Platform for ergonomic intraoral photodynamic therapy using low-cost, modular 3D-printed components: Design, comfort and clinical evaluation.
Platform for ergonomic intraoral photodynamic therapy using low-cost, modular 3D-printed components: Design, comfort and clinical evaluation.
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使用低成本、模块化 3D 打印组件进行符合人体工程学的口腔内光动力治疗的平台：设计、舒适度和临床评估。
DOI：
10.1038/s41598-019-51859-6
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发表时间：
2019
影响因子：
4.6
通讯作者：
Hasan,Tayyaba
中科院分区：
文献类型：
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作者：
Mallidi,Srivalleesha;Khan,AmjadP;Liu,Hui;Daly,Liam;Rudd,Grant;Leon,Paola;Khan,Shakir;Hussain,BilalMA;Hasan,SyedA;Siddique,ShahidA;Akhtar,Kafil;August,Meredith;Troulis,Maria;Cuckov,Filip;Celli,JonathanP;Hasan,Tayyaba
口腔癌的发病率在全球范围内以惊人的速度增长，特别是在缺乏医疗基础设施的发展中国家。例如，印度的口腔癌负担已被确定为公共卫生危机。获得手术、放疗和化疗治疗的高费用和后勤障碍通常导致进展为具有高发病率的不可管理的晚期疾病。即使是治愈性的，这些方法也可能是美容和功能性毁容的，具有广泛的副作用。口腔癌的替代有效疗法是称为光动力疗法（PDT）的基于光的空间靶向细胞毒性疗法。尽管PDT中的口腔粘膜愈合良好，但缺乏用于口内光递送的稳健的使能技术限制了其更广泛的实施。利用3D打印的进步，我们开发了一种口内光传输系统，该系统由模块化3D打印光施加器组成，具有预校准的剂量测定和口腔道具，可用于在有意识的受试者中进行PDT，而无需广泛的基础设施或手动定位光纤。为了评价光施加器的稳定性，我们使用内窥镜代替光纤来监测基准标记的运动。在这里，我们展示了我们的施源器的稳定性（水平轴和垂直轴偏差小于2 mm）和人体工程学，将光线精确地输送到10名健康志愿者的目标位置。我们还在5名患有T1N0M0口腔病变的受试者中证明，我们的施源器与低成本光纤耦合LED光源配合使用，可作为口内光输送的完整平台，在这些患者的初始组织病理学随访中实现完全肿瘤缓解，无残留疾病。总的来说，我们的方法增强了PDT作为早期口腔病变的可行治疗选择，可以在低资源环境中提供。
Oral cancer prevalence is increasing at an alarming rate worldwide, especially in developing countries which lack the medical infrastructure to manage it. For example, the oral cancer burden in India has been identified as a public health crisis. The high expense and logistical barriers to obtaining treatment with surgery, radiotherapy and chemotherapy often result in progression to unmanageable late stage disease with high morbidity. Even when curative, these approaches can be cosmetically and functionally disfiguring with extensive side effects. An alternate effective therapy for oral cancer is a light based spatially-targeted cytotoxic therapy called photodynamic therapy (PDT). Despite excellent healing of the oral mucosa in PDT, a lack of robust enabling technology for intraoral light delivery has limited its broader implementation. Leveraging advances in 3D printing, we have developed an intraoral light delivery system consisting of modular 3D printed light applicators with pre-calibrated dosimetry and mouth props that can be utilized to perform PDT in conscious subjects without the need of extensive infrastructure or manual positioning of an optical fiber. To evaluate the stability of the light applicators, we utilized an endoscope in lieu of the optical fiber to monitor motion in the fiducial markers. Here we showcase the stability (less than 2 mm deviation in both horizontal and vertical axis) and ergonomics of our applicators in delivering light precisely to the target location in ten healthy volunteers. We also demonstrate in five subjects with T1N0M0 oral lesions that our applicators coupled with a low-cost fiber coupled LED-based light source served as a complete platform for intraoral light delivery achieving complete tumor response with no residual disease at initial histopathology follow up in these patients. Overall, our approach potentiates PDT as a viable therapeutic option for early stage oral lesions that can be delivered in low resource settings.