Photodynamic therapy (PDT), the combination of tumor-selective photosensitizers (PS) and light at the appropriate wavelength is under investigation for adjuvant therapy in brain tumors. Malignant ...brain tumors carry a lethal prognosis with a median survival of 15 months despite surgery, radiotherapy and chemotherapy.
Recently photodynamic diagnosis mediated by FOSCAN
® (meta-tetrahydroxyphenylchlorin – mTHPC) was introduced by our institution for intraoperative photo diagnosis (PDD) and fluorescence guided resection (FGR) for a more radical tumor removal. Twenty-six patients suffering from malignant brain tumors were sensitized with 0.15
mg/kg m-THPC body weight and underwent a combination of fluorescent guided resection followed by intraoperative PDT (20
J/cm
2 at 652
nm) after 4 days.
Intraoperative fluorescence was induced by a UV light source at 370–440
nm. A standard neurosurgical microscope was optimized for fluorescence detection. Intraoperative PDT was performed by lasers at 652
nm and 20
J/cm
2.
The fluorescence sensitivity and specificity in 172 tissue samples were 87.9% and 95.7%, respectively. Tumor could be predicted to an accuracy of 90.7%. Photodynamic diagnosis (PDD) proved to be useful in tumor resection accounting for a radical resection in 75% under fluorescenceguided resection as compared to 52% in the control group. The median survival time for the PDD/PDT group was 9 months as compared to the matched pair control group of 3.5 months, respectively.
The side effects consisted of two severe toxic reactions to sunlight due to unintentional exposure to direct sunlight and one patient experienced a transitional brain swelling.
Our results indicate that fluorescence guided surgery is feasible and proved to be of significant help in delineating tumor margins and in resection of residual tumor that could not be detected by the surgeon. The addition of intraoperative PDT significantly enhanced survival.
Die Photodynamische Therapie (PDT), bestehend aus einem tumorselektiven Photosensitizer und Licht der geeigneten Wellenlänge, wird als neue Therapieoption bei malignen Hirntumoren untersucht. Patienten mit malignen Hirntumoren weisen eine mittlere Überlebenszeit von 15 Monaten auf, trotz Operation, Strahlentherapie und Chemotherapie.
Neuerdings wird an unserer Institution eine sogenannte Photodynamische Diagnose (PDD), d.h. eine fluoreszenzgestützte Tumorresektion eingesetzt, um eine radikalere Operation zu ermöglichen, mit anschließender intraoperativer PDT.
Sechsundzwanzig Patienten mit rezidivierenden Glioblastomen wurden einer Sensibilisierung mit FOSCAN
® (0.15
mg/kg Körpergewicht), einem Photosensitizer der 2. Generation, unterzogen. Vier Tage danach erfolgte die offene Tumorresektion unter Fluoreszenzdiagnose mit UV Licht zwischen 370 und 440
nm (Peak 417
nm) mittels eines adaptierten Standard-Mikroskops für die Neurochirurgie. Die intraoperative photodynamische Therapie wurde mit einem Dioden-laser bei 652
nm und einer Energie von 20
J/cm
2 durchgeführt.
Die Sensitivität und Spezifität der Fluoreszendiagnose in 172 Proben von 26
Patienten betrugen 87,9% bzw. 95,7%. Die Tumor voraussage konnte in 90,7% der Fälle korrekt getroffen werden. In 75% der Fälle konnte der Tumor unter PDD makroskopisch radikal entfernt werden, im Vergleich zu 52% in der Kontrollgruppe. Die mittlere Überlebenszeit betrug in der PDD/PDT-behandelten Gruppe 9 Monate, welches signifikant besser war als 3,5 Monate der Vergleichsgruppe.
Zwei Patienten erlitten Nebenwirkungen mit Hautverbrennungen 2. Grades auf Grund einer zufälligen ungewollten direkten Sonneneinstrahlung, ein Patient zeigte eine vorübergehende Hirnschwellung.
Unsere Resultate zeigen eine deutliche Verbesserung des Resektionsergebnisses unter fluoreszenzgestützter Tumorresektion. Die Kombination aus PDD und PDT resultierte in einer signifikanten Lebensverlängerung der Patienten mit rezidivierenden Glioblastomen.
La Terapia Fotodinámica (PDT), que combina el uso de fotosensibilizadores selectivos de tumores y luz de una determinada longitud de onda, se encuentra bajo investigación como terapia adyuvante para tumores cerebrales. A pesar de la cirugía, la radio- y la quimioterapia, los tumores malignos del cerebro poseen un pronóstico letal con una sobrevida media de 15 meses.
Recientemente, el diagnóstico fotodinámico con FOSCAN
® (metatetrahidroxifenilclorina – mTHPC) ha sido introducido en nuestra Institución para el fotodiagnóstico intraoperatorio (PDD) y la resección guiada por fluorescencia (FGR) para una remoción más radical del tumor.
Veintiseis pacientes con tumores malignos cerebrales fueron sometidos a un tratamiento con 0.15
mg m-THPC por kilogramo de peso corporal, y posterior resección guiada por fluorescencia seguida de PDT intraoperatoria (20
J/cm
2 at 652
nm) luego de 4 días. La fluorescencia intraoperatoria fue inducida con una fuente de luz UV de 370–440
nm. Un microscopio estándar para neurocirugía fue optimizado para la detección de fluorescencia. La PDT intraoperatoria se realizó con láser de 652
nm y 20
J/cm
2. La sensibilidad y especificidad de la fluorescencia en 172 muestras de tejido fue de 87.9% y 95.7%, respectivamente. Se pudo predecir el tumor con una precisión del 90,7%. El diagnóstico fotodinámico (PDD) resultó útil para la resección del tumor, teniendo en cuenta que bajo resección guiada por fluorescencia se alcanzó una resección radical del 75%, en comparación con un 52% del grupo control. El tiempo medio de sobrevida fue de 9 meses para el grupo tratado con PDD/PDT, mientras que para el grupo control fue de sólo 3,5 meses.
Los efectos colaterales consistieron en dos casos de reacción tóxica severa a la luz solar debido a una exposición involuntaria directa, y un paciente experimentó tumefacción cerebral transitoria.
Nuestros resultados indican que la cirugía guiada por fluorescencia es practicable y de gran ayuda para delinear los márgenes del tumor, así como en la resección residual de tumores que no pueden ser detectados por el cirujano. La incorporación de PDT significativamente incrementó la sobrevida de los pacientes.
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Glioblastom maloga mozga je veoma rijedak. Dosad su u literaturi prikazana 33 bolesnika starije životne dobi s glioblastomom maloga mozga. Prikazan je slučaj muškarca u dobi od 65 godina. ...Kompjutorizirana tomografija maloga mozga pokazala je ekspanzivni proces maloga mozga veličine 34x33x52 mm. U kliničkoj slici je bila prisutna cerebelarna simptomatologija. Bolesnik je operiran u dva zahvata: najprije je zbog hipertenzijskog opstrukcijskog hidrocefalusa učinjena vanjska ventrikularna drenaža, a u drugom zahvatu medijalna subokcipitalna kraniektomija i ablacija tumora. Histopatološki nalaz je ukazao na glioblastom maloga mozga. Poslijeoperacijski je provedeno onkološko liječenje koje je uključivalo radioterapiju i kemoterapiju temozolomidom.
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Provider: - Institution: - Data provided by Europeana Collections- Frankfurt (Main), Univ., Diss., 2007- All metadata published by Europeana are available free of restriction under the Creative ...Commons CC0 1.0 Universal Public Domain Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
