 10 mg/kg; then the skull was opened in the rat brain, the site of tumor transplant was irradiated with a diode laser beam at 664 nm, and the time-course intensity and distribution of emerging fluorescence were observed. Furthermore, the correlation between fluorescence distribution and histopathological findings was investigated in the removed brain. Fluorescence was observed in the site of brain tumor transplant from 5 min after injection, and stable fluorescence was recognized at the site until 4 h after administration. No differences were noted in fluorescence intensity at NPe6 doses of 2.5 mg/kg or more; therefore, it was possible to estimate the optimal dose range. Fluorescence distribution had a clear correlation with tumor cell density, and it was possible to capture the margin of tumor cell invasion with fluorescence. The photosensitizer NPe6 is capable of assessing tumor cell density in malignant glioma tissue in terms of differences in fluorescence intensity. The usefulness of PDD using 5-aminoleveulinic acid during surgery for malignant glioma has been recognized in recent years. The results of the present study suggested the potential of NPe6 as a promising photosensitizer for use in PDD for accurate grasp of the extent of removal during the course of malignant glioma surgery.
Collapse
Affiliation(s)
- Hiroyuki Matsumura
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo 160-0023, Japan
| | | | | | | |
Collapse
|
11
|
Kostron H, Fiegele T, Akatuna E. Combination of FOSCAN® mediated fluorescence guided resection and photodynamic treatment as new therapeutic concept for malignant brain tumors. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.mla.2006.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Stylli SS, Kaye AH. Photodynamic therapy of cerebral glioma – A review Part II – Clinical studies. J Clin Neurosci 2006; 13:709-17. [PMID: 16567094 DOI: 10.1016/j.jocn.2005.11.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 11/27/2005] [Indexed: 01/02/2023]
Abstract
Photodynamic therapy (PDT) is a binary treatment modality that has been used to treat malignant brain tumours for 25 years. The treatment involves the selective uptake of a photosensitizer (PS) by the tumour cells followed by irradiation of the tumour with light of the appropriate wavelength to excite and activate the PS resulting in selective tumour destruction and is a potentially valuable adjunct to surgical excision and other conventional therapies. PDT has undergone extensive laboratory studies and clinical trials with a variety of PS and tumour models. These are discussed with reference mainly to clinical studies involving the PDT of brain tumours.
Collapse
Affiliation(s)
- Stanley S Stylli
- Department of Neurosurgery, Department of Surgery, 5th Floor Clinical Sciences Building, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3052, Australia.
| | | |
Collapse
|
13
|
Ozawa T, Britz GW, Kinder DH, Spence AM, VandenBerg S, Lamborn KR, Deen DF, Berger MS. Bromophenol blue staining of tumors in a rat glioma model. Neurosurgery 2006; 57:1041-7; discussion 1041-7. [PMID: 16284574 DOI: 10.1227/01.neu.0000180036.42193.f6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE For patients with gliomas, decreasing the tumor burden with macroscopic surgical resection may affect quality of life, time to tumor progression, and survival. Injection of bromophenol blue (BPB) may enhance intraoperative visualization of an infiltrating tumor and its margins and improve the extent of resection. In this study, we investigated the uptake of BPB in experimental rat brain tumors. METHODS We first conducted a toxicity study with bolus intravenous injections of 5, 60, and 360 mg/kg doses of BPB in nontumor-bearing Fischer 344 rats. No adverse effects were observed in any of the animals during the 60 day observation period. We then injected 9L tumor cells intracerebrally into Fischer 344 rats and approximately 2 weeks later, administered a bolus intravenous injection of 5 to 360 mg/kg BPB. Fifteen minutes after BPB injection, we sacrificed the animals and removed their brains. In a subsequent study, we injected 180 mg/kg BPB and sacrificed animals at several time points to monitor tumor staining over time. RESULTS The stain was clearly visible and localized to the tumor for all BPB concentrations 60 mg/kg or greater, and in an additional experiment, we found that tumor staining persisted for at least 8 hours after BPB injection. CONCLUSION We conclude that BPB helped visualize experimental tumors at time points from a few minutes to several hours after injection. Because BPB also proved to be nontoxic to the animals at effective concentrations, we believe the compound may be potentially useful in helping neurosurgeons visualize brain tumors in humans.
Collapse
Affiliation(s)
- Tomoko Ozawa
- Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Allison R, Mota H, Sibata C. Clinical PD/PDT in North America: An historical review. Photodiagnosis Photodyn Ther 2004; 1:263-77. [DOI: 10.1016/s1572-1000(04)00084-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 12/19/2004] [Indexed: 10/25/2022]
|
15
|
Eljamel MS. Brain PDD and PDT unlocking the mystery of malignant gliomas. Photodiagnosis Photodyn Ther 2004; 1:303-10. [DOI: 10.1016/s1572-1000(05)00008-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Revised: 11/15/2004] [Accepted: 01/29/2005] [Indexed: 11/24/2022]
|
16
|
Olzowy B, Hundt CS, Stocker S, Bise K, Reulen HJ, Stummer W. Photoirradiation therapy of experimental malignant glioma with 5-aminolevulinic acid. J Neurosurg 2002; 97:970-6. [PMID: 12405389 DOI: 10.3171/jns.2002.97.4.0970] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Accumulation of protoporphyrin IX (PPIX) in malignant gliomas is induced by 5-aminolevulinic acid (5-ALA). Because PPIX is a potent photosensitizer, the authors sought to discover whether its accumulation might be exploited for use in photoirradiation therapy of experimental brain tumors, without injuring normal or edematous brain. METHODS Thirty rats underwent craniotomy and were randomized to the following groups: 1) photoirradiation of cortex (200 J/cm2, 635-nm argon-dye laser); 2) photoirradiation of cortex (200 J/cm2) 6 hours after intravenous administration of 5-ALA (100 mg/kg body weight); 3) cortical cold injury for edema induction; 4) cortical cold injury with simultaneous administration of 5-ALA (100 mg/kg body weight) and photoirradiation of cortex (200 J/cm2) 6 hours later; or 5) irradiation of cortex (200 J/cm2) 6 hours after intravenous administration of Photofrin II (5 mg/kg body weight). Tumors were induced by cortical inoculation of C6 cells and 9 days later, magnetic resonance (MR) images were obtained. On Day 10, animals were given 5-ALA (100 mg/kg body weight) and their brains were irradiated (100 J/cm2) 3 or 6 hours later. Seventy-two hours after irradiation, the brains were removed for histological examination. Irradiation of brains after administration of 5-ALA resulted in superficial cortical damage, the effects of which were not different from those of the irradiation alone. Induction of cold injury in combination with 5-ALA and irradiation slightly increased the depth of damage. In the group that received irradiation after intravenous administration of Photofrin II the depth of damage inflicted was significantly greater. The extent of damage in response to 5-ALA and irradiation in brains harboring C6 tumors corresponded to the extent of tumor determined from pretreatment MR images. CONCLUSIONS Photoirradiation therapy in combination with 5-ALA appears to damage experimental brain tumors selectively, with negligible damage to normal or perifocal edematous tissue.
Collapse
Affiliation(s)
- Bernhard Olzowy
- Department of Neurosurgery, Institute for Neuroradiology, Laser Research Laboratory, Institute for Neuropathology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | | | | |
Collapse
|
17
|
Chan Y, Ip SM, Poon WS, Wickham N. Photodynamic therapy in malignant brain tumour: Is intratumoral injection of photosensitizer superior to conventional intravenous administration? ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1442-2034.2002.00129.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
18
|
Keller E, Ishihara H, Nadler A, Niederer P, Seifert B, Yonekawa Y, Frei K. Evaluation of brain toxicity following near infrared light exposure after indocyanine green dye injection. J Neurosci Methods 2002; 117:23-31. [PMID: 12084561 DOI: 10.1016/s0165-0270(02)00044-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Indocyanine green (ICG) has excellent safety records and is widely used in medical diagnosis. Recently, a new method has been developed to estimate cerebral blood flow (CBF) using ICG in combination with near-infrared spectroscopy (NIRS). The new technique may be of wide clinical interest, as it is noninvasive and easy to perform at the bedside in stroke patients. Additionally, ICG with the use of specific wavelength lasers is documented to be effective in photodynamic therapy (PDT). Under normal conditions ICG does not cross the intact blood brain barrier (BBB). However, in patients with brain injuries where the BBB may be disturbed, ICG could accumulate in brain parenchyma and in combination with NIR-light exposure, phototoxicity could occur. The aim of the present study was to examine the possible toxicity of ICG in combination with NIRS in a specific setting for CBF measurements. In five rats with mannitol induced BBB breakdown no traces of ICG were found during spectrophotometric analysis of the brain cell suspensions. In ten rats with disrupted BBB there were no significant increases of brain temperature or histological signs of brain damage following 1 h NIR-light exposure after ICG injection. The existing literature concerning the application of ICG in combination with NIR light is reviewed.
Collapse
Affiliation(s)
- Emanuela Keller
- Department of Neurosurgery, University of Zurich, University Hospital, Nord 1, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
19
|
Britz GW, Ghatan S, Spence AM, Berger MS. Intracarotid RMP-7 enhanced indocyanine green staining of tumors in a rat glioma model. J Neurooncol 2002; 56:227-32. [PMID: 12061728 DOI: 10.1023/a:1015035213228] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The extent of resection in patients with primary brain tumors may affect the quality of life, time to tumor progression, and survival. Currently, the extent of resection during surgery is guided by the visual appearance and consistency of tumor, frozen sections of the margins, intraoperative ultrasound, and frameless navigational systems and intraoperative imaging modalities. A new method that enhances the visualization of an infiltrating tumor and its margins may further aid in obtaining a more complete resection. A study was thus undertaken to assess the staining of brain tumors using Indocyanine green (ICG), a water-soluble emerald green tricarbocynanine dye concomitantly with RMP-7, a bradykinin analog, that selectively increases vascular permeability in brain tumors. METHODS A syngeneic ethyl-nitrosourea-induced F-344 rat cell line (36B-10) was stereotactically implanted into 25 rats, and allowed to mature for 15-18 days. Intracarotid administration of 0.75 ml of RMP-7 at a standard dose of 0.4 microg/ml over 15 min was then infused. Varying doses of ICG (range, 0-60 mg/kg) were then injected 15 min after the RMP-7 infusion ended. The animals were sacrificed 15 min after the ICG infusion was completed, and the brains examined macroscopically and microscopically for evidence of tumor staining. RESULTS This study demonstrated consistent staining of the tumor at only slightly lower ICG doses than previously described, however uptake at the tumor margins was evident at much lower doses. Thus the combination of ICG and RMP-7 administered preoperatively may provide visual enhancement of an infiltrating tumor and its margins to help facilitate a radical tumor removal.
Collapse
Affiliation(s)
- Gavin W Britz
- Department of Neurological Surgery, University of Washington, Seattle, USA
| | | | | | | |
Collapse
|
20
|
Affiliation(s)
- D C Shackley
- Patterson Institute for Cancer Research, Christie Hospital NHS Trust, Manchester, UK.
| | | | | | | | | |
Collapse
|
21
|
Tudge SH, Kaye AH, Hill JS. Modulation of light delivery in photodynamic therapy of brain tumours. J Clin Neurosci 1999; 6:227-32. [DOI: 10.1016/s0967-5868(99)90508-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/1998] [Accepted: 05/05/1998] [Indexed: 10/26/2022]
|
22
|
Fanuel-Barret D, Patrice T, Foultier MT, Vonarx-Coinsmann V, Robillard N, Lajat Y. Influence of epidermal growth factor on photodynamic therapy of glioblastoma cells in vitro. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1998; 197:219-33. [PMID: 9440140 DOI: 10.1007/s004330050071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Photodynamic therapy (PDT) could be a useful adjuvant in glioblastoma treatment. The fact that epidermal growth factor (EGF) and its receptor are involved in glioblastoma growth control led us to investigate the relationships between EGF and PDT with respect to three different glioma cell lines (C6, T98 G, U87 MG) responsive to growth stimulation by EGF. Flow cytometric analysis revealed that each cell line expressed EGF receptors. PDT was then applied to the cells using haematoporphyrin derivative (HPD) as photosensitizer and argon laser irradiation. When cells were incubated for 2 h with HPD (0.1-10 micrograms/ml) and then laser-irradiated (lambda = 514 nm; energy density 25 J/cm2), all three cell lines showed photosensitivity. The median lethal dose was respectively 3, 4.5 and 2.7 micrograms/ml for C6, T98 G and U87 MG. EGF (2-50 ng/ml) had no effect on HPD- and laser-induced toxicity when added to cells before PDT, whereas toxicity decreased for all three cell lines when EGF was added after PDT. HPD (1-2 micrograms/ml, incubation times 30-180 min) also induced an increase in EGF receptor expression for the C6 line.
Collapse
Affiliation(s)
- D Fanuel-Barret
- Laboratoire de Médecine, Ecole Nationale Vétérinaire de Nantes, France
| | | | | | | | | | | |
Collapse
|
23
|
Kostron H, Obwegeser A, Jakober R. Photodynamic therapy in neurosurgery: a review. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 1996; 36:157-68. [PMID: 9002253 DOI: 10.1016/s1011-1344(96)07364-2] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Photodynamic therapy (PDT) has been investigated extensively, both experimentally and clinically, as an adjunctive treatment in the neuro-oncological field. It is based on the more selective accumulation of a photosensitizer in malignant than normal tissue with low systemic toxicity. Subsequent light activation induces photo-oxidation, followed by selective tumour destruction via vascular and direct cellular mechanisms. Malignant brain tumours carry a lethal prognosis with a median survival of 15 months despite surgery, radiotherapy and chemotherapy. PDT is therefore a logical therapeutic concept for brain tumours infiltrating into normal brain. In this review, all the available data on patients treated with haematoporphyrin derivative-mediated PDT are critically analysed. Over 310 patients have been reported in the literature suffering from primary or recurrent malignant brain tumours which were treated with PDT following tumour resection in open clinical phase I/II trials. This number includes 58 patients treated at our own institution. Variations in the treatment protocols make evaluation scientifically difficult; however, there is a clear trend of increased median survival after surgical resection and one single photodynamic treatment. PDT is generally well tolerated and side effects consist of moderate increased intracranial pressure and prolonged skin sensitivity to direct sunlight. The current available data indicate that PDT is a safe treatment, which is well tolerated by the patients and yields an improvement in survival of those with malignant brain tumours. Conclusive information can be expected from controlled clinical trials which are currently being designed. The results raise the hope that PDT will be a valuable addition to the armamentarium for the treatment of cerebral malignancies.
Collapse
Affiliation(s)
- H Kostron
- Department of Neurosurgery, University of Innsbruck, Austria
| | | | | |
Collapse
|
24
|
Popovic EA, Kaye AH, Hill JS. Photodynamic therapy of brain tumors. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1996; 14:251-61. [PMID: 9612191 DOI: 10.1089/clm.1996.14.251] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Photodynamic therapy (PDT) for the treatment of a variety of brain tumors, particularly gliomas, has been extensively investigated in laboratory studies and has been studied in clinical trials. The main advantage of PDT lies in its ability to select out tumor cells that are infiltrating brain parenchyma and that are responsible for local tumor recurrence, the major therapeutic dilemma in the treatment of gliomas. PDT has been shown to be safe clinically but adequate trials have yet to be undertaken to prove its efficacy and much work remains to be done to optimize treatment. The laboratory studies and clinical trials involving PDT in the treatment of cerebral tumors, particularly the commonest brain tumors, gliomas, are discussed.
Collapse
Affiliation(s)
- E A Popovic
- Department of Neurosurgery, Melbourne Neuroscience Centre, Royal Melbourne Hospital, Victoria, Australia
| | | | | |
Collapse
|
25
|
Muller PJ, Wilson BC. Photodynamic therapy for malignant newly diagnosed supratentorial gliomas. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1996; 14:263-70. [PMID: 9612192 DOI: 10.1089/clm.1996.14.263] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report the use of photodynamic therapy (PDT) in the treatment of 20 patients with newly diagnosed malignant supratentorial gliomas. There were 10 males and 10 females; their mean age was 56 years and the mean Karnofsky score was 75. Eleven patients had glioblastoma multiforme (GBM) and 9 had malignant astrocytoma (MA). Intravenous porphyrin photosensitizer was administered 12-36 h prior to surgery and photoillumination. At operation all patients had the tumor subtotally resected followed by intraoperative cavitary photoillumination. Interstitial photoillumination using fibers with 2-cm diffusing tips supplemented the cavitary illumination in 3 patients. The total light energy delivered ranged from 570 to 4050 J (median = 1260 J). The energy density ranged from 15 to 110 J/cm2 (median = 32 J/cm2). All but two had postoperative radiation therapy (5000 cGy in 5 weeks). No untoward effects of radiation in conjunction with PDT were identified. There was 1 postoperative death and 1 patient had a persistent increase in postoperative neurological deficit. The median survival of these 20 patients with newly diagnosed malignant gliomas was 44 weeks with a 1- and 2-year survival of 40 and 15%, respectively. The median survival of these patients with newly diagnosed GBM was 37 weeks with a 1- and 2-year survival of 35 and 0%, respectively, and the median survival for MA was 48 weeks with a 1- and 2-year survival of 44 and 33%, respectively. Six patients with a Karnofsky score of > 70 who received a light dose of > 1260 J (mean energy density = 62 +/- 20 SEM J/cm2) had a median survival of 92 weeks with a 1- and 2-year survival of 83 and 33% respectively. Patients with malignant astrocytic tumors (GBM and MA) have a very poor prognosis. Nevertheless PDT is safe in newly diagnosed patients with supratentorial malignant gliomas who undergo postoperative radiation and appears to prolong survival in selected patients when an adequate light dose is used. Further improvement in survival may be expected with higher light doses.
Collapse
Affiliation(s)
- P J Muller
- Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | | |
Collapse
|
26
|
Abstract
One of the potential variables affecting the overall survival and quality of life of patients with intracranial gliomas is the extent of tumor resection that results in the smallest volume of residual disease. A technique involving enhanced optical imaging of human gliomas has the potential to localize tumors, identify tumor remaining at the resection margins, and determine the grade of the tumor. In a preliminary study involving nine patients undergoing surgery for the removal of intrinsic brain tumors, enhanced optical imaging was performed using indocyanine green as an intravenous contrast-enhancement agent. Optical images were obtained before and after injection of the indocyanine green. The studies in the nine patients showed differences in the dynamic optical signals among normal brain, low-grade astrocytomas, and malignant astrocytomas. Optical imaging of the resection margins in malignant tumors showed differences between adjacent normal tissue and remaining tumor tissue. Enhanced optical imaging of human gliomas using a contrast-enhancing dye, indocyanine green, provides a potential means to differentiate between normal brain and tumor tissue at the cortical surface and the depths of the resection margins. Having the ability to obtain real-time information and feedback in the operating room may allow neurosurgeons to maximize the extent of tumor resection while sparing normal brain and increasing the diagnostic accuracy of intraoperative biopsies. Enhanced optical imaging potentially could facilitate the accuracy and safety of surgery when tumors are removed at sites even outside the central nervous system.
Collapse
Affiliation(s)
- M M Haglund
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, USA
| | | | | |
Collapse
|
27
|
Popovic EA, Kaye AH, Hill JS. Photodynamic therapy of brain tumors. SEMINARS IN SURGICAL ONCOLOGY 1995; 11:335-45. [PMID: 7569555 DOI: 10.1002/ssu.2980110503] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Photodynamic therapy (PDT) is a binary treatment modality suitable for various malignant tumors including brain. It involves the selective uptake of a photosensitizer into tumor followed by intraoperative irradiation of the tumor with light of an appropriate wavelength to cause activation of the sensitizer and subsequent selective tumor destruction. PDT has been extensively investigated in laboratory studies and has been used in clinical trials to treat a variety of brain tumors, particularly gliomas. The main advantage of PDT lies in its ability to select out infiltrating tumor cells that are responsible for local tumor recurrence. The therapy has been shown to be safe clinically but adequate trials have yet to be undertaken to prove its efficacy and much work remains to be done to optimize treatment. The biological basis, laboratory studies, and clinical trials involving PDT in the treatment of cerebral tumors are discussed.
Collapse
Affiliation(s)
- E A Popovic
- Department of Neurosurgery, Melbourne Neuroscience Centre, Royal Melbourne Hospital, Victoria, Australia
| | | | | |
Collapse
|
28
|
Muller PJ, Wilson BC. Photodynamic therapy for recurrent supratentorial gliomas. SEMINARS IN SURGICAL ONCOLOGY 1995; 11:346-54. [PMID: 7569556 DOI: 10.1002/ssu.2980110504] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have used photodynamic therapy (PDT) in the treatment of 56 patients with recurrent supratentorial gliomas who had failed radiation therapy and who were candidates for palliative reoperation. There were 34 males and 22 females; their mean age was 41 years and the mean Karnofsky score was 79. Thirty-two patients had glioblastoma multiforme (GBM), 14 had malignant astrocytoma (MA), 6 had malignant mixed glioma (MM), and 4 had ependymoma (EP). Porphyrin photosensitizer was administered intravenously (i.v.) 12-36 hours prior to photoillumination. All patients had the recurrent tumor subtotally resected or cyst drained at surgery followed by intraoperative cavitary photoillumination. In 15 cases interstitial photoillumination using fibers with 2 cm diffusing tips supplemented the cavitary illumination. The total light energy delivered ranged from 440 to 4,500 Joules (J) (median = 1,800 J). The energy administered ranged from 120 to 150 J per fiber and the linear energy density ranged from 65 to 450 J/cm. The energy density ranged from 8 to 110 J/cm2 (median = 38 J/cm2). There were two postoperative deaths and three patients were left with a persistent increase in their postoperative neurological deficit. The post-PDT median survival of patients with recurrent GBM was 30 weeks with a 1- and 2-year actuarial survival of 18% and 0%, respectively. The median survival of patients with recurrent GBM from first diagnosis was 118 weeks with a 1- and 2-year actuarial survival of 82% and 57%, respectively. The post-PDT median survival of patients with recurrent MA was 44 weeks with a 1- and 2-year actuarial survival of 43% and 36%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P J Muller
- Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | | |
Collapse
|
29
|
Abstract
Photodynamic therapy (PDT) is a treatment modality that utilizes a photosensitizing drug activated by laser generated light, and is proving effective for oncologic and nononcologic applications. This report provides an overview of photosensitizers, photochemistry, photobiology, and the lasers involved in photodynamic therapy. Clinical and preclinical PDT studies involving Photofrin and various second generation photosensitizers are reviewed.
Collapse
Affiliation(s)
- A M Fisher
- Clayton Ocular Oncology Center, Childrens Hospital Los Angeles, California 90027, USA
| | | | | |
Collapse
|
30
|
|
31
|
Haglund MM, Hochman DW, Spence AM, Berger MS. Enhanced optical imaging of rat gliomas and tumor margins. Neurosurgery 1994; 35:930-40; discussion 940-1. [PMID: 7838344 DOI: 10.1227/00006123-199411000-00019] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Current intraoperative methods used to maximize the extent of tumor removal are limited to intraoperative biopsies, ultrasound, and stereotactic volumetric resections. A new technique involving the optical imaging of an intravenously injected dye has the potential to localize tumors and their margins with a high degree of accuracy. In a rat glioma model, enhanced optical imaging was performed and indocyanine green was used as the contrast-enhancing agent. In all 22 animals, the peak optical change in the tumor was greater than in the ipsilateral brain around the tumor and the contralateral normal hemisphere. The clearance of the dye was significantly delayed to a greater extent in the tumor than in the brain around the tumor and the normal brain. After attempts were made at complete microscopic resection, enhanced optical imaging of the tumor margins and the histological samples demonstrated a specificity of 93% and a sensitivity of 89.5%. Enhanced optical imaging was capable of outlining the tumor even when the imaging was done through the cranium. The optical imaging of rat gliomas with a contrast-enhancing dye is able to differentiate between normal brain and tumor tissue both at the cortical surface and at the tumor margins. The application of these studies in an intraoperative clinical setting may allow for the more accurate determination of tumor margins and may increase the extent of tumor removal.
Collapse
Affiliation(s)
- M M Haglund
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle
| | | | | | | |
Collapse
|
32
|
Marcus J, Glassberg E, Dimino-Emme L, Yamamoto R, Moy RL, Vari SG, Papaioannou T, Pergadia VR, Snyder WJ, Grundfest WS. Photodynamic therapy for the treatment of squamous cell carcinoma using benzoporphyrin derivative. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1994; 20:375-82. [PMID: 8014262 DOI: 10.1111/j.1524-4725.1994.tb02621.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Photodynamic therapy (PDT) involves laser light excitation of a tumor-localizing photosensitizer to destroy neoplasms. Benzoporphyrin derivative (BPD) is a new photosensitizer with several favorable characteristics. OBJECTIVE Studies were designed to: 1) assess the efficacy of BPD-mediated PDT in treating in vivo squamous cell carcinomas (SCC); 2) obtain dosimetry data for BPD and laser parameters; and 3) establish clinical and histologic correlates of BPD-induced tumor regression. METHODS Human SCC was implanted into nude mice. One group received BPD followed by laser light of 150 J/cm2 from an argon-pumped dye laser at 690 nm. Three control groups included laser energy alone, BPD alone, and no treatment. RESULTS At day 21 posttreatment only PDT-treated tumors showed a statistically significant decrease in tumor volume and complete cure rate. Clinical resolution (scar) correlated perfectly with histologic resolution (scar). CONCLUSION Human SCC in a nude mouse model responds to BPD-mediated PDT.
Collapse
Affiliation(s)
- J Marcus
- Division of Dermatology, UCLA Medical Center, Los Angeles, California 90024
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Origitano TC, Caron MJ, Reichman OH. Photodynamic therapy for intracranial neoplasms. Literature review and institutional experience. MOLECULAR AND CHEMICAL NEUROPATHOLOGY 1994; 21:337-52. [PMID: 8086042 DOI: 10.1007/bf02815360] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Primary malignant glial neoplasms of the central nervous system have a dismal 2-yr prognosis. An innovative approach to these formidable lesions is photodynamic therapy that employs a chemotherapeutic photosensitizing agent in combination with wavelength specific light to produce cytotoxic reactions capable of destroying neoplastic tissues. Animal and initial clinical studies of the application of photodynamic therapy to intracranial neoplasms have been promising. Parameters to optimize the efficacy of this treatment are under investigation. A review of the preclinical and clinical studies of photodynamic therapy for intracranial neoplasms is described.
Collapse
Affiliation(s)
- T C Origitano
- Division of Neurological Surgery, Loyola University Medical Center, Maywood, IL 60153
| | | | | |
Collapse
|
34
|
Ji Y, Powers SK, Brown JT, Walstad D, Maliner L. Toxicity of photodynamic therapy with photofrin in the normal rat brain. Lasers Surg Med 1994; 14:219-28. [PMID: 8208048 DOI: 10.1002/lsm.1900140304] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The widespread acceptance of photodynamic therapy (PDT), a potential adjuvant brain tumor therapy under clinical evaluation since 1980, has been partially restrained by its potential toxicity toward normal brain tissue. This study examined PDT-produced injury of normal rat brain as a function of photosensitizer dose. Brain injury was characterized by correlating measurements of the area of cerebral edema using T2-weighted magnetic resonance images, measurement of brain water content at the lesion site, microscopic examination of histological sections through the PDT lesion, and by evaluation of the area of blood brain barrier (BBB) disruption using computerized morphometric analysis of the region of Evans blue (EB) dye-labelled albumin extravasation. Monochromatic red light (630 nm) was delivered intracerebrally using a 5-mm-long cylindrical, diffusion-tip optical fiber at a constant energy dose of 15 joules. A Photofrin dose of 2 mg/kg of body weight produced a transient breakdown in the blood brain barrier around the site of the implanted optical fiber demonstrated by magnetic resonance imaging (MRI), extravasation of EB dye and pallor on hematoxylin and eosin-stained microscopic tissue sections. A much larger area of BBB disruption was seen at a dose of 4 mg/kg of Photofrin, and this drug dose resulted in significant permanent brain injury. In this model, a Photofrin dose of 4 mg/kg body weight is not tolerated by the normal brain.
Collapse
Affiliation(s)
- Y Ji
- Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033
| | | | | | | | | |
Collapse
|
35
|
Hansen DA, Spence AM, Carski T, Berger MS. Indocyanine green (ICG) staining and demarcation of tumor margins in a rat glioma model. SURGICAL NEUROLOGY 1993; 40:451-6. [PMID: 7694381 DOI: 10.1016/0090-3019(93)90046-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The ability of indocyanine green (ICG) to stain and demarcate brain tumor margins was investigated using an intracerebral rat glioma model. Indocyanine green was injected intravenously into tumor-bearing rats and was found to stain the tumor intensely at 60 to 120 mg/kg for at least 1 hour after injection. Furthermore, gross tissue staining was found to coincide with the actual histologic tumor margins within 1 mm. After resection of stained tumor tissue, minimal residual tumor cells at the margins of the resection cavity were identified. This investigation established the capacity of indocyanine green to grossly delineate a rat brain tumor and its margins from adjacent normal parenchyma.
Collapse
Affiliation(s)
- D A Hansen
- Department of Neurological Surgery, University of Washington, Seattle 98195
| | | | | | | |
Collapse
|
36
|
Stummer W, Götz C, Hassan A, Heimann A, Kempski O. Kinetics of Photofrin II in perifocal brain edema. Neurosurgery 1993; 33:1075-81; discussion 1081-2. [PMID: 8133993 DOI: 10.1227/00006123-199312000-00016] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Photodynamic therapy is under intense investigation as a possible adjuvant for the treatment of malignant tumors of the central nervous system. It relies on the fact that photosensitizers are selectively taken up or retained by malignant tissue. However, most brain tumors are accompanied by substantial vasogenic edema as a consequence of blood-brain barrier disruption within the tumor, leading to extravasation and propagation of plasma constituents into the surrounding brain tissue. Systemically administered photosensitizers may enter healthy tissue together with the edema fluid, possibly leading to sensitization of tissues outside the tumor. To test this hypothesis, vasogenic edema was induced by cold injury to the cortex in rats. The edema thus obtained is highly reproducible and very similar to tumor-associated edema. Just after injury induction, Photofrin II (PF-II), a commonly used photosensitizing agent, was administered at a dose of 5 mg per kilogram of body weight along with fluorescein isothiocyanate (FITC)-labeled albumin to mark edema advancement. After 1, 4, 12, or 24 hours, the brains were removed and frozen, and cryosections were studied with high-sensitivity video fluorescence microscopy for edema extravasation within the lesion and propagation of PF-II into the surrounding gray matter. PF-II advanced with edema along the corpus callosum underlying the cortex to a distance of 5 mm from the lesion after 4 hours. With the exception of the lesion, PF-II fluorescence returned to baseline after 24 hours, indicating subsequent washout. Propagation was comparable to the spreading of FITC-marked albumin. The authors conclude that photosensitizers spread with edema, an observation that may be pertinent to a number of questions concerning photodynamic therapy of cerebral tumors.
Collapse
Affiliation(s)
- W Stummer
- Department of Neurosurgery, Ludwig-Maximilians University, Mainz, Germany
| | | | | | | | | |
Collapse
|
37
|
Kinetics of Photofrin II in Perifocal Brain Edema. Neurosurgery 1993. [DOI: 10.1097/00006123-199312000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
38
|
Photodynamic Therapy for Intracranial Neoplasms. Neurosurgery 1993. [DOI: 10.1097/00006123-199304000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
39
|
Origitano TC, Reichman OH. Photodynamic therapy for intracranial neoplasms: development of an image-based computer-assisted protocol for photodynamic therapy of intracranial neoplasms. Neurosurgery 1993; 32:587-95; discussion 595-6. [PMID: 8386342 DOI: 10.1227/00006123-199304000-00015] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Photodynamic therapy is being studied as an adjuvant therapy for malignant gliomas. Therapeutic efficacy is based on photosensitizer uptake kinetics and the ability to deliver adequate light doses to an appropriate treatment volume at the optimal time. Our laboratory has developed an image-based, computer-assisted treatment-planning protocol to study the treatment variables leading to optimizing photodynamic therapy for intracranial neoplasms. Fifteen patients with recurrent malignant glial tumors underwent 16 treatments in the developmental phase of the project in which light treatment volume was progressively expanded. Group I (n = 4) received postresection intracavitary photoillumination only, Group II (n = 3) received limited interstitial/intracavitary photoillumination, and Group III (n = 9) received multiple interstitial/intracavitary photoillumination. Between 3 and 18 interstitial fiber probes were placed through optically lucent tumor access catheters. Computed three-dimensional image-based treatment planning provided reproducible data-based tumor volumes, treatment volumes, and stereotactic accuracy for tumor volume resection and interstitial light fiber insertion. Initial observations include: 1) treatment failures occur outside of the effective light treatment volumes; 2) effective light volumes can be expanded safely with multiple stereotactically implanted interstitial light fibers; and 3) optimal treatment involves individualized tailoring of light dose volume and geometry. This protocol allows standardized scientific study of the variables affecting the application of photodynamic therapy for intracranial neoplasms.
Collapse
Affiliation(s)
- T C Origitano
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
| | | |
Collapse
|
40
|
Origitano TC, Karesh SM, Henkin RE, Halama JR, Reichman OH. Photodynamic therapy for intracranial neoplasms: investigations of photosensitizer uptake and distribution using indium-111 Photofrin-II single photon emission computed tomography scans in humans with intracranial neoplasms. Neurosurgery 1993; 32:357-63; discussion 363-4. [PMID: 8384325 DOI: 10.1227/00006123-199303000-00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Photodynamic therapy is being investigated as an adjuvant treatment for intracranial neoplasms. The efficacy of this therapy is based on the uptake of photosensitizer by neoplastic tissue, its clearance from surrounding brain tissue, and the timing and placement of photoactivating sources. Photofrin-II is the photosensitizer most actively being investigated. We labeled Photofrin-II with Indium-111 and studied the uptake and distribution of this agent in 20 patients with intracranial neoplasms, using single photon emission computed tomography (SPECT) with volume rendering in three dimensions. Of these patients, 16 had malignant glial tumors, 2 had metastatic deposits, 1 had a chordoma, and 1 had a meningioma. Anatomical-spatial data correlated well between the SPECT images and contrast-enhanced computed tomography or magnetic resonance images. Regions of focal uptake on SPECT images correlated with the surgical histopathological findings of the neoplasm. The kinetics of photosensitizer uptake varied according to the tumor's histological findings, the patient's use of steroids, and among patients with similar types of tumor histology. Peak ratios of target-to-nontarget tissue varied from 24 to 72 hours after injection. The study data show that, to be most effective, photodynamic therapy may need to be tailored for each patient by correlating SPECT images with anatomical data produced by computed tomography or magnetic resonance images. Photoactivating sources then can be placed, using computer-assisted stereotactics, to activate a prescribed volume of photosensitized tumor at the optimal time for treatment.
Collapse
Affiliation(s)
- T C Origitano
- Division of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
| | | | | | | | | |
Collapse
|
41
|
Photodynamic Therapy for Intracranial Neoplasms. Neurosurgery 1993. [DOI: 10.1097/00006123-199303000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
42
|
Powers SK. Current status of lasers in neurosurgical oncology. SEMINARS IN SURGICAL ONCOLOGY 1992; 8:226-32. [PMID: 1641545 DOI: 10.1002/ssu.2980080408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
During the past decade and a half, the photothermal and photochemical effects of several medical lasers have been studied for the clinical treatment of benign and malignant, primary and secondary central nervous system tumors. Increased precision and hemostasis during tumor excision while limiting manipulation and retraction of nervous tissues are possible with the microsurgical carbon dioxide, argon, and frequency doubled neodymium:YAG lasers. Computerized tomography and magnetic resonance imaging-directed volumetric tumor removal by laser is feasible with computer-generated visual displays referenced to the patient's anatomy using stereotactic instrumentation. Photodynamic therapy with hematoporphyrin derivative as the photosensitizer and neodymium:YAG laser hyperthermia are currently under evaluation for the treatment of residual and recurrent malignant tumors. Encouraging results have been reported for each of these nonablative forms of laser use.
Collapse
Affiliation(s)
- S K Powers
- Division of Neurosurgery, University of North Carolina, Chapel Hill 27599-7060
| |
Collapse
|
43
|
Affiliation(s)
- L A Weber
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195-5032
| | | | | | | |
Collapse
|
44
|
Whelan HT, Traul DL, Przybylski C, Segura A, Thomas J, Meyer G, Sieber F. Interactions of merocyanine 540 with human brain tumor cells. Pediatr Neurol 1992; 8:117-20. [PMID: 1580954 DOI: 10.1016/0887-8994(92)90031-s] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Merocyanine 540 (MC 540), a photosensitizing dye, has been used in preclinical studies and in a phase I clinical trial for the purging of leukemia, lymphoma, and neuroblastoma cells from bone marrow grafts. We evaluated MC 540 as an agent for the inactivation of brain tumor cell lines of medulloblastoma or glioma origin. The U373 glioma and 74SA medulloblastoma demonstrated significantly reduced survival as determined by in vitro clonogenic assay compared to normal glial cells when exposed to MC 540 and light. U87 glioma and Daoy medulloblastoma, however, were less sensitive than normal glial cells to MC 540 photoinactivation. In vivo injection of MC 540 into mice with malignant brain tumors disclosed greater dye incorporation into the malignant tissue compared with normal control mice brains or normal tissue surrounding the brain tumor. Increased uptake of MC 540 was observed in mice injected with either photosensitive (U373 and 74SA) or photoresistant (Daoy) cell lines. These data suggest that MC 540 may be an effective agent against certain brain tumors and that dye uptake in vivo does not reflect photosensitivity.
Collapse
Affiliation(s)
- H T Whelan
- Department of Neurology, Medical College of Wisconsin, Milwaukee 53226
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
The effect on normal brain of continuous interstitial laser irradiation at 630 nm through an implanted cylindrical-shape, diffusion-tipped optical fiber was studied in the rat. Brain water content in the laser irradiation area (LIA) and Evans blue (EB) dye content in selected areas of the brain were measured for different laser power outputs from 0 to 250 mW after 5 minutes of photoradiation. The degree and nature of tissue damage was examined histologically and correlated with the laser power level. There is significant brain damage, blood brain barrier (BBB) disruption, and brain edema in LIA for laser power outputs in excess of 100 mW from the diffusion tip (p less than 0.001). Brain edema in the LIA is strongly correlated with BBB disruption indicated by the presence of EB. Histologically, the cortical surface was more susceptible than deeper white matter regions to interstitial laser irradiation. Possible indirect mechanisms of brain injury from interstitial laser irradiation are discussed.
Collapse
Affiliation(s)
- Y Ji
- Division of Neurological Surgery, University of North Carolina, Chapel Hill 27599-7060
| | | | | | | |
Collapse
|
46
|
Warnick RE, Edwards MS. Pediatric brain tumors. CURRENT PROBLEMS IN PEDIATRICS 1991; 21:129-73; discussion 174-5. [PMID: 1860343 DOI: 10.1016/0045-9380(91)90023-e] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R E Warnick
- Department of Neurological Surgery, School of Medicine, University of California, San Francisco (UCSF)
| | | |
Collapse
|
47
|
Noske DP, Wolbers JG, Sterenborg HJ. Photodynamic therapy of malignant glioma. A review of literature. Clin Neurol Neurosurg 1991; 93:293-307. [PMID: 1665763 DOI: 10.1016/0303-8467(91)90094-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Photodynamic therapy is a new form of cancer treatment which can serve as an adjuvant therapy for malignant glioma. It is based on the selective retention of a photosensitive dye in tumour tissue. Subsequent exposure of the tumour to light of an appropriate wavelength causes selective destruction of tumour tissue. Experimental data indicates that the blood-brain barrier plays an important role in the delivery of the photosensitizer to a brain tumour and that intratumoral injection of the photosensitizer may be advantageous as compared to intravenous administration. A limited group of patients have entered clinical trials. Treatment protocols varied too much and the number of patients was too small to draw any conclusions on the efficiency of PDT of gliomas.
Collapse
Affiliation(s)
- D P Noske
- Department of Neurosurgery, Free University Hospital, Amsterdam, The Netherlands
| | | | | |
Collapse
|
48
|
Perria C, Casu G, Sgaramella E. Proposal of a protocol for the photodynamic therapy of malignant brain tumours. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 1990; 6:443-9. [PMID: 2145410 DOI: 10.1016/1011-1344(90)85117-f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- C Perria
- Clinica Neurochirurgica, Università di Sassari, Italy
| | | | | |
Collapse
|
49
|
|
50
|
Abstract
Fifty patients with malignant supratentorial tumours were treated with intra-operative photodynamic therapy (PDT); in 33 cases the tumour was recurrent. In 45 patients the tumour was a cerebral glioma and in 5 cases a solitary cerebral metastasis. All patients received a porphyrin photosensitizer 18-24 hours pre-operatively. Photoillumination was carried out at 630 nm to a tumour cavity created by radical tumour resection and/or tumour cyst drainage. The light energy density ranged from 8 to 175 J/cm2. In 8 patients additional interstitial light was administered. The operative mortality was 4%. Follow up has ranged from 1 to 30 months. The median survival for the 45 primary malignant tumours was 8.6 months with a 1 and 2 year actuarial survival rate of 32% and 18%, respectively. In 12 patients a complete or near complete CT scan response was identified post PDT. These patients tended to have a tumour geometry (eg. cystic) that allowed complete or near complete light distribution to the tumour. The median survival for this group was 17.1 months with a 1 and 2 year actuarial survival of 62% and 38%, respectively. In the 33 cases who did not have a complete response the median survival was 6.5 months with a 1 and 2 year actuarial survival of 22% and 11%, respectively. Photodynamic therapy of malignant brain tumours can be carried out with acceptable risk. Good responses appear to be related to adequate light delivery to the tumour.
Collapse
Affiliation(s)
- P J Muller
- Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | | |
Collapse
|