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Siddiqui SA, Siddiqui S, Hussain MAB, Khan S, Liu H, Akhtar K, Hasan SA, Ahmed I, Mallidi S, Khan AP, Cuckov F, Hopper C, Bown S, Celli JP, Hasan T. Clinical evaluation of a mobile, low-cost system for fluorescence guided photodynamic therapy of early oral cancer in India. Photodiagnosis Photodyn Ther 2022; 38:102843. [PMID: 35367616 DOI: 10.1016/j.pdpdt.2022.102843] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Morbidity and mortality due to oral cancer in India are exacerbated by a lack of access to effective treatments amongst medically underserved populations. We developed a user-friendly low-cost, portable fibre-coupled LED system for photodynamic therapy (PDT) of early oral lesions, using a smartphone fluorescence imaging device for treatment guidance, and 3D printed fibreoptic attachments for ergonomic intraoral light delivery. METHODS 30 patients with T1N0M0 buccal mucosal cancer were recruited from the JN Medical College clinics, Aligarh, and rural screening camps. Tumour limits were defined by external ultrasound (US), white light photos and increased tumour fluorescence after oral administration of the photosensitising agent ALA (60 mg/kg, divided doses), monitored by a smartphone fluorescence imaging device. 100 J/cm2 LED light (635 nm peak) was delivered followed by repeat fluorescence to assess photobleaching. US and biopsy were repeated after 7-17 days. This trial is registered with ClinicalTrials.gov, NCT03638622, and the study has been completed. FINDINGS There were no significant complications or discomfort. No sedation was required. No residual disease was detected in 22 out of 30 patients who completed the study (26 of 34 lesions, 76% complete tumour response, 50 weeks median follow-up) with up to 7.2 mm depth of necrosis. Treatment failures were attributed to large tumour size and/or inadequate light delivery (documented by limited photobleaching). Moderately differentiated lesions were more responsive than well-differentiated cancers. INTERPRETATION This simple and low-cost adaptation of fluorescenceguided PDT is effective for treatment of early-stage malignant oral lesions and may have implications in global health.
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Affiliation(s)
- Shahid Ali Siddiqui
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India
| | - Shaista Siddiqui
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiodiagnosis, Aligarh, India
| | - M A Bilal Hussain
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India
| | - Shakir Khan
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India; University of Massachusetts at Boston, Boston, MA, United States; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Hui Liu
- University of Massachusetts at Boston, Boston, MA, United States
| | - Kafil Akhtar
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Pathology, Aligarh, India
| | - Syed Abrar Hasan
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Otorhinolaryngology (E.N.T.), Aligarh, India
| | - Ibne Ahmed
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiodiagnosis, Aligarh, India
| | - Srivalleesha Mallidi
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Amjad P Khan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Filip Cuckov
- Wentworth Institute of Technology, Boston, Massachusetts, United States
| | | | | | - Jonathan P Celli
- University of Massachusetts at Boston, Boston, MA, United States; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Tayyaba Hasan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States; Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA, USA.
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Khan S, Hussain MAB, Khan AP, Liu H, Siddiqui S, Mallidi S, Leon P, Daly L, Rudd G, Cuckov F, Hopper C, Bown SG, Akhtar K, Hasan SA, Siddiqui SA, Hasan T, Celli JP. Clinical evaluation of smartphone-based fluorescence imaging for guidance and monitoring of ALA-PDT treatment of early oral cancer. J Biomed Opt 2020; 25:1-10. [PMID: 32279466 PMCID: PMC7148420 DOI: 10.1117/1.jbo.25.6.063813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/10/2020] [Indexed: 05/04/2023]
Abstract
SIGNIFICANCE India has one of the highest rates of oral cancer incidence in the world, accounting for 30% of reported cancers. In rural areas, a lack of adequate medical infrastructure contributes to unchecked disease progression and dismal mortality rates. Photodynamic therapy (PDT) has emerged as an effective modality with potential for treating early stage disease in resource-limited settings, while photosensitizer fluorescence can be leveraged for treatment guidance. AIM Our aim was to assess the capability of a simple smartphone-based device for imaging 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence for treatment guidance and monitoring as part of an ongoing clinical study evaluating low-cost technology for ALA-based PDT treatment of early oral cancer. APPROACH A total of 29 subjects with <2 cm diameter moderately/well-differentiated microinvasive ( < 5 mm depth) oral squamous cell carcinoma lesions (33 lesions total, mean area ∼1.23 cm2) were administered 60 mg / kg ALA in oral solution and imaged before and after delivery of 100 J / cm2 total light dose to the lesion surface. Smartphone-based fluorescence and white light (WL) images were analyzed and compared with ultrasound (US) imaging of the same lesions. RESULTS We present a comparative analysis of pre- and post-treatment fluorescence, WL, and US images of oral lesions. There was no significant difference in the distribution of lesion widths measured by fluorescence and US (mean widths of 14.5 and 15.3 mm, respectively) and linear regression shows good agreement (R2 = 0.91). In general, PpIX fluorescence images obtained prior to therapeutic light delivery are able to resolve lesion margins while dramatic photobleaching (∼42 % ) is visible post-treatment. Segmentation of the photobleached area confirms the boundaries of the irradiated zone. CONCLUSIONS A simple smartphone-based approach for imaging oral lesions is shown to agree in most cases with US, suggesting that this approach may be a useful tool to aid in PDT treatment guidance and monitoring photobleaching as part of a low-cost platform for intraoral PDT.
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Affiliation(s)
- Shakir Khan
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India
- University of Massachusetts at Boston, Boston, Massachusetts, United States
| | - M. A. Bilal Hussain
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India
| | - Amjad P. Khan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Hui Liu
- University of Massachusetts at Boston, Boston, Massachusetts, United States
| | - Shaista Siddiqui
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiodiagnosis, Aligarh, India
| | - Srivalleesha Mallidi
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Paola Leon
- University of Massachusetts at Boston, Boston, Massachusetts, United States
| | - Liam Daly
- University of Massachusetts at Boston, Boston, Massachusetts, United States
| | - Grant Rudd
- University of Massachusetts at Boston, Boston, Massachusetts, United States
| | - Filip Cuckov
- University of Massachusetts at Boston, Boston, Massachusetts, United States
| | - Colin Hopper
- University College London, London, England, United Kingdom
| | | | - Kafil Akhtar
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Pathology, Aligarh, India
| | - Syed Abrar Hasan
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Otorhinolaryngology (E.N.T.), Aligarh, India
| | - Shahid Ali Siddiqui
- Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India
| | - Tayyaba Hasan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Jonathan P. Celli
- University of Massachusetts at Boston, Boston, Massachusetts, United States
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Liu H, Daly L, Rudd G, Khan AP, Mallidi S, Liu Y, Cuckov F, Hasan T, Celli JP. Development and evaluation of a low-cost, portable, LED-based device for PDT treatment of early-stage oral cancer in resource-limited settings. Lasers Surg Med 2018; 51:345-351. [PMID: 30168618 DOI: 10.1002/lsm.23019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Photodynamic therapy (PDT) using δ-aminolevulinic acid (ALA) photosensitization has shown promise in clinical studies for the treatment of early-stage oral malignancies with fewer potential side effects than traditional therapies. Light delivery to oral lesions can also carried out with limited medical infrastructure suggesting the potential for implementation of PDT in global health settings. OBJECTIVES We sought to develop a cost-effective, battery-powered, fiber-coupled PDT system suitable for intraoral light delivery enabled by smartphone interface and embedded electronics for ease of operation. METHODS Device performance was assessed in measurements of optical power output, spectral stability, and preclinical assessment of PDT response in ALA-photosensitized squamous carcinoma cell cultures and murine subcutaneous tumor xenografts. RESULTS The system achieves target optoelectronic performance with a stable battery-powered output of approximately 180 mW from the fiber tip within the desired spectral window for PpIX activation. The device has a compact configuration, user friendly operation and flexible light delivery for the oral cavity. In cell culture, we show that the overall dose-response is consistent with established light sources and complete cell death of ALA photosensitized cells can be achieved in the irradiated zone. In vivo PDT response (reduction in tumor volume) is comparable with a commercial 635 nm laser. CONCLUSIONS We developed a low-cost, LED-based, fiber-coupled PDT light delivery source that has stable output on battery power and suitable form factor for deployment in rural and/or resource-limited settings. Lasers Surg. Med. 9999:1-7, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Hui Liu
- Department of Physics, University of Massachusetts, Boston, Massachusetts, 02125
| | - Liam Daly
- Department of Engineering, University of Massachusetts, Boston, Massachusetts, 02125
| | - Grant Rudd
- Department of Engineering, University of Massachusetts, Boston, Massachusetts, 02125
| | - Amjad P Khan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Srivalleesha Mallidi
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Yiran Liu
- Department of Physics, University of Massachusetts, Boston, Massachusetts, 02125
| | - Filip Cuckov
- Department of Engineering, University of Massachusetts, Boston, Massachusetts, 02125
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Jonathan P Celli
- Department of Physics, University of Massachusetts, Boston, Massachusetts, 02125
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