Photodynamic therapy for Barrett's oesophagus and oesophageal carcinoma—How I do it

We have considerable experience in the use of both ALA and Photofrin-induced photodynamic therapy in the treatment of Barrett's oesophagus (with and without dysplasia) and both early and advanced oesophageal carcinoma. The drugs used and the techniques vary depending on the condition being treated. The techniques and doses used for the various conditions are outlined here.     

Photodynamic therapy and photodiagnosis for Barrett''s oesophagus and early oesophageal carcinoma

Over the last few decades the there has been a huge increase in the incidence of oesophageal adenocarcinoma, surpassing that of any other solid tumour. Barrett's oesophagus is recognised as a pre-malignant cursor. Surveillance programmes have evolved to monitor Barrett's oesophagus, with the intention to detect early malignant transformation. Using photosensitive agents photodiagnosis is developing to detect this transformation before it is visible endoscopically to allow early treatment. Photodynamic therapy is a non-thermal endoscopic ablative technique, which incorporates the same photosensitive agents to treat Barrett's oesophagus as well as malignant disease. In this article we review the present status of photodiagnosis and photodynamic therapy in the management of Barrett's oesophagus and early oesophageal carcinoma.     

Barrett's oesophagus and photodynamic therapy (PDT)

Barrett's oesophagus is a precursor of oesophageal adenocarcinoma. This cancer has the fastest growing incidence of any solid tumour in the Western world. Surveillance of Barrett's oesophagus is routinely undertaken to detect early malignant transformation. However, ablative endoscopic treatments are available and these can obliterate the abnormal epithelium, allowing neo-squamous re-growth. Photodynamic therapy (PDT) using haematoporphyrin derivative (HpD)/porfimer sodium (Photofrin^®), m-tetrahydroxyphenyl chlorin (mTHPC) and 5-aminolaevulinic acid (ALA) utilise such a technique. In this non-thermal method of ablation, the photosensitisers, together with light and oxygen, produce local tissue destruction. The use of PDT ablation of Barrett's oesophagus is reviewed.     

Photodynamic therapy for Barretts’ adenocarcinoma associated with an Angelchik device

We present a novel case of an elderly patient with a Barrett's adenocarcinoma in the presence of an Angelchik prosthesis. We aim to draw attention to issues relating to metaplastic Barretts’ oesphagus and its adenocarcinoma complications and highlight relevant issues in multimodal endoscopic management and palliation using photodynamic therapy in the presence of the device.     

Endoscopic photodynamic therapy for oesophageal disease

Photodynamic therapy is a very important technique for the eradication of widespread oesophageal mucosal disease which has the potential to degenerate to cancer. Patients unsuitable or unwilling to undergo radical therapy can be cured using photodynamic therapy. We predominantly treat patients with high-grade dysplasia in Barrett's oesophagus. Lesions that are visible macroscopically are removed using endoscopic mucosal resection. The remaining area is then treated in 5 cm segments at 3 monthly intervals with separate photosensitisation using endoscopic photodynamic therapy.     

Barrett食管的光动力学治疗

探讨光动力学疗法（PDT）治疗Barrett食管的有效性。对比各种类型光敏剂治疗Barrett食管的优点和不足，比较PDT与其他内镜下治疗Barrett食管的疗效及其并发症。PDT疗法Barrett食管具有损伤小，造成穿孔等并发症的机会较小，且对于一些边界不清或者多病灶的病变可减少治疗遗漏等特点，但可造成食管狭窄且某些光敏剂需要长达一个月的避光期造成患者治疗期间不方便。PDT是一种可重复性，侵袭性小，特异性强而疗效可靠的一种治疗Barratt食管的方法，不仅对不典型增生而且对早期癌都有疗效，与其他内镜下治疗联合可提高治疗效果。     

Photodynamic therapy for prostate cancer: One urologist's perspective

Photodynamic therapy (PDT) has slowly found its place in the treatment of human disease. Currently, photodynamic therapy is being explored as a treatment option for localized prostate cancer. PDT for the treatment of prostate cancer will require ablation of both malignant and non-malignant glandular epithelium. Ablation of both malignant and normal epithelium adds a new treatment dimension since traditionally PDT has not targeted normal epithelial tissue. PDT for prostate cancer as currently envisioned will present challenges in terms of in situ monitoring of light, drug concentration, p_O2 levels and biologic endpoints. The introduction of vascular-targeted photosensitizers fundamentally alters the traditional axioms for successful PDT treatment by obviating the need for “selective” tumor localization. Should clinical trials demonstrate the utility of this approach, patients with organ-confined disease will benefit.     

Photodynamic therapy for tracheal thyroid metastasis

We report the case of a patient with recurrence of follicular carcinoma of the thyroid 8 years after surgical resection followed by external beam radiotherapy and radio-iodine treatment. The patient was treated by endoscopic photodynamic therapy (PDT) with complete endoscopic response after 12 months with good symptom relief.     

Photodynamic therapy for onychomycosis: A systematic review

Other than a cosmetic concern, Onychomycosis is also a prevalent nail disease, which is extremely difficult to treat, and sometimes is refractory to conventional therapy. Moreover, many patients are not eligible to take oral antifungals owing to polypharmacy and comorbidities. Systemic side effects seen with oral antifungals have lead to patient nonadherence and adverse events. Therefore, newer therapies are being investigated for onychomycosis that would be free of systemic complications posed by oral therapy. Photodynamic therapy (PDT) is one of those being currently studied, which involves the use of photosensitizer and a light source to excite the photosensitizer to generate reactive oxygen species. The present review will put some light on PDT as an upcoming treatment modality for onychomycosis. We performed a systematic review of the literature to find the articles relevant to the use of PDT for onychomycosis. From the primary search of 43 articles, 17 papers are included in this review.     

Current practice in management of high-grade dysplasia in Barrett''s oesophagus: The real problem

The management of high-grade dysplasia within Barrett's oesophagus is highly topical and indeed controversial. It is becoming clear that radical surgery may be excessive treatment for many patients. This is because the natural history is not understood with some indicating of rapid degeneration to cancer, others demonstrating a low rate of degeneration over many years. Early detection and optical diagnosis has allowed minimally invasive destruction using endoscopic mucosal resection, thermal ablation and photodynamic therapy. Long-term eradication is possible and is real alternative to surgical excision. The current practice is variable and there is a requirement for randomised evidence comparing endoscopic therapy with surgical excision. This is becoming more appropriate with the development of minimally invasive oesophagectomy.     

Photodynamic therapy for pancreatic carcinoma: experimental and clinical studies

Pancreatic carcinoma is the sixth leading cause of cancer-related mortality in the United Kingdom, with an overall 5-year survival of less than 5%. Attempted curative surgery is possible in less than 20% of cases and is associated with a 5-year survival of just 10–20%. Palliative radio-chemotherapy improves symptoms of pancreatic cancer but rarely extends median survival beyond 12 months. There is a need to develop novel therapies that improve outcome. Photodynamic therapy, which is a way of producing localised non-thermal tissue necrosis with light, is currently under evaluation as a treatment for pancreatic cancer. This review will examine some of the mechanisms underlying photodynamic therapy, and the preclinical work, which has led to this treatment being piloted in human studies.     

Photodynamic therapy in cholangiocarcinoma: an overview

Cholangiocarcinoma is a challenge to manage; mortality rate is nearly as high as the incidence. Unless curative resection is performed, these tumours are rapidly fatal because they respond poorly to current therapies. Symptoms occur late in cholangiocarcinoma and curative resection can be performed in less than half of the patients. In non-resectable disease, endoprostheses insertion can relieve jaundice and improve quality of life, provided that tumour extension does not lead to diffuse intrahepatic stenoses of ductal system. However, tumour growth cannot be influenced and therefore, prognosis remains dismal. Despite the fact, that radiotherapy and chemotherapy could reduce tumour volume and growth, no survival advantage has yet been shown.Photodynamic therapy has been evaluated as an new additional, palliative option. A randomised trial comparing photodynamic therapy plus endoprostheses insertion versus endoprostheses insertion alone, indicates a considerably benefit on survival time, cholestasis and quality of life in large, advanced cholangiocarcinoma. Furthermore, few specific side effects occurred. Since photodynamic therapy is the first approach leading to an improvement of prognosis, it should be offered to patients with non-resectable cholangiocarcinoma.     

Photodynamic therapy as initial treatment for small choroidal melanomas

PurposeTo evaluate Verteporfin photodynamic therapy (PDT) as primary treatment for small, posterior choroidal melanoma.DesignRetrospective cohort review.Subjects, participants and controlsRetrospective case note review of 20 patients with small juxtapapillary and juxtafoveal choroidal melanomas treated with PDT at the Liverpool Ocular Oncology Clinic.MethodsPatient and tumour characteristics, PDT session details, visual acuity and B-scan ultrasonography measurements as well as colour fundus photographs at each examination were collated and analysed.Main outcome measuresLocal tumour control and Best Corrected Visual Acuity (BCVA).ResultsThe 20 patients (14 male, 6 female) had a mean age of 61.2 years (range, 40–85) and were treated between 2001 and 2012. Seven tumours were amelanotic, while 13 were pigmented. Of 20 melanomas, 11 (55%) showed complete regression on B-scan ultrasonography and colour photography; five (25%) showed partial regression; four (20%) remained unchanged and two (10%) showed further growth, for which alternative standard treatment was required. Baseline BCVA was 0.1 logMAR (mean; range 0.0–0.6) compared to a post-PDT BCVA of 0.4 logMAR (mean; range −0.2 to 1.7) over a follow-up of 60.0 months (mean; range 25–156 months).ConclusionsPDT can induce tumour regression in a significant proportion of small, posterior, choroidal melanomas but is less reliable than other forms of therapy. It may have a role in patients with special visual requirements if they accept the increased risk of treatment failure requiring radiotherapy.     

Photodynamic therapy in dermatology beyond non-melanoma cancer: An update

Photodynamic therapy (PDT) employs a photosensitizer (PS) and visible light in the presence of oxygen, leading to production of cytotoxic reactive oxygen species, which can damage the cellular organelles and cause cell death. In dermatology, PDT has usually taken the form of topical application of a precursor in the heme biosynthesis pathway, called 5-aminolevulinic acid (or its methyl ester), so that an active PS, protoporphyrin IX accumulates in the skin. As PDT enhances dermal remodeling and resolves chronic inflamation, it has been used to treat cutaneous disorders include actinic keratoses, acne, viral warts, skin rejuvenation, psoriasis, localized scleroderma, some non-melanoma skin cancers and port-wine stains. Efforts are still needed to mitigate the side effects (principally pain) and improve the overall procedure.     

Photodynamic therapy: An option in mycosis fungoides

BackgroundPhotodynamic therapy (PDT) is a well-known and effective treatment for non-melanoma skin-cancer. Numerous studies have also shown its effectiveness in mycosis fungoides. The aim of the study was to analyse MF patients treated with PDT at the Dermatology Unit of Bologna University.MethodsWe retrospectively analysed MF patients treated with PDT over the last ten years. Each PDT protocol consisted of the appliance for 3 h under an occlusive film dressing on each lesion of a one-mm-thick layer of 16% methyl aminolaevulinate (MAL) 160 mg/g cream (Metvix^®, Galderma, Paris, France). The cream was then removed and the skin was exposed to 630 nm red light from a diode lamp (Aktilite^®, Galderma Benelux, Rotterdam, the Netherlands), with a total radiation dose of 37 J/cm2 for 9 mins. A protocol of one session every month was scheduled. The treated lesions were clinically examined, before each treatment.ResultsFour cases, three male and one female, had been treated with PDT. Two patch lesions on the plantar area, one leg and the pubic area were treated. The number of PDT sessions ranged from 4 to 9. Two complete remissions and two partial remissions were observed. A low-to-mild burning sensation was reported during the treatment, and persisted over the next day; no further side effects were observed.ConclusionsOur series shows that PDT can be considered an effective second-line treatment in patients characterised by a disease located in difficult-to-treat anatomical areas such as the feet and the pubic area.     

不可切除胆管癌PDT治疗的进展

胆管癌是一种少见的原发性胆道恶性肿瘤,预后较差,根治性切除仅适用于少部份早期确诊的患者,大部份失去手术机会的患者采取胆道引流的姑息治疗方式治疗。胆道缓解引流是一种采用经皮或内镜插入的内镜置管术,可减轻患者骚痒、胆管炎和疼痛等症状,提高患者生活质量,但是仅有少量文献报道胆道缓解引流可提高胆管癌患者的生存时间。光动力疗法（photodynamic therapy,PDT）是一种相对新的、局部的、微创的姑息治疗方法,PDT是通过能聚集在增生组织（或肿瘤）中的光敏剂分子,是治疗不可手术切除胆管癌的标准的辅助治疗方式。     

Photodynamic therapy for treatment of bacterial keratitis

Microbial keratitis is the main cause of corneal opacification and the fourth leading cause of blindness worldwide, with bacteria the major infectious agent. Recently, bacterial keratitis has become a serious threat due to routine use of antibiotics leading to selection of resistant and multidrug-resistant bacteria strains. New approaches for treatment of bacterial keratitis are necessary to outcome the increasing antibiotic resistance. Antimicrobial photodynamic therapy is based on three agents: photosensitizer, oxygen, and light radiation. This therapy has been successful for treatment of infections in different tissues and organs as well as against different type of infectious agents and no resistance development. Also, new photosensitizers are being developed that has increased the spectrum of therapeutic protocols for treatment of a number of infectious diseases. Thus, antimicrobial photodynamic therapy has an extraordinary potential for treatment of those bacterial keratitis cases that actually are not solved by traditional antibiotic therapy.