Photodiagnosis and photodynamic therapy最新文献

Background: PDT using Photofrin® (P-PDT) has been applied to over 900 gynecologic tumor cases since 1989, demonstrating excellent efficacy and fertility preservation; however, post-treatment photosensitivity has limited its clinical application for CIN and cervical cancer. This study aimed to establish a safe, effective, and fertility-preserving alternative to cervical conization.

Methods: To overcome photosensitivity, we conducted a prospective Phase I/II clinical study to evaluate the safety, efficacy, oncological control, and fertility outcomes of L-PDT using talaporfin sodium (Laserphyrin®) and a diode laser for CIN grades 2-3. Forty-three women with biopsy-confirmed CIN2-3 were enrolled. Phase I determined the optimal light dose (50, 75, or 100 J/cm²), and Phase II assessed efficacy and safety at 100 J/cm². Talaporfin sodium (40 mg/m²) was administered intravenously 4 hours before laser irradiation under colposcopic guidance.

Results: Complete response (CR) was achieved in 95% (95% CI: 89.1-100%) at 3 months and 98% (95% CI: 93.2-100%) at 6 months after treatment. Original high-risk human papillomavirus clearance was 92.5% at 3 months and 95% at 12 months. Adverse events were mild and transient, including abdominal pain and low-grade fever. No recurrences occurred during a median follow-up of 66.4 months among patients achieving CR. Among women desiring pregnancy, the conception rate was 74% (23/31) and the live birth rate was 79% (27/34), with a low preterm birth rate of 3.7% (1/27).

Conclusions: These results suggest that L-PDT is a safe and highly effective non-excisional treatment for CIN that may contribute to fertility preservation; however, potential advantages over conventional conization and laser vaporization need to be confirmed in comparative studies.

Background and objectives: Viral warts are benign proliferative skin lesions caused by the human papillomavirus (HPV) and are contagious among humans. Currently, there are no effective treatments to address the high recurrence rate of viral warts, presenting challenges in achieving their complete eradication. The aim of this study was to evaluate the efficacy and safety of curettage combined with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for the treatment of recalcitrant acral warts.

Methods: Our study was carried out between July 2023 to June 2025, and the clinical data of 50 patients diagnosed with acral warts were retrospectively collected. Patients were assigned to the curettage group (n=24) or the combination group (n=26) based on whether they received photodynamic therapy after curettage. The clinical response effects, recurrence rate and adverse reactions of the two groups were observed and compared.

Results: The cure rate in the combination group was 80.8% (21/26), which was significantly higher than 45.8% (11/24) in curettage group. The recurrence rate in the combination group was 19.2% (5/26), which was lower than 54.2% (13/24) in curettage group (P<0.05). After three months of follow-up, moderate pain was the main adverse reaction in both groups, and no systemic adverse reactions were observed.

Conclusion: Our results suggest that curettage combined with ALA-PDT is promising as a safe and effective therapy for patients with recalcitrant acral warts.

Objectives: To compare transurethral laser ablation (TULA) outcomes for non-muscle invasive bladder cancer (NMIBC) performed under topical anesthesia versus general or spinal anesthesia in a Japanese cohort.

Methods: We retrospectively reviewed 28 patients who underwent 32 TULA sessions with a 980-nm diode laser from February 2024 to June 2025. Patients treated between February and October 2024 received TULA under general or spinal anesthesia (general or spinal anesthesia group, n = 14). Those treated between October 2024 and June 2025 underwent TULA with topical lidocaine lubrication (topical anesthesia group, n = 18). We compared demographic, perioperative, and short-term oncologic outcomes. Complications were graded according to Clavien-Dindo classification.

Results: Baseline characteristics were similar between groups. Operation time, treatment energy, and treatment duration were comparable. The topical anesthesia group experienced a significantly shorter median post-treatment hospital stay (1 [1-1] vs. 2 [2-2.75] days; p < 0.001) and catheterization duration (0 [0-0] vs. 1 [1-1] days; p < 0.001). Complications were mild (grade 1-2), affecting one general or spinal anesthesia group patient (7.1%) and three topical anesthesia group patients (16.7%). Under strict follow-up criteria (≥90 and ≥180 days), 3-month recurrence-free survival (RFS) was 100% (14/14) in both groups, and 6-month RFS was 92.3% (12/13) in the anesthesia group vs. 58.3% (7/12) in the topical anesthesia group. Kaplan-Meier analysis showed no statistically significant difference (p = 0.19).

Conclusions: TULA under topical anesthesia for selected NMIBC patients was associated with shorter post-treatment hospital stays and a catheter-free recovery. Early oncologic outcomes, including short-term RFS, seem promising; however, these preliminary, pilot-scale findings warrant further validation in larger studies. TULA with topical anesthesia may provide perioperative advantages compared with procedures performed under general or spinal anesthesia, particularly in older patients or those with significant comorbidities.

Background: Granular parakeratosis (GP) is an uncommon dermatosis characterized by scaly, erythematous to brownish eruptions in intertriginous areas. Diagnosis is challenging and traditionally requires histological confirmation. While dermoscopy and ultraviolet-induced fluorescence dermoscopy (UVFD) offer non-invasive diagnostic approaches, their characteristic findings in GP remain inadequately defined.

Objective: This study aimed to systematically characterize the dermoscopic and UVFD features of GP, with a secondary aim of evaluating their diagnostic utility in differentiating GP from other intertriginous dermatoses.

Methods: We retrospectively analyzed 21 patients with clinicopathologically confirmed GP. Dermoscopic and UVFD data from patients with inverse psoriasis (n=10), tinea cruris (n=23), and erythrasma (n=12) were collected for comparison. Parameters included background color, vascular morphology and distribution, scale color and distribution, and UVFD fluorescence.

Results: Among 21 GP patients (male: female 13:8; mean age 38.4 ± 15.2 years), 71.4% reported prior exposure to disinfectants containing benzalkonium chloride. Symmetrical, erythematous to brown patches/plaques with variable scaling were observed, predominantly in axillae (61.9%), with pruritus /burning in 71.4%. Dermoscopy revealed large, geographic, polygonal, light-brown scales. Under UVFD, 81% of GP exhibited bright-blue margins. Comparative analysis distinguished GP from inverse psoriasis (uniform red background with regular vessels), tinea cruris (peripheral scaling and distinct vascular patterns), and erythrasma (coral-red fluorescence under UVFD, also seen in 60.0% of inverse psoriasis cases).

Conclusion: Dermoscopy and UVFD provide reliable, non-invasive diagnostic clues for the GP. The presence of light-brown geographic scales and fluorescent bright-blue margins offers a practical, non-invasive tool for accurate GP diagnosis.

Purpose: To determine whether untreated intermittent exotropia (IXT) accelerates pediatric myopia and whether strabismus surgery modifies this risk.

Methods: This retrospective study enrolled 259 children aged 6-14 years with spherical equivalent refraction (SER) ≤ -0.75 D; 90 orthotropic controls, 86 untreated IXT, and 83 post-surgery IXT (PS-IXT) with successful alignment. Exclusion criteria included prior ocular surgery, trauma, or myopia-control interventions. After standardized cycloplegia, certified optometrists measured SER and axial length (AL) at baseline, 6 and 12 months.

Results: Baseline SER, AL, age and gender distribution did not differ among the three cohorts (all P > 0.05). At the 12-month endpoint, the IXT group exhibited a significantly greater myopic shift (-0.91 ± 0.36 D vs -0.50(-0.75,-0.37) D; P < 0.001) and axial elongation (0.41 ± 0.17 mm vs 0.30(0.20,0.36) mm; P < 0.001) relative to orthotropic controls. Similarly, when compared with the surgically aligned (PS-IXT) group, the IXT cohort displayed excess myopic progression (-0.91 ± 0.36 D vs -0.38(-0.63,-0.13) D; P < 0.001) and axial elongation (0.41 ± 0.17 mm vs 0.25(0.13,0.37) mm; P < 0.001). In contrast, the PS-IXT and control groups were comparable for both refractive change (-0.50(-0.75,-0.37) D vs -0.38(-0.63,-0.13) D; P = 0.204) and axial elongation (0.30(0.20,0.36) mm vs 0.25(0.13,0.37) mm; P=0.998).

Conclusion: Untreated IXT constitutes an independent, modifiable driver of accelerated myopia in children; timely surgical realignment normalizes the subsequent refractive and axial trajectory and should be incorporated into comprehensive myopia-prevention strategies.

Hexylaminoacetylpropionic acid (HAL), a third-generation photosensitizer prodrug, exhibits targeted accumulation within tumor tissues and microbial biofilms. This review outlines advances in HAL-based drug delivery systems and their expanding use in various diseases, including oncology, antimicrobial therapy, and dermatologic diseases. Clinically, HAL has proven instrumental in enhancing diagnostic accuracy for bladder cancer by facilitating more complete surgical resections, while also demonstrating therapeutic efficacy against actinic keratosis and cervical intraepithelial neoplasia. These clinical advantages are complemented by novel nanocarrier systems that optimize drug delivery that improve patient tolerability. Recent findings point to an underappreciated the interplay between HAL-induced metabolic changes in tumours and anti-tumour immune responses, in which HAL-induced thiol oxidation and redoxsensitive oxidative modifications of key regulatory proteins reshape the tumour microenvironment and enhance immunogenicity. Thus, HAL is a candidate for combination with immune checkpoint inhibitors. However, challenges such as shallow light penetration (<2 mm) and the need for long-term safety validation limit its broader clinical utility. We propose three convergent strategies to address these limitations: (i) reactive oxygen species-responsive nanocarriers for targeted delivery in hypoxic environments, (ii) biomarker-guided combinatorial regimens, and (iii) data-driven treatment personalisation using patient-specific biomarkers. Together, these advances establish a translational framework for HAL as a platform in next-generation metabolism-targeted photomedicine.

Photodynamic therapy (PDT) is a novel light-based modality that relies on photoactivatable photosensitizers (PSs) to generate cytotoxic reactive oxygen species (ROS), but its clinical prospects are impeded by issues related to poor tumour specificity, penetration and off-target phototoxicity. Milk-derived exosomes (MDE), naturally occurring extracellular vesicles (30-150 nm in diameter) with excellent biocompatibility and low immunogenicity, have recently emerged as promising vehicles in drug delivery. MDE enhance intercellular communication by transporting proteins, lipids, and nucleic acids between cells. They have gained significant attention in recent years for their potential use in drug delivery, particularly for hydrophobic PSs, gene and protein delivery. MDE are of particular interest due to their abundance, ease of isolation, and biocompatibility. Herein we reviewed recent developments in MDE-mediated PDT, with a focus on three key areas: isolation and loading techniques, stimuli-responsive release and targeting such as pH-sensitive linkers or surface-anchored ligands (e.g., folic acid), therapeutic applications and in vivo efficacy. Several lines of evidence showed that MDE loaded with PSs significantly enhance tumour uptake and cause severe regression in in vivo tumour models of glioblastoma and oral cancer, following systemic or oral administration. Overall findings from this review suggest that clinical translation depends on addressing key challenges related to scalable purification, reproducible drug loading and thorough safety profile screening. Therefore, it is essential for researchers to actively standardize manufacturing processes, conduct thorough in vivo validation, and investigate combination therapies with modalities for enhanced therapeutic efficacy.

Objective: Vaginal Intraepithelial Neoplasia (VaIN) is a precancerous condition that can progress to vaginal cancer if untreated. Photodynamic Therapy (PDT), recognized for its minimally invasive nature and favorable side effect profile, is increasingly employed for VaIN treatment; however, comprehensive evidence synthesis on its efficacy and safety remains limited. This study aims to comprehensively evaluate the efficacy and safety of 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) in treating VaIN.

Methods: We systematically searched PubMed, Embase, Web of Science, and Cochrane Library databases for studies evaluating PDT efficacy in VaIN. Primary outcomes were complete response (CR) rate and HPV clearance rate; secondary outcomes included recurrence rate and adverse events (AE). Meta-analysis was performed using Stata 18.0.

Results: Nine trials (421 patients) were included. Pooled outcomes: 6-month CR:87% (95% CI: 78%-94%), 12-month CR:84% (95% CI:76%-91%); 6-month HPV clearance:61% (95% CI:55%-66%), 12-month:73% (95% CI:67%-78%); 6-month HPV16/18 clearance:71% (95% CI:61%-80%), 12-month:76% (95% CI:63%-88%); 6-month recurrence:4% (95% CI:2%-8%), 12-month:7% (95% CI:0%-24%); AEs: Increased vaginal discharge (20%, 95% CI: 8%-36%), itching (25%, 95% CI: 1%-62%), burning sensation (23%, 95% CI: 1%-57%), abdominal pain (7%, 95% CI: 0%-21%), and mild vaginal bleeding (0%, 95% CI: 0%-3%). No serious AEs.

Conclusion: ALA-PDT demonstrates high efficacy and favorable safety in treating VaIN. However, as current evidence primarily stems from single-arm studies, future high-quality multicenter randomized controlled trials are essential to confirm these findings and directly compare ALA-PDT with standard therapies.

Verrucous xanthoma is an uncommon skin condition, most frequently occur in the oral cavity and other sites,¹ and its occurrence on the glans penis is especially rare. Conventional treatment methods such as surgical excision or laser therapy often carry a significant risk of scarring, which can reduce glans sensitivity and negatively impact sexual function. To date, the use of photodynamic therapy (PDT) for this condition has not been documented. This case report describes a successful outcome using PDT as a non-invasive treatment alternative.

Objective: To evaluate clinical outcomes and supportive-care needs in photoimmunotherapy (PIT) restricted to oral sites in a multicentre real-world cohort.

Methods: We retrospectively analysed 40 consecutive patients with unresectable, locally recurrent head and neck cancer undergoing PIT between 1 January 2021 and 31 August 2024. The oral-site subgroup comprised 12 patients receiving ≥1 illumination to the oral cavity (tongue, gingiva, buccal mucosa, floor of mouth, hard palate, or flap). The primary endpoint was objective response rate (ORR). Secondary endpoints included time-to-treatment failure (TTF), overall survival (OS), progression-free survival (PFS), and adverse events (AEs). Kaplan-Meier analyses assessed time-to-event outcomes.

Results: Best overall responses comprised complete response, partial response, stable disease, and progressive disease in six, four, one, and one patients, respectively, yielding an ORR of 83.3 % (95 % confidence interval [CI], 51.6-97.9) and a disease control rate of 91.7 % (95 % CI, 61.5-99.8). The median TTF, OS, and PFS were 6.0 months (95 % CI, 1.4-18.3), 22.0 months (95 % CI, 6.0-unreached), and 6.0 months (95 % CI, 1.4-10.4), respectively. AEs included pain (100 %; grade≥3, 25 %), mucositis (92 %; grade≥3, 17 %), facial oedema (75 %), laryngeal oedema (67 %; grade≥3, 8 %), dysphagia (50 %), bleeding (50 %), and fistula (33 %). Commonly required supportive interventions included anticipatory analgesia, airway protection (e.g., preventive tracheostomy), and temporary enteral nutrition.

Conclusions: Oral-site PIT demonstrated high antitumour activity with frequent but manageable local toxicities, necessitating proactive, multidisciplinary supportive care. This first dedicated multicentre analysis focused on oral illumination corroborates site-specific PIT evaluation and its integration within multimodal treatment strategies.