Pathophysiological justification of the use of photodynamic therapy in the initial stage of squamous cell skin cancer

Abstract

The work is based on an analysis of the course of the disease in 185 patients with squamous cell skin cancer. The study program included studies in three major groups. The first included 74 (40%) patients who underwent combined treatment: an operation involving widespread excision of a tumor under intravenous anesthesia + photodynamic therapy (group 1). The second group was 111 (60%) patients with squamous cell carcinoma of the skin who received only operative treatment. To control and compare the obtained laboratory indicators, a second group was created, which included patients without established pathology. This group included 17 people who voluntarily agreed to conduct the study. The study traced the dynamics of changes in hemostasis scores and metalloproteinases in the two groups being compared. In the group of patients with squamous cell skin cancer, there was a statistically significant decrease in the metalloproteinase-1 inhibitor index, which led to an increase in all metalloproteinase-2, -7 and -9 indicators. Performing surgical treatment did not lead to correction of these indicators, both in the near and distant periods after treatment. The mechanism of influence of photodynamic therapy in squamous cell skin cancer can be characterized as follows: there is a decrease in the inhibitor of metalloproteinase-1, which leads to an increase in matrix metalloproteinases-2, -7 and -9 in the blood, as a result of damage to the endothelium of the vascular wall, which is confirmed by an increase in endothelin, this, in turn, led to the development of vasoconstriction and increased procoagulant activity The use of photodynamic therapy restores the index of metalloproteinase-1 inhibitor, this leads to the restoration of matrix metalloproteinases-2, -7 and -9 in the blood and the prevention of damage to the vascular wall. Comprehensive treatment of patients with squamous cell skin cancer in the initial stage of the disease should include photodynamic therapy with simultaneous intravenous blood irradiation, laser tumor training, and then surgical treatment, consisting in excision of the tumor with observance of oncological principles.