Lesion oxygenation associates with clinical outcomes in premalignant and early stage head and neck tumors treated on a phase 1 trial of photodynamic therapy
Lesion oxygenation associates with clinical outcomes in premalignant and early stage head and neck tumors treated on a phase 1 trial of photodynamic therapy
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DOI：
10.1016/j.pdpdt.2017.10.015
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发表时间：
2018-03-01
影响因子：
3.3
通讯作者：
Busch, Theresa M.
中科院分区：
文献类型：
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作者：
Ahn, Peter H.;Finlay, Jarod C.;Busch, Theresa M.
背景：我们报道了一项光动力疗法（PDT）用于头颈部浅表病变的1期试验。由于已知PDT对氧的依赖性，我们研究了病变血红蛋白氧饱和度（S1O2）和血容量（tHb）的转化测量值与患者预后的相关性。
方法：采用氨基乙酰丙酸（ALA）和递增光剂量的PDT对头颈部的高度异型增生、原位癌和微浸润癌进行了评估。在29例可评估的患者中，大多数（18例）病变位于舌或口底（EOM）。18例患者疾病完整，11例患者手术切缘有病变。对26例患者测量了病变的S1O2和tHb。
结果：所有患者在24个月时的局部控制率（LC）为57.5%。舌/口底病变患者的局部控制率为42.7%，病变完整患者的局部控制率为50.1%。病变tHb与3个月完全缓解率（CR）无关，但CR患者的S1O2较高。在舌/口底病变中，完全缓解患者（n = 12）的基线S1O2[均值（标准误）]为54(4)%，而局部复发/持续存在患者（n = 6）为23(8)%（p = 0.01）。同样，对于病变完整的患者，完全缓解患者（n = 10）的基线S1O2为54(3)%，未完全缓解患者（n = 5）为28(8)%（p = 0.03）。在病变完整的患者中，较高的基线S1O2与24个月局部控制相关（p = 0.02）。
结论：对靶病变生理特性的测量可能有助于识别最有可能从PDT中获益的患者。这为根据病变特征优化光传递和/或为最能从PDT中获益的患者的临床决策提供了机会。
Background: We report on a Phase 1 trial of photodynamic therapy (PDT) for superficial head and neck (H&N) lesions. Due to known oxygen dependencies of PDT, translational measurements of lesion hemoglobin oxygen saturation (S1O2) and blood volume (tHb) were studied for associations with patient outcomes.Methods: PDT with aminolevulinc acid (ALA) and escalating light doses was evaluated for high-grade dysplasia, carcinoma-in-situ, and microinvasive carcinomas of the H&N. Among 29 evaluable patients, most (18) had lesions of the tongue or floor of mouth (EOM). Disease was intact in 18 patients and present at surgical margins in 11 patients. In 26 patients, lesion S1O2 and tHb was measured.Results: Local control (LC) at 24 months was 57.5% among all patients. In patients with tongue/FOM lesions LC was 42.7%, and it was 50.1% for those with intact lesions. Lesion tHb was not associated with 3-month complete response (CR), but S1O2 was higher in patients with CR. In tongue/FOM lesions, baseline S1O2 [mean(SE)] was 54(4)% in patients (n = 12) with CR versus 23(8)% in patients (n = 6) with local recurrence/persistence (p = 0.01). Similarly, for intact disease, baseline S1O2 was 54(3)% in patients (n = 10) with CR versus 28(8)% in patients (n = 5) without CR (p = 0.03). In patients with intact disease, higher baseline S1O2 associated with 24 month local control (p = 0.02).Conclusions: Measurement of the physiologic properties of target lesions may allow for identification of patients with the highest probability of benefiting from PDT. This provides opportunity for optimizing light delivery based on lesion characteristics and/or informing ongoing clinical decision-making in patients who would most benefit from PDT.