荧光成像光动力治疗非黑色素瘤皮肤恶性肿瘤-回顾性临床研究

S. Gamayunov, I. Turchin, I. Fiks, K. Korchagina, M. Kleshnin, N. Shakhova
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引用次数: 10

摘要

背景与目的:光动力疗法(PDT)已成功应用于临床实践数十年;然而,临床结果数据并不总是一致的,因此非常需要实时监测来预测治疗结果。研究设计和方法:在一项回顾性临床研究中,402例非黑色素瘤皮肤恶性肿瘤患者接受PDT治疗和荧光实时成像。使用的光敏剂是氯e6衍生物(Fotoditazin®);用光纤传输系统的连续波二极管激光器照射肿瘤,总能量可达300 J/cm2。荧光成像使用市售系统,在710-800 nm范围内使用相机和带通滤波器。测量肿瘤的荧光对比(FC)(肿瘤与周围组织的平均荧光强度之比)及其在PDT治疗(光漂白,dFC)期间的变化。然后评估临床结果(肿瘤反应和复发率)与测量的荧光参数之间的相关性。随访6 ~ 53个月(中位28个月)。结果:FC或dFC低于中位值分别对应肿瘤复发率显著升高(p<0.05),部分或无肿瘤反应的病例略有增加。肿瘤反应与FC值相关性较好,与光漂白无关。结论:PDT治疗后基线FC及其变化可作为复发的预测指标。这一发现是个体化PDT癌症治疗的一步。
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Fluorescence imaging for photodynamic therapy of non-melanoma skin malignancies – A retrospective clinical study
Abstract Background and objective: Photodynamic therapy (PDT) has been successfully used in clinical practice for decades; however, clinical outcome data are not always consistent resulting in a great necessity for real-time monitoring to predict the therapy outcome. Study design and methods: In a retrospective clinical study, 402 patients with non-melanoma skin malignancies were enrolled who underwent PDT treatment and fluorescence real-time imaging. The photosensitizer used was a chlorine e6 derivative (Fotoditazin®); the tumors were irradiated with a 662 nm continuous wave diode laser with fiber delivery system and total fluence of up to 300 J/cm2. The fluorescence imaging was performed using a commercially available system with a camera and bandpass filter in the range of 710–800 nm. Fluorescence contrast (FC) of the tumor (the ratio of the average fluorescence intensities in the tumor and the surrounding tissues) and its change during the PDT treatment (photobleaching, dFC) was measured. Then the correlation between the clinical outcome (tumor response and recurrence rate) and measured fluorescence parameters was evaluated. The follow-up period was 6–53 months (median, 28 months). Results: FC or dFC below their median values independently correspond to a significant increase in tumor recurrence rate (p<0.05), and slight increase of partial or no tumor response cases. Tumor response is better correlated with the value of FC, and not correlated with the photobleaching. Conclusion: Baseline FC and its change after PDT treatment may serve as a predictor of recurrence. This finding is a step towards individualized PDT cancer treatment.
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