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Finlayson L, McMillan L, Suveges S, Steele D, Eftimie R, Trucu D, Brown CTA, Eadie E, Hossain-Ibrahim K, Wood K. Simulating photodynamic therapy for the treatment of glioblastoma using Monte Carlo radiative transport. J Biomed Opt 2024; 29:025001. [PMID: 38322729 PMCID: PMC10846422 DOI: 10.1117/1.jbo.29.2.025001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
Significance Glioblastoma (GBM) is a rare but deadly form of brain tumor with a low median survival rate of 14.6 months, due to its resistance to treatment. An independent simulation of the INtraoperative photoDYnamic therapy for GliOblastoma (INDYGO) trial, a clinical trial aiming to treat the GBM resection cavity with photodynamic therapy (PDT) via a laser coupled balloon device, is demonstrated. Aim To develop a framework providing increased understanding for the PDT treatment, its parameters, and their impact on the clinical outcome. Approach We use Monte Carlo radiative transport techniques within a computational brain model containing a GBM to simulate light path and PDT effects. Treatment parameters (laser power, photosensitizer concentration, and irradiation time) are considered, as well as PDT's impact on brain tissue temperature. Results The simulation suggests that 39% of post-resection GBM cells are killed at the end of treatment when using the standard INDYGO trial protocol (light fluence = 200 J / cm 2 at balloon wall) and assuming an initial photosensitizer concentration of 5 μ M . Increases in treatment time and light power (light fluence = 400 J / cm 2 at balloon wall) result in further cell kill but increase brain cell temperature, which potentially affects treatment safety. Increasing the p hotosensitizer concentration produces the most significant increase in cell kill, with 61% of GBM cells killed when doubling concentration to 10 μ M and keeping the treatment time and power the same. According to these simulations, the standard trial protocol is reasonably well optimized with improvements in cell kill difficult to achieve without potentially dangerous increases in temperature. To improve treatment outcome, focus should be placed on improving the photosensitizer. Conclusions With further development and optimization, the simulation could have potential clinical benefit and be used to help plan and optimize intraoperative PDT treatment for GBM.
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Affiliation(s)
- Louise Finlayson
- SUPA, University of St Andrews, School of Physics and Astronomy, St Andrews, United Kingdom
| | - Lewis McMillan
- SUPA, University of St Andrews, School of Physics and Astronomy, St Andrews, United Kingdom
| | - Szabolcs Suveges
- University of Dundee, Division of Mathematics, Dundee, United Kingdom
| | - Douglas Steele
- University of Dundee, Medical School, Division Imaging Science and Technology, Dundee, United Kingdom
| | - Raluca Eftimie
- Université de Bourgogne Franche-Comté, Laboratoire Mathématiques de Besançon, Besançon, France
| | - Dumitru Trucu
- University of Dundee, Division of Mathematics, Dundee, United Kingdom
| | | | - Ewan Eadie
- Ninewells Hospital, Photobiology Unit, Dundee, United Kingdom
| | - Kismet Hossain-Ibrahim
- University of Dundee, School of Medicine, Division Cellular and Molecular Medicine, Dundee, United Kingdom
- Ninewells Hospital and Medical School, Department of Neurosurgery, Dundee, United Kingdom
| | - Kenneth Wood
- SUPA, University of St Andrews, School of Physics and Astronomy, St Andrews, United Kingdom
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Hall AJ, Clement ND, Ojeda-Thies C, MacLullich AMJ, Toro G, Johansen A, White TO, Duckworth AD, Abdul-Jabar H, Abu-Rajab R, Abugarja A, Adam K, Aguado Hernández HJ, Améstica Lazcano G, Anderson S, Ansar M, Antrobus J, Aragón Achig EJ, Archunan M, Arrieta Salinas M, Ashford-Wilson S, Assens Gibert C, Athanasopoulou K, Awadelkarim M, Baird S, Bajada S, Balakrishnan S, Balasubramanian S, Ballantyne JA, Bárcena Goitiandia L, Barkham B, Barmpagianni C, Barres-Carsi M, Barrett S, Baskaran D, Bell J, Bell K, Bell S, Bellelli G, Benchimol JA, Boietti BR, Boswell S, Braile A, Brennan C, Brent L, Brooke B, Bruno G, Burahee A, Burns S, Calabrò G, Campbell L, Carabelli GS, Carnegie C, Carretero Cristobal G, Caruana E, Cassinello Ogea MC, Castellanos Robles J, Castillon P, Chakrabarti A, Cecere AB, Chen P, Clarke JV, Collins G, Corrales Cardenal JE, Corsi M, Cózar Adelantado GM, Craxford S, Crooks M, Cuarental-García J, Cuthbert R, Dall G, Daskalakis I, De Cicco A, Diana DLFDD, Demaria P, Dereix J, Díaz Jiménez J, Dinamarca Montecinos JL, Do Le HP, Donoso Coppa JP, Drosos G, Duffy A, East J, Eastwood D, Elbahari H, Elias de Molins Peña C, Elmamoun M, Emmerson B, Escobar Sánchez D, Faimali M, Farré-Mercadé MV, Farrow L, Fayez A, Fell A, Fenner C, Ferguson D, Finlayson L, Flores Gómez A, Freeman N, French J, Gabardo Calvo S, Gagliardo N, Garcia Albiñana J, García Cruz G, García de Cortázar Antolín U, García Virto V, Gealy S, Gil Caballero SM, Gill M, González González MS, Gopireddy R, Guntley D, Gurung B, Guzmán Rosales G, Haddad N, Hafeez M, Haller P, Halligan E, Hardie J, Hawker I, Helal A, Herrera Cruz M, Herreros Ruiz-Valdepeñas R, Horton J, Howells S, Howieson A, Hughes L, Hünicken Torrez FL, Hurtado Ortega A, Huxley P, Hamid HK, Ilahi N, Iliadis A, Inman D, Jadhao P, Jandoo R, Jawad L, Jayatilaka MLT, Jenkins PJ, Jeyapalan R, Johnson D, Johnston A, Joseph S, Kapoor S, Karagiannidis G, Karanam KS, Kattakayam F, Konarski A, Kontakis G, Labrador Hernández G, Lancaster V, Landi G, Le B, Liew I, Logishetty K, Lopez Marquez ACD, Lopez J, Lum J, Macpherson GJ, Madan S, Mahroof S, Malik-Tabassum K, Mallina R, Maqsood A, Marson B, Martin Legorburo MJ, Martin-Perez E, Martínez Jiménez T, Martinez Martin J, Mayne A, Mayor A, McAlinden G, McLean L, McDonald L, McIntyre J, McKay P, McKean G, McShane H, Medici A, Meeke C, Meldrum E, Mendez M, Mercer S, Merino Perez J, Mesa-Lampré MP, Mighton S, Milne K, Mohamed Yaseen M, Moppett I, Mora J, Morales-Zumel S, Moreno Fenoll IB, Mousa A, Murray AW, Murray EV, Nair R, Neary F, Negri G, Negus O, Newham-Harvey F, Ng N, Nightingale J, Noor Mohamed Anver S, Nunag P, O'Hare M, Ollivere B, Ortés Gómez R, Owens A, Page S, Palloni V, Panagiotopoulos A, Panagiotopoulos E, Panesar P, Papadopoulos A, Spyridon P, Pareja Sierra T, Park C, Parwaiz H, Paterson-Byrne P, Patton S, Pearce J, Porter M, Pellegrino A, Pèrez Cuellar A, Pezzella R, Phadnis A, Pinder C, Piper D, Powell-Bowns M, Prieto Martín R, Probert A, Ramesh A, Ramírez de Arellano MVM, Renton D, Rickman S, Robertson A, Roche Albero A, Rodrigo Verguizas JA, Rodríguez Couso M, Rooney J, Sáez-López P, Saldaña-Díaz A, Santulli A, Sanz Pérez MI, Sarraf KM, Scarsbrook C, Scott CE, Scott J, Shah S, Sharaf S, Sharma S, Shirley D, Siano A, Simpson J, Singh A, Singh A, Sinnett T, Sisodia G, Smith P, Sophena Bert E, Steel M, Stewart A, Stewart C, Sugand K, Sullivan N, Sweeting L, Symes M, Tan DJH, Tancredi F, Tatani I, Thomas P, Thomson F, Toner NS, Tong A, Toro A, Tosounidis T, Tottas S, Trinidad Leo A, Tucker D, Vemulapalli K, Ventura Garces D, Vernon OK, Viveros Garcia JC, Ward A, Ward K, Watson K, Weerasuriya T, Wickramanayake U, Wilkinson H, Windley J, Wood J, Wynell-Mayow W, Zatti G, Zeiton M, Zurrón Lobato M. IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit. Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic. Surgeon 2022; 20:e429-e446. [PMID: 35430111 PMCID: PMC8958101 DOI: 10.1016/j.surge.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
Aims This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. Methods A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. Results A total of 7090 patients were included, with a mean age of 82.2 (range 50–104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. Conclusion The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher 30-day mortality risk.
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