Intraperitoneal photodynamic therapy.
Intraperitoneal photodynamic therapy.
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DOI：
10.1007/978-0-387-48993-3_34
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
Hahn, S M
中科院分区：
文献类型：
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作者：
Cengel, K A;Glatstein, E;Hahn, S M
腹膜癌病和肉瘤病通常是无法治愈的问题，很少有好的治疗选择。腹腔内光动力疗法因其治疗效果相对较浅而有可能成为治疗腹膜癌病的理想方法。使用第一代光敏剂Photofrin的IP PDT的II期试验表明，这种治疗方法在临床上是可耐受的，但与实质性毒性相关，表明治疗指数较窄。值得注意的是，在大量预先治疗的患者中观察到反应，表明临床活性。相关的研究表明，光敏剂在人体肿瘤和正常组织摄取肿瘤的选择性很小。这种缺乏光敏剂对肿瘤的选择性与肿瘤缺氧（与含氧正常组织相反）的组合可能是腹膜内PDT治疗指数狭窄的主要原因。然而，新的和潜在的分子靶向光敏剂的出现，结合通过抑制生长因子信号传导增强PDT癌细胞的细胞毒性，应该大大提高腹膜内PDT的治疗指数。此外，其他方法，包括使用纳米技术，可以允许给予分次PDT，这也可以提高这种治疗的治疗指数。这些技术的临床实施可能允许使用PDT高度有效且耐受性良好的腹膜内癌病治疗。
Peritoneal carcinomatosis and sarcomatosis are generally incurable problems for which there are few good treatment options. Intraperitoneal PDT is potentially an ideal therapy for peritoneal carcinomatosis because of its relatively superficial treatment effect. A Phase II trial of IP PDT with the first generation photosensitizer, Photofrin, demonstrates that this treatment approach is tolerable clinically but is associated with substantial toxicity suggesting a narrow therapeutic index. Remarkably, responses were observed in heavily pre-treated patients suggesting clinical activity. Correlative studies of photosensitizer uptake in human tumour and normal tissues show little tumour selectivity. This lack of photosensitizer selectivity for tumour in combination with tumour hypoxia (as opposed to oxic normal tissues) is likely a major reason for the narrow therapeutic index of intraperitoneal PDT. However, the advent of novel and potentially molecularly targeted photosensitizers, combined with enhancement of PDT cancer cell cytotoxicity through inhibition of growth factor signaling should greatly improve the therapeutic index of intraperitoneal PDT. In addition, other approaches, including the use of nanotechnology, may allow the administration of fractionated PDT which may also improve the therapeutic index of this treatment. The clinical implementation of these technologies may allow for highly effective and well tolerated treatment of intraperitoneal carcinomatosis with PDT.