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Development of photodynamic and radiodynamic therapy with acridine orange for new limb salvage surgery in musculoskeletal sarcomas

吖啶橙光动力和放射动力疗法在肌肉骨骼肉瘤保肢手术中的应用进展

基本信息

批准号：
14207058
负责人：
KUSUZAKI Katsuyuki
金额：
$ 16.06万
依托单位：
Mie University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (A)
财政年份：
2002
资助国家：
日本
起止时间：
2002 至 2004
项目状态：
已结题

项目摘要

Introduction : Recent our experimental study revealed that photodynamic or radiodynamic therapy with acridine orange (AO-PDT or AO-RDT) had a strong cytocidal effect in vitro as well as in vivo on mouse osteosarcoma cells. Also AO had a tumor visualization effect during surgery, because AO is tumorphilic and has a capability to emit fluorescence by excitation. In this study, we have attempted to apply reduction surgery of intralesional excision (curettage) by AO-PDT with/without AO-RDT to musculoskeletal sarcoma patients, to obtain good limb function.Materials & Methods : 47 patients with musculosketetal sarcomas were treated by curettage using AO-PDT with/without AO-RDT during July 1999 to February 2005. Clinical out come was analysed in 37 patients who are followed longer than 6 months after the treatment. Histologically, 6 were synovial sarcomas, 6 rhabdomyosarcomas, 5 Ewing'sarcomas/PNETs, 5 osteosarcomas, 3 MFHs, 2 MPNST, 2 chondrosarcomas, etc. Average age of these patients with … More 19 males and 13 females was 29 years (1 to 82 years). Follow-up period was ranged from 6 month to 68 months. For these patients, macroscopic curettage of tumor was first performed, and then microscopic curettage under tumor visualization was done after local administration of 1□g/ml AO solution for 5 minutes followed by excitation with blue light using fluorescence surgical microscope. Finally, AO-PDT was applied to tumor curettage area for 10 minutes using surgical microscope. After closure of surgical wound without washing of AO, 5 Gy of X-ray was immediately irradiated to resected area for AO-RTD.Results : Out of 21 patients primarily treated wit AO-PDT with/without AO-RDT, only one patient had a local recurrence. Local recurrence rate was 4.8%, which is quite better local control. However, 3(25%) of 12 lesions which recurred after primary surgery without AO-PDT recurred again even after AO-PDT. 5 patients with locally aggressive tumors such as bone GCT and desmoid tumor did not show local recurrence after AO-PDT. All of patients studied maintained an excellent limb or organ function. Any patients did not have systemic or local complications by AO administration or AO-PDT and AO-RDT.Conclusion : Based on these results, we concluded that AO-PDT with AO-RDT will become a novel limb salvage modality to inhibit local tumor recurrence and to preserve an excellent limb or organ function in musculoskeletal sarcomas. Less

简介：最近我们的实验研究表明，光动力或放射动力疗法与吖啶橙子（AO-PDT或AO-RDT）在体外和体内对小鼠骨肉瘤细胞有很强的杀伤作用。此外，AO在手术期间具有肿瘤可视化效果，因为AO是亲肿瘤的并且具有通过激发发射荧光的能力。在这项研究中，我们已经尝试应用AO-PDT病灶内切除（刮除）的复位手术与/AO-RDT的肌肉骨骼sarcoma.Materials和方法：47例患者进行刮除术与AO-PDT与/AO-RDT在1999年7月至2005年2月期间，获得良好的肢体功能。对37例随访6个月以上的患者进行了临床疗效分析。组织学上，滑膜肉瘤6例，横纹肌肉瘤6例，尤文氏肉瘤5例，骨肉瘤5例，MFH 3例，MPNST 2例，软骨肉瘤等2例。关于我们男19例，女13例，年龄29岁（1 ~ 82岁）。随访6 ~ 68个月。对于这些患者，首先进行肿瘤的肉眼刮除，然后在局部施用1□g/ml AO溶液5分钟后，使用荧光手术显微镜用蓝光激发，在肿瘤可视化下进行显微刮除。最后，在手术显微镜下将AO-PDT应用于肿瘤刮除区域10分钟。结果：21例患者经AO-PDT联合或不联合AO-RDT治疗后，仅1例局部复发。局部复发率为4.8%，局部控制较好。然而，12个病灶中有3个（25%）在初次手术后没有AO-PDT复发，即使在AO-PDT后再次复发。5例骨巨细胞瘤、硬纤维瘤等局部侵袭性肿瘤患者经AO-PDT治疗后均未出现局部复发。所有患者均保持了良好的肢体或器官功能。任何患者都没有全身或局部并发症AO管理或AO-PDT和AO-RDT.Conclusion：基于这些结果，我们得出结论，AO-PDT与AO-RDT将成为一种新的保肢方式，以抑制局部肿瘤复发，并保持良好的肢体或器官功能的肌肉骨骼肉瘤。少