Safety Of Photodynamic Therapy Research Articles

Experience of using photodynamic therapy for treatment of genitourinary syndrome of menopause

This study reports about efficacy and safety of photodynamic therapy in Genitourinary Syndrome of Menopause (GSM).Material and methods. The study group included 12 patients with a diagnosis of urogenital syndrome of menopause. The trismeglumine salt of chlorin E6 in the form of a 1% gel was used as a photosensitizer. LED phototherapy apparatus Garmonia (photodynamic therapy apparatus (emitter 660 nm) was used as a radiation source. The PDT procedure was performed once every 7 days. The following scales were used to assess the effectiveness: Vaginal Health Index, Visual Analogue Scale, Dermatology Life Quality Index score, and general satisfaction with the course of procedures was also assessed.Results. The patients noted a significant regression of itching, burning, pain and dyspareunia after the course of photodynamic therapy. There was a decrease in dryness, on average, up to 3 points upon completing the course of procedures. Itching completely regressed in 6 out of patients. Dyspareunia significantly decreased in 4 patients and completely disappeared in 2 patients. The greatest effect according to the results of assessing the index of vaginal health was noted in relation to Ph-metry, as well as in relation to elasticity (4.17 points) and moisture (4.33 points). The median satisfaction score with treatment outcomes was 2.7 at last follow-up. There were no serious side effects during the entire period of treatment and after it.Conclusions. The following study reports that the photosensitizer with trismeglumine salt of chlorin E6 and PDT with a wavelength of 660 nm with an exposure for 30 minutes, an energy of 100 J/cm2, a power of 100 mV/cm2 , once every 7 days, is an effective and harmless method of treating GSM.

Effectiveness of Photodynamic Therapy for Management of Primary Palmar Hyperhidrosis

Abstract Background Hyperhidorsis is a condition in which sweat production exceeds that which is needed for thermoregulation, and can affect the hands, feet, axiall, face, back, grain, and legs. It is adisabling condition that affect, both children and adults, with in audience rate of 1-3% and onset usually during childhood or adokscne. Although not a dangerous condition, hyperhidrosis can cause social and occupational impairment and emotional distress and facilitate the development of secondary morbidity. Objectives So our aim to study the efficacy and safety of photodynamic therapy in management of primary palmar hyperhidrosis using two photosensitizers [MB2% and eosin]. Patients and Methods Twenty patients with primary palmar hyperhidrosis were recruited from the outpatient clinic of the Dermatology and Venereology department, Faculty of Medicine – Ain Shams University during the period from 2017 to 2018. The protocol was approved by Faculty of Medicine, Ain Shams University ethical committee (FWA000017585). An informed written consent was obtained from all patients prior to enrolment in the study. It is a right-left controlled study which included 20 patients with primary palmar hyperhidrosis. Results Our study showed that the PDT had positive treatment outcome in palmar hyperhidrosis with sustainable efficacy for at least twelve weeks after treatment stoppage. Conclusion Photodynamic therapy is an effective, safe and cheap method for management of primary palmar hyperhidrosis. Both eosin and methylene blue 2% can be used effectively as photosensitizers for photodynamic therapy with good results for treatment of primary palmar hyperhidrosis with minimal tolerable side effects.

Photodynamic therapy in the treatment of intraepithelial neoplasia of the cervix, vulva and vagina

In the present review the authors analyzed the effectiveness of treatment of intraepithelial neoplasia I-II-III of the cervix (CIN), vulva (VIN) and vagina (VaIN) using photodynamic therapy (PDT). PDT is a method based on exposure to light after preliminary introduction of a photosensitizer into the body with the formation of singlet oxygen, which has a cytotoxic effect. The results of research on the use of PDT with various photosensitizers in the complex of therapeutic measures in patients with CIN, VIN, VaIN are presented. These data on the effectiveness and safety of PDT, ease of use allow this medical technology to be attributed to one of the most promising areas in the treatment of pathological intraepithelial changes of the cervix, vulva and vagina. The presented information allows focusing the attention on the PDT method and informing doctors and researchers about the broad prospects for applying this treatment method in clinical practice.

A xanthene derivative, free or associated to nanoparticles, as a new potential agent for anticancer photodynamic therapy

The efficacy and safety of photodynamic therapy (PDT) have drawn much attention from clinicians and researchers in the field of anticancer treatments since the last century. Despite the numerous positive outcomes, the works on PDT have brought to light over the last decades, much room remains for improvements in PDT tools, mainly on the photosensitizer molecules. This work reports the first experiments evidencing the photosensitizing activity of DHX-1, a xanthene derivative-based near-infrared probe recently described in the literature, both as a free molecule and associated to a nanostructured lipid carrier. The results show that the DHX-1 presents a broad band of light absorption within the optical window of biological tissues (600–800 nm), generates reactive oxygen species when photoactivated, and is phototoxic against murine breast adenocarcinoma 4T1 cells and murine fibroblast NIH-3T3 in vitro. Moreover, the association of DHX-1 to a nanostructured lipid carrier strongly reduced its phototoxicity against the normal cell line.

Sa1248 EFFICACY OF PHOTODYNAMIC THERAPY USING TALAPORFIN SODIUM AND A DIODE LASER AS SALVAGE TREATMENT FOR LOCAL FAILURE AFTER RADIOTHERAPY OR CHEMO RADIOTHERAPY FOR ESOPHAGEAL CANCER

Local failure at the primary site is a major problem after radiotherapy (RT) or chemoradiotherapy (CRT) in patients with esophageal cancer (EC). The indication of endoscopic resection (ER) is restricted to mucosal residue due to curability. Surgery is a first choice for deeper local residue invaded into submucosal or muscular layer. However, surgery is associated with a high complication and mortality rate. We had reported that photodynamic therapy (PDT) using talaporfin sodium and a diode laser had the high Complete Response (CR) rate (88.5%) for local failure after RT or CRT in patients with EC. However, few studies have reported on PDT using talaporfin sodium. This study aims to evaluate the efficacy and safety of PDT as a salvage treatment after RT or CRT in patients with EC. This study subjects were recruited from a database of patients treated by PDT using talaporfin at Hyogo Cancer Center. The eligibility criteria of PDT were as follows: 1) local failure after RT or CRT for EC without distant metastasis; 2) esophageal squamous cell carcinoma (ESCC) or esophageal adenocarcinoma (EAC) were histologically proven; 3) salvage ER not indicated due to incurability; 4) salvage surgery not indicated due to intolerable or patient’s wishes; 5) lesions limited to within the muscularis propria; 6) longitudinal lesion length of 3 cm or shorter and 1/2 the circumference of the lumen or less. PDT was applied with intravenous administration of 40 mg/m2 dose of talaporfin sodium followed by a diode laser irradiation of 100J/cm2 4-6 hours later after administration. The Local (L)-CR rate, the times of PDT session required to achieve L-CR, adverse events, clinical course after PDT and overall survival were assessed in this study. Between April 2013 and September 2019, 33 patients with 37 lesions were treated with PDT at Hyogo Cancer Center. ESCC or EAC were histologically proven in 31 patients, in 2 patients, respectively. The L-CR rate per patients was 81.8% (95% CI: 65.6%-91.4%) (T1: 88.9%, T2: 50.0%) (ESCC: 80.6%, EAC: 100%). The times of PDT session required to achieve L-CR was 3 in one patient, 2 in one patient, 1 in 31 patients, respectively. No grade 3 or worse non-hematological toxicities related to PDT were observed. The median follow up period was 12 months (range: 3-72). Two patients received salvage surgery for progressive disease (PD) at 3 months and 16 months after PDT. Three patients died from esophageal cancer progression at 558 days, 686 days and 878 days after PDT. One patient died with pneumonia at 81 days after PDT, and another patient died with pulmonary embolism at 403 days after PDT. Twenty-eight patients are alive. DT using talaporfin sodium and a diode laser is a safe and potentially curative salvage treatment for local failure after RT or CRT for patients with EC.

Thermomechanical Ablation‐Assisted Photodynamic Therapy for the Treatment of Acne Vulgaris. A Retrospective Chart Review of 30 Patients

Acne vulgaris, a chronic inflammatory disease, affects more than 90% of teenagers. The first-line treatments for acne vulgaris are topical and oral medications, mainly antibiotics and retinoids. However, antibiotic resistance of Propionibacterium acnes, contraindications, partial response, significant adverse effects, or recurrence creates demand for novel treatment options in acne. Aminolevulinic acid (ALA) photodynamic therapy (PDT) is a well-established modality in the treatment of acne. Nevertheless, PDT has limitations: it may not be effective for every patient; several treatments are usually required to achieve sufficient outcome; incubation time is 1-3 hours; treatment pain and post-treatment downtime may be difficult for some patients to endure; and adverse effects may occur. This retrospective chart review was conducted to evaluate the efficacy and safety of PDT, assisted by a thermomechanical ablation (TMA) fractional injury device in the treatment of patients with moderate to severe acne. We conducted a retrospective chart review of 30 acne patients treated with TMA immediately before 5% ALA application with an incubation time of 1 hour and exposure to 60 J/cm2 red light (630 nm). Patients received up to three monthly treatments and were followed for 16 weeks. Two independent investigators evaluated the subject outcomes according to high definition photographs taken at baseline, before each treatment and at follow-up visits. Three acne grading methods were used: Acne Grading Scoring System (AGSS), the Leeds revised acne grading system, and the general response to the treatment score. Patients also provided self-assessments of improvement using the patient global impression of change (PGIC). Compared with baseline, the AGSS has showed a statistically significant reduction of 26.7% and 23.7%, respectively, at weeks 8 and 16 after final treatment. The Leeds score showed 65.2% and 60.6% improvement at the respective visits. The overall response rate was graded 3.3 ± 0.5 out of 4. PGIC score given by the patients was 5.5 out of 7, reflecting high satisfaction. TMA used immediately prior to ALA application may enhance the effectiveness of PDT in the treatment of acne with minimal side effects, reduced downtime, and fewer sessions. The exact mechanism of TMA-assisted PDT is still to be understood. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Efficacy and safety of photodynamic therapy with RLP068 for diabetic foot ulcers: a review of the literature and clinical experience.

This article is the second part of a literature review concerning diabetic foot ulcers (DFUs) and the use of antimicrobial photodynamic therapy (PDT). PDT involves the topical application of a photosensitiser into the tissue, followed by illumination that induces the formation of reactive oxygen species (ROS). PDT provides bacterial inactivation and promotes wound healing, and it can be used to manage the infection and microbial colonisation of DFUs. It has pivotal advantages in comparison with chemotherapeutics, such as no potential to induce resistance, and a wide spectrum of activity. Tetracationic Zn(II) phthalocyanine derivatives have been developed for PDT. Among these, we would like to focus on RLP068, whose antimicrobial activity has been widely demonstrated in preclinical studies and in a clinical trial. This article reports previously published evidence and presents four unpublished clinical cases of DFUs treated in the real-life setting with PDT.

Long-Term Efficacy and Safety of Photodynamic Therapy in Patients With Chronic Central Serous Chorioretinopathy.

To investigate the long-term results of photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR). The authors reviewed patients with chronic CSCR treated with verteporfin PDT in their hospital and followed up for 36 months or longer. Among 94 eyes, 76 eyes underwent half-fluence PDT (80.9%), 12 eyes (12.8%) underwent half-dose PDT, and six eyes (6.4%) underwent standard PDT. Mean follow-up duration was 58.1 months± 20.3 months. Mean best-corrected visual acuity improved by 0.15 ± 0.31 logMAR. Seventy-two eyes (77%) had resolution of subretinal fluid 1 month after treatment. Nine eyes (9.6%) showed nonresponse, and 23 (24.5%) showed recurrence. Older age (P = .009) and smaller macular thickness reduction post-PDT (P = .017) were associated with nonresponse. Male sex (P = .021), bilateral CSCR (P = .008), and smaller choroidal thickness reduction (P = .024) were associated with recurrence. Retreatment using PDT resulted in a 90% success rate. Verteporfin PDT for chronic CSCR conferred good visual outcomes, as well as good safety results up to mean 5 years. Although the disease recurred in about one-fifth of the eyes, additional PDT conferred a good response rate. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:760-770.].

Safety of photodynamic therapy using aminolevulinic acid hydrochloride 10% nanoemulsion gel with illumination for widespread actinic keratosis

Safety of photodynamic therapy using aminolevulinic acid hydrochloride 10% nanoemulsion gel with illumination for widespread actinic keratosis

Treatment of Bowen’s disease with photodynamic therapy. Observational study in 171 patients with 5-aminolaevulinic acid (BF-200 ALA) and methyl aminolaevulinate (MAL)

An observational study was carried out in the photodynamic therapy (PDT) section of Fuenlabrada's hospital (Madrid, Spain). Our goal was to investigate the efficacy and safety of PDT in Bowen's disease (BD). Between June 2011-June 2017 171 patients (191 lesions) with diagnosis of BD were enrolled in the study (95 women and 76 men; average age of 74.31 years). Lesions were treated with one 5-aminolaevulinic acid (BF-200 ALA)-PDT or methyl-5-aminolaevulinate (MAL)-PDT cycle of two sessions in one week. A second treatment cycle was performed in cases of clinical persistence at 12 weeks. Our results showed that 47/55 lesions were resolved (84.75%) after one or two ALA-PDT cycle and 75/136 lesions (55.15%) after one or two MAL-PDT cycles, in the 12-month follow-up. In conclusion PDT is a safe and non-invasive treatment option in BD. In addition, our results suggest a better response with ALA-PDT over MAL-PDT. Limits: observational study with a limited number of patients.

Efficacy and safety of photodynamic therapy with amino-5-laevulinate nanoemulsion versus methyl-5-aminolaevulinate for actinic keratosis: A meta-analysis.

Photodynamic therapy is an effective treatment for actinic keratosis. 5-aminolevulinic acid nanoemulsion (BF-200 ALA) and methyl-5-aminolevulinate (MAL) are both prodrugs for the treatment of actinic keratosis with photodynamic therapy. A comparison of the efficacy and safety between the drugs is critical for clinical practice. To investigate if photodynamic therapy in combination with BF-200 ALA is superior to photodynamic therapy with MAL for actinic keratosis. We performed a meta-analysis to investigate the combination of photodynamic therapy with BF-200 ALA and with MAL. The PubMed, Cochrane Library, Web of Science and EMBASE databases were searched to select eligible randomized controlled trials. Our search was conducted on April 1, 2019, and included the search terms "5-aminolevulinic acid nanoemulsion or BF-200 ALA", "methyl-5-aminolevulinate or methyl aminolaevulinate" and "actnic keratosis". Cochrane Risk of Bias Tool was used to estimate the risk of bias. The meta-analysis consisted of 5988 actinic keratosis lesions in five eligible randomized controlled trials, with a total of 2953 actinic keratosis lesions treated with BF-200 ALA and 3035 actinic keratosis lesions treated with MAL. BF-200 ALA in combination with photodynamic therapy showed significantly higher overall complete clearance rates (RR: 1.07, 95% CI 1.02-1.12, p = 0.01) and 3 month complete clearance rates (RR: 1.09, 95% CI 1.06-1.12, p < 0.00001) compared to MAL. A subgroup analysis was performed for photodynamic therapy combined with BF-200 ALA, revealing increased complete clearance rates of grade II-III lesions in comparison with MAL (RR: 1.24, 95% CI 1.05-1.46, p = 0.01). Compared with MAL, the pooled relative risk for the meta-analysis for recurrence was 0.67 (95% CI 0.48-0.92, p = 0.01) at 12 month after BF-200 ALA treatment. Photodynamic therapy with BF-200 ALA has a 9% better chance of complete clearance at 3 months and a 24% better chance of grade II-III lesions after treatment than with MAL for patients with actinic keratosis.

Sa1220 EVALUATION OF THE EFFICACY AND SAFETY OF TWO TREATMENTS FOR ESOPHAGEAL CANCER: PHOTODYNAMIC THERAPY AND ENDOSCOPIC ARGON PLASMA COAGULATION. WHICH SHOULD WE SELECT?

In clinical practice to treat esophageal cancer, both photodynamic therapy (PDT) and argon plasma coagulation therapy (APC) are often used because they are less invasive than surgery and chemoradiotherapy. In japan, because PDT requires sophisticated equipment, its availability is limited to few hospitals. On the other hand, APC is more available than PDT. The selection criteria for esophageal cancer therapy has not been definitely established. For better therapeutic selection, we retrospectively investigated the efficacy and safety of PDT and APC in esophageal cancer.

Efficacy of photodynamic therapy in treatment of adult patients with skin cancer

Photodynamic therapy (PDT) is a relatively new non-surgical treatment for cancer and precancerous conditions. The present review focused on studies using PDT in the treatment of basal cell and squamous cell carcinoma and skin melanoma. The aim was to obtain evidence on the efficacy of PTD in the treatment of skin cancer in patients over 18 years old. To that end, we screened the PubMed database of medical and biological publications and the Cochrane Library without restricting the depth of search. Materials and methods. We evaluated the data of meta-analyses, results of randomized controlled trials (RCTs), and systematic reviews on RCTs, where the overall survival, survival without relapse, and survival without progression were assessed. Results. We have found one systematic review of 27 studies of different designs, one meta-analysis of 5 RCTs, and also five RCTs (1165 participants in total), where the efficacy and safety of PDT in patients with basal cell and squamous cell carcinoma were directly compared to surgical treatment, cryotherapy, and chemo-radiation therapy. In another systematic review, PDT used for squamous cell carcinoma was compared with electro-dissection, cryotherapy, curettage, microsurgery and chemo-radiation therapy. According to our search criteria, no comparative studies on the efficacy and safety of PDT in patients with melanoma were found. Conclusion. The review underscores the efficacy of PDT in patients with both basal cell and squamous cell carcinoma. However, the use of PDT resulted in a lower 5-year survival and a greater recurrence rate compared to the surgical treatment. PDT can be recommended as an alternative to surgery and other treatments for basal cell and squamous cell carcinoma.

Green synthesis of carrier-free curcumin nanodrugs for light-activated breast cancer photodynamic therapy

Photodynamic therapy (PDT) is a promising procedure for breast cancer therapy. Curcumin (Cur), a hydrophobic polyphenol derived from the spice turmeric, has been considered as a potential photosensitizer for PDT with evoked immune response, excellent safety, and low cost. However, the translation of curcumin in clinical cancer therapy suffers from an insufficient therapeutic dose in tumor tissues due to its poor solubility and low bioavailability. In this study, carrier-free curcumin nanodrugs (Cur NDs) were prepared without using any toxic solvents through a facile and green reprecipitation method. Cur NDs exhibited distinct optical properties, light-sensitive drug release behavior, resulting in increased reactive oxygen species (ROS) generation and PDT efficacy on breast cancer cells compared with free Cur. Furthermore, cell apoptosis during Cur-based PDT was concomitant with the activation of the ROS-mediated JNK/caspase-3 signaling pathway. Overall, our carrier-free Cur nanodrugs may be promising candidates for facilitating the efficacy and safety of PDT against breast cancer.

Role of photodynamic therapy in the treatment of esophageal cancer.

Photodynamic therapy (PDT), a treatment of choice for cancer, induces a photochemical reaction, thereby eradicating tumor cells. This is achieved through the administration of a photosensitizer drug, which is activated with a laser after localization to the tumor mass, and is an approved curative endoscopic ablative treatment for superficial esophageal squamous cell carcinoma (ESCC) in Japan. PDT has been approved for dysplastic Barrett's esophagus and as a palliative treatment for patients with symptomatic obstructive esophageal cancer in US. However, its adverse events and complicated procedure and the development of alternative endoscopic procedures such as endoscopic submucosal dissection, radiofrequency ablation and cryotherapy, have largely limited the practice of PDT in esophageal cancer worldwide. Recently, owing to the invention of second-generation PDT using talaporfin sodium and diode laser, PDT can be performed with less phototoxicity and therefore has regained popularity in the treatment of ESCC. As a salvage treatment for patients with local failure after chemoradiotherapy (CRT), PDT has shown promising complete response with less phototoxicity and shorter sun shade period. In addition, the efficacy and safety of PDT in patients with local failure of ESCC after CRT were shown in several clinical trials. The direction of the study interest of the next-generation PDT is the safety and potential expansion of the indications for its application in the future. This review covers the PDT for the treatment of ESCC and dysplastic Barrett's esophagus, with special focus on the role of PDT in practice for esophageal cancer.

Role of photodynamic therapy using talaporfin sodium and a semiconductor laser in patients with newly diagnosed glioblastoma.

In this study on the effectiveness and safety of photodynamic therapy (PDT) using talaporfin sodium and a semiconductor laser, the long-term follow-up results of 11 patients with glioblastoma enrolled in the authors' previous phase II clinical trial (March 2009-2012) and the clinical results of 19 consecutive patients with newly diagnosed glioblastoma prospectively enrolled in a postmarket surveillance (March 2014-December 2016) were analyzed and compared with those of 164 patients treated without PDT during the same period. The main outcome measures were the median overall survival (OS) and progression-free survival (PFS) times. Moreover, the adverse events and radiological changes after PDT, as well as the patterns of recurrence, were analyzed and compared between the groups. Kaplan-Meier curves were created to assess the differences in OS and PFS between the groups. Univariate and multivariate analyses were performed to identify the prognostic factors, including PDT, among patients with newly diagnosed glioblastoma. The median PFS times of the PDT and control groups were 19.6 and 9.0 months, with 6-month PFS rates of 86.3% and 64.9%, respectively (p = 0.016). The median OS times were 27.4 and 22.1 months, with 1-year OS rates of 95.7% and 72.5%, respectively (p = 0.0327). Multivariate analyses found PDT, preoperative Karnofsky Performance Scale score, and IDH mutation to be significant independent prognostic factors for both OS and PFS. Eighteen of 30 patients in the PDT group experienced tumor recurrence, including local recurrence, distant recurrence, and dissemination in 10, 3, and 4 patients, respectively. Conversely, 141 of 164 patients in the control group experienced tumor recurrence, including 101 cases of local recurrence. The rate of local recurrence tended to be lower in the PDT group (p = 0.06). The results of the present study suggest that PDT with talaporfin sodium and a semiconductor laser provides excellent local control, with few adverse effects even in cases of multiple laser irradiations, as well as potential survival benefits for patients with newly diagnosed glioblastoma.

PS02.034: EFFICACY AND SAFETY OF SALVAGE PHOTODYNAMIC THERAPY USING TALAPORFIN SODIUM FOR LOCAL FAILURE AFTER CHEMORADIOTHERAPY IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Background We previously conducted an investigator-initiated trial of photodynamic therapy (PDT) using talaporfin sodium (talaporfin-PDT) and laser irradiation (PD-laser) against local failure after chemoradiotherapy (CRT) in patients with esophageal cancer (EC) and reported a high local complete response rate (L-CR) (88.5%) (Yano et al., Oncotarget 2017). Thereafter, talaporfin-PDT has been applied clinically as a salvage treatment for local failure after CRT in Japan since October 2015. The current study retrospectively reviewed the efficacy and safety of talaporfin-PDT in patients who underwent this treatment in our clinical practice. Methods This study was a single-center retrospective observational study. Patients who received salvage talaporfin-PDT for local failure of EC limited to T1–2 after definitive CRT or radiotherapy from May 2011 to July 2017 in our hospital were included. PDT was applied with an intravenous administration of talaporfin sodium (40 mg/kg) followed 4 h later by diode laser irradiation at 100 J/cm2. The primary and secondary endpoints were the rate of L-CR and the safety of PDT, respectively. The criteria for L-CR were as follows: 1) no residual tumor, 2) disappearance of post-PDT ulcer and scar formation, and 3) disappearance of cancer cells as assessed histologically. Results Thirty-one patients were analyzed in this study (26 men, 5 women, median age: 68 years). Histological types were squamous cell carcinoma and adenocarcinoma (30 and 1 patients, respectively). The failure patterns of lesions after CRT were recurrence after achieving a CR and residual lesion just after CRT (25 and 6 patients, respectively). The recurrent T stages were T1a, T1b, and T2 (1, 18, and 12 patients, respectively). The median total laser exposure dose was 500 J (range: 200–900). The L-CR rates were 84.2% (16/19), 41.7% (5/12), and 61.3% (19/31) in patients with T1, T2, and all stages, respectively. No severe adverse events greater than grade 3 related to PDT were observed. Although four patients had grade 2 esophageal stenosis after PDT, the stenosis was controlled by endoscopic balloon dilation. Conclusion Salvage talaporfin-PDT is a safe and curative treatment for local failure, especially stage T1, after CRT in patients with EC. Disclosure All authors have declared no conflicts of interest.

PS02.217: CLINICAL RESULTS OF PHOTODYNAMIC THERAPY FOR INOPERABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background Although surgical resection is the best way for curing cancer, there has been a certain portion of patients who could not undergo surgery because of various reasons. We experienced 9 cases of photodynamic therapy for esophageal cancer patients with inoperable conditions, and investigated the feasibility and safety of photodynamic therapy. Methods Medical records of patients of esophageal cancers who received photodynamic therapies in Korea University Anam Hospital were reviewed retrospectively. Survival, complication rates and treatment results were evaluated. Results A total of 9 patients (all men) with esophageal cancer had been received photodynamic therapy between 2007 and 2015. Average age at the time of treatment was 70.9 (± 4.62, ranging 64 to 78) and average follow-up periods were 18.2 (± 16.59, ranging 3.8 to 53.6). The average Charlson Comorbidity Index (CCI) were 7.3 (± 2.29, ranging 4 to 10). During the follow-up periods, 5 patients died, and only one death was related with the distant metastasis progression. There was one case of skin reaction and no other complications were appeared. There were no complication related deaths. Complete remission of esophageal cancer showed in 6 patients (66.7%) and partial remission showed in 3 patients (33.3%). Two patients with partial remission showed loco-recurrence. One patient with complete remission had to undergo surgery because of preexisting esophageal stenosis. In patients with complete remission, no recurrence was observed. Conclusion Photodynamic therapy is feasible and safe with acceptable rates of complications. For esophageal cancer patients with inoperable condition or refusal of surgery, photodynamic therapy could provide alternative way to treatment. Disclosure All authors have declared no conflicts of interest.

Case Series of Anti-Vascular Endothelial Growth Factor and Photodynamic Therapy in the Treatment of Circumscribed Choroidal Hemangiomas

Purpose: To describe circumscribed choroidal hemangioma (CCH) management in the era of intravitreal anti-vascular endothelial growth factor. Methods: Retrospective chart review of 11 patients (4 men and 7 women; mean age: 47 years) who were treated at University of Wisconsin for CCH between January 1, 2009 and June 1, 2015, using photodynamic therapy (PDT), intravitreal bevacizumab, or a combination of both PDT and bevacizumab. We define change in visual acuity with each treatment as change in Snellen visual acuity from the day of treatment compared to the follow-up appointment closest to the 3-month posttreatment time point. We report visual acuity score (VAS) by converting Snellen visual acuity using the formula, VAS = 100 − 50 × logarithm of the minimum angle of resolution. Results: We treated 7 eyes with PDT only, 1 eye with bevacizumab only, and 4 eyes with combined PDT and bevacizumab. In the PDT-only group, visual acuity improved in 4 eyes, stabilized in 2 eyes, and worsened in 1 eye (average +7.8 letters by VAS). In the 1 eye treated with bevacizumab alone, visual acuity improved by 2.6 letters by VAS. In the combined group, visual acuity improved in 3 eyes and stabilized in 1 eye (average +6.2 letters by VAS). Conclusion: Our study supports the effectiveness and safety of PDT as a primary treatment modality. In addition, our study suggests the independent efficacy of bevacizumab monotherapy in select patients, the synergistic response to bevacizumab with repeated PDT, and potentially reduction of PDT treatments by adding bevacizumab to the treatment protocol.

Effects of repetitive photodynamic therapy using indocyanine green for acne vulgaris.

Indocyanine green (ICG) is a photosensitizer recently introduced for the treatment of acne. To evaluate the efficacy and safety of photodynamic therapy (PDT) using ICG in subjects with acne vulgaris and to evaluate whether there was a difference in the efficacy of ICG-PDT between different numbers of treatment. Subjects with acne on the face were included. ICG lotion (0.1%) was applied for 30 minutes, and a long pulse diode laser was used. Three or five treatments per subject were performed over 2 weeks. Acne lesion counts and Leeds revised acne grades were evaluated at baseline and 2 weeks after the last treatment. In total, 47 subjects completed the study. After both three and five ICG-PDT sessions, a significant reduction in acne lesions and significant improvement in Leeds revised acne grades were found in all treated subjects compared to baseline. In the subjects receiving five ICG-PDT sessions, the reduction of papules/pustules was greater than in the subjects receiving three ICG-PDT sessions (P < 0.01, respectively). However, there was no significant change in the count of nodules/cysts, although it is a negative trend (P = 0.066). Adverse effects were minimal. ICG-PDT using long-pulsed diode laser can be a safe and effective tool for acne vulgaris. Moreover, repetitive treatments of five can cause further improvement of inflammatory acne lesions.