Interstitial Photodynamic Therapy—A Focused Review
Abstract
:1. Introduction
2. Interstitial PDT (I-PDT) in Prostate, Pancreatic, Head and Neck, and Brain Cancers
2.1. I-PDT in Prostate Cancer
2.1.1. Image-Based Treatment Planning in I-PDT of Prostate Cancer
2.1.2. Phase III Trial of PDT versus Active Surveillance of Prostate Cancer
2.2. I-PDT for Pancreatic Cancer
2.3. I-PDT for Locally-Advanced Head and Neck Cancer
2.4. I-PDT for Brain Cancers
3. Summary
Acknowledgments
Conflicts of Interest
Abbreviations
PDT | photodynamic therapy |
I-PDT | interstitial photodynamic therapy |
RPCI | Roswell Park Cancer Institute |
PS | photosensitizer |
EB-PDT | external beam PDT |
SOC | standard of care |
MLu, Lutex | motexafin lutetium |
TookadTM | palladium bacteriopheophorbide |
mTHPC, FoscanTM | meso-tetrahydroxyphenylchlorin |
5-ALA | 5-aminolevulinic acid |
Verteporfin | VisudyneTM |
3-D | three-dimensional |
TRUS | transrectal ultrasound |
PSA | Prostate Specific Antigen |
BOLD | blood oxygenation level-dependent |
MRI | magnetic resonance imaging |
J | energy |
J/cm2 | energy density |
J/cm | linear energy |
mW/cm2 | intensity |
FEM | finite elements method |
iDOSE | Interactive Dosimetry by Sequential Evaluation |
MC | Monte Carlo |
CT | computed tomography |
LAHNC | locally advanced head and neck cancer |
EMA | European Medicines Agency |
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Drug | Drug Dose (mg/kg) | λ (nm) | Laser Settings | # of Patients | Results/Findings | Reference |
---|---|---|---|---|---|---|
ALA (*) | 20 | 633 | 250 J/cm | 14 | Significant reduction in prostate-specific antigen (PSA) values was found. | Zack et al., 2003 [21] |
MLu | 2 | 732 | 150 J/cm | 18 | The 2 mg/kg MLu dose was found too low for effective treatment. | Verigos et al., 2006 [17] |
MLu | 2 | 732 | 150 mW/cm with 100 J/cm2 measured with isotropic detectors | 3 | Pilot study of diffuse reflectance spectroscopy (DRS) for tumor blood oxygenation and diffuse correlation spectroscopy (DCS) for tumor blood flow. Hemoglobin concentration decreased by 50% following I-PDT. | Yu et al., 2006 [22] |
MLu | 2 | 732 | 150 mW/cm | 4 | Simulations showed wide variation in light intensity in I-PDT treatment of prostate cancer. | Li and Zhu 2008 [9] |
MLu | 2 | 732 | 150 mW/cm | 1 | Numerical simulations demonstrate significant variation in optical properties in the target tumor. | Wang and Zhu 2009 [23] |
TookadTM (**) | 2 | 763 | 230–360 J/cm | 6 | Phase I study. Treatment was found to be safe and well tolerated. | Trachtenberg et al., 2007 [24] |
TookadTM | 4,6 | 763 | 200–300 J/cm | 4 | Retrospective analysis of clinical trials to examine drug dose, energy fluence and time on I-PDT; Best result with 4 mg/kg and 200 J/cm. | Gross et al., 2003 [20]; Davidson et al., 2009 [15]; Betrouni et al., 2011 [19] |
TookadTM | 4, 6 | 753 | 200J/cm | 83 | Negative biopsy after 6 months for 61/83 (74%); 4mg/kg and 200 J/cm were optimal for 38/46 (82.6%). | Azzouzi et.al., 2013 [25] |
TookadTM | 2, 4, 6 | 753 | 200 J/cm | 40 | Phase II trial using 4 mg/kg activated with 753-nm light at a dose of 200 J/cm resulted in a treatment effect of 95% of the planned treatment volume in 12 men and negative biopsy after 6 months for 10/12 or 83.3%. | Moore et al., 2015 [26] |
TookadTM | 4 | 753 | 150 mW/cm 200 J/cm | 206/PDT, 207/active surveillance | Phase III trial; negative biopsy after 24 months in 49% (101) of patients who received PDT versus 14% (28) in the active surveillance group. | Azzouzi et. al., 2016 [27] |
mTHPC (***) | 0.15 | 652 | 100–150 mW | 14 | Phase I study, following radiotherapy treatment; partial gland was treated. Up to 91% necrosis or 49% necrosis if one lobe only; cited need for improved dosimetry. | Nathan et. al., 2002 [28] |
mTHPC | 0.15 | 652 | 100 J/cm | 6 | Early study, after 8–10 I-PDT treatments PSA level fell by 67%. | Moore et al., 2006 [29] |
mTHPC | 0.15 | 652 | 5 J/cm2 Calculated from lesion size measured with MRI | 4 | Online dosimetry, dose plans were provided with fiber positions and light dose was based on model; Results were that 5 J/cm2 was too low a light dose. | Swartling et al., 2010 [30] |
Drug | Drug Dose (mg/kg) | λ (nm) | Laser Settings | # of Patients | Results/Findings | Reference |
---|---|---|---|---|---|---|
mTHPC | 0.15 | 652 | 100 mW per fiber; 20–40 J/cm | 16 | Tumors regrew at edges of necrotic regions. Median survival: 9.5 months. | Bown et al., 2002 [6] |
Verteporfin | 0.4 | 690 | 150 mW/cm; 5–40 J/cm per fiber | 15 | No necrosis at 5 J/cm; at 40 J/cm, necrosis was >12 mm in diameter; considerable variation depending on dose; median survival: 8.8 months. | Huggett et al., 2014 [35] |
Drug | Drug Dose (mg/kg) | λ (nm) | Laser Settings | # of Patients | Results/Findings | Reference |
---|---|---|---|---|---|---|
mTHPC | 0.15 | 652 | 100 mW/cm, 20 J/cm, flat cut | 45 | Median overall survival 14 months for responders (73%), versus 2 months for non-responders. | Lou et al., 2004 [37] |
mTHPC | 0.15 | 652 | 100 mW/cm, 20 J/cm, flat cut | 14 | Median overall survival 14 months. | Jager et al., 2005 [38] |
mTHPC | 0.15 | 652 | 200 J per site (10 mm) at 100 mW. Flat-cut fiber | 21 | Improvement in palliation (9/11), 60% overall survival after 45 months. | Jerjes et al., 2011 [7] |
mTHPC | 0.15 | 652 | 100 mW/cm, 30 J/cm, Cylindrical diffuser fiber | 20 | Median overall survival 15 months. | Karakullukcu et al., 2012 [8] |
Drug | Drug Dose (mg/kg) | λ (nm) | Laser Settings | # of Patients | Results/Findings | Reference |
---|---|---|---|---|---|---|
ALA | 20 | 633 | Up to six cylindrical diffusers; total 4320–11,520 J (at 200 mW/cm) | 10 | Adult patients with recurrent malignant glioma; median survival 15 months. | Beck et al., 2007 [44] |
ALA | 20 or 30 | 635 | 4–6 cylindrical diffusers; total 5700–12,960 J; 720 J/cm (at 150-200 mW/cm) | 5 | Survival >29 months in three responders, <9 months in two non-responders. | Johansson et al., 2013 [45] |
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Shafirstein, G.; Bellnier, D.; Oakley, E.; Hamilton, S.; Potasek, M.; Beeson, K.; Parilov, E. Interstitial Photodynamic Therapy—A Focused Review. Cancers 2017, 9, 12. https://doi.org/10.3390/cancers9020012
Shafirstein G, Bellnier D, Oakley E, Hamilton S, Potasek M, Beeson K, Parilov E. Interstitial Photodynamic Therapy—A Focused Review. Cancers. 2017; 9(2):12. https://doi.org/10.3390/cancers9020012
Chicago/Turabian StyleShafirstein, Gal, David Bellnier, Emily Oakley, Sasheen Hamilton, Mary Potasek, Karl Beeson, and Evgueni Parilov. 2017. "Interstitial Photodynamic Therapy—A Focused Review" Cancers 9, no. 2: 12. https://doi.org/10.3390/cancers9020012