Intraoperative Photodiagnosis for Malignant Glioma Using Photosensitizer Talaporfin Sodium
Intraoperative Photodiagnosis for Malignant Glioma Using Photosensitizer Talaporfin Sodium
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DOI：
10.3389/fsurg.2019.00012
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发表时间：
2019-03-21
影响因子：
1.8
通讯作者：
Kohno, Michihiro
中科院分区：
文献类型：
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作者：
Akimoto, Jiro;Fukami, Shinjiro;Kohno, Michihiro
目的：探讨肿瘤光动力疗法(PDT)中应用他拉普芬钠(TPS)对术中恶性脑肿瘤进行光诊断(PD)的临床可行性。方法：47例经术前影像确诊的恶性脑胶质瘤患者(胶质瘤42例，其他脑肿瘤5例)于手术前24 h静脉注射他拉普芬钠40 mg/m(2)。术中用半导体激光664 nm照射，观察肿瘤荧光。荧光强度按3分评分标准[强荧光、弱荧光和无荧光]进行视觉分级。结果：TPS荧光强度在所有II级胶质瘤患者中均较弱，而在III、IV级胶质瘤患者中几乎全部较强，反映了胶质瘤的恶性程度。除1例脑转移瘤外，非胶质瘤脑瘤的荧光强度均较强。TPS在组织中的平均浓度分别为1.62、0.67、0.19µg/g。结论：建立了合适的荧光观察系统，使TPS在荧光引导下切除脑恶性肿瘤成为可能，肿瘤的荧光强度与组织中的TPS浓度呈正相关。这些结果表明，TPS是一种有用的光敏剂，可用于术中荧光诊断和光动力学治疗。
Objective: The aim of this study was to demonstrate the clinical feasibility of intraoperative photodiagnosis (PD) of malignant brain tumor using talaporfin sodium (TPS), which is an agent used in photodynamic therapy (PDT) for cancers.Methods: Forty-seven patients diagnosed with malignant gliomas by preoperative imaging (42 patients with gliomas and 5 patients with other brain tumors) received an intravenous injection of TPS at 40 mg/m(2) 24 h before resection. During surgery, these patients were irradiated with diode laser light at 664 nm, and tumor fluorescence was observed. The fluorescence intensity was visually rated on a 3-point rating scale [strong fluorescence, weak fluorescence and no fluorescence]. TPS concentrations in 124 samples from 47 cases were measured by HPLC (High performance liquid chromatography).Results: The fluorescence intensity was confirmed to be weak in all patients with Grade II gliomas and strong in almost all patients with Grade III or IV gliomas, reflecting the histological grade of malignancy. In patients with non-glioma brain tumors except for 1 patient with a metastatic brain tumor, the fluorescence intensity was strong. The mean TPS concentration in tissues was 1.62 mu g/g for strong fluorescence areas, 0.67 mu g/g for weak fluorescence areas and 0.19 mu g/g for no fluorescence areas.Conclusions: Establishment of an appropriate fluorescence observation system enabled fluorescence-guided resection of malignant brain tumors using TPS, and the fluorescence intensity of tumors correlated with the TPS concentrations in tissues. These results suggest that TPS is a useful photosensitizer for both intraoperative fluorescence diagnosis and photodynamic therapy.