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Background The second-generation photosensitizer NPe6 has strong anti-tumor effects with a much shorter photosensitive period than the first-generation photosensitizer Photofrin. Although photosensitive period has been reduced, skin photosensitivity is still a major side effect of photodynamic therapy (PDT). Therefore, we conducted a prospective study to investigate whether the NPe6 fluorescence intensity in skin after PDT could be measured effectively in human patients to improve the management of a patient's photosensitive period. Methods The NPe6 fluorescence measurements using a constructed fluorescence sensing system at the inside of the arm were acquired prior to and 5 and 10 min after NPe6 administration as well as at the time of PDT (4–5 h after administration), at discharge (2 or 3 days after PDT), and at 1 or 2 weeks after PDT. Participants were interviewed as to whether they had any complications at 2 weeks after PDT. Results Nine male patients and one female patient entered this study. Nine patients were inpatients and one patient was an outpatient. All of the measurements of NPe6 fluorescence in the skin could be obtained without any complications. The spectral peak was detected at the time of discharge (2–3 days after administration) in most cases and it decreased at 1 or 2 weeks after PDT. Conclusions The fluorescence of NPe6 in the skin could be detected feasibly using the fluorescence sensing system in human patients. Measuring the relative concentration of NPe6 in the skin indirectly by measuring fluorescence intensity might be useful to predict the period of skin photosensitivity after PDT.

Summary Background Using 5-aminolevulinic acid (ALA) as an intraoperative fluorescence contrast has been proven to improve the resection of glioblastoma and contribute to prolonged patient survival. ALA accumulates as protoporphyrin IX (PpIX) in the tumor cells and is administered in an advised dose of 20 mg/kg body weight (b.w.) for brain tumor resection using fluorescence surgical microscopes. PpIX fluorescence availability and intensities of a four folds lower ALA dose (5 mg/kg b.w.) has been investigated in glioblastomas and skin using a spectroscopy system adapted for surgical guidance. Methods A total of 30 adult patients diagnosed with high grade gliomas were included in the analysis. ALA was orally administered in doses of 5 mg/kg b.w. ( n = 15) dissolved in orange juice or 20 mg/kg b.w. ( n = 15) dissolved in water. A fluorescence spectroscopy system with a handheld fiber-optical probe was used for performing the quantitative fluorescence measurements. Results The binominal comparison of the diagnostic performance parameters showed no significant statistical difference ( p > 0.05). The median fluorescence values in tumor were 2–3 times higher for the high ALA dose group. No PpIX was detected in the skin of the patients in the low dose group (0/4) while PpIX was detected in the skin of the majority of the patients in the high ALA dose group (13/14). Conclusions Application of 5 mg/kg ALA was evaluated as equally reliable as the higher dose regarding the diagnostic performance when guidance was performed using a spectroscopic system. Moreover, no PpIX was detected in the skin of the patients.

Summary Background Yorkshire Laser Centre experience of PDT in early oesophageal cancer (EOCa) to determine long survival at 3 and 5 years (absolute) and factors which might influence outcome. Material/Method The records of patients who had PDT (1997–2009) for oesophageal cancer were reviewed and those with EOCa were studied and analysed. All patients had standard work up and staging. PDT was carried out using Photofrin 2 mg/kw bw, iv followed 24–72 h later by endoscopic illumination with 630 nm laser light. Results were assessed based on pathological response to treatment and survival at 3 and 5 years post-PDT. Results There were 40 patients with EOCa amongst 144 who had PDT for oesophageal cancer. 30 male and 10 female (mean age 77, range 48–84). 35 had adenocarcinoma and 5 squamous cell carcinoma. 20 of the former had Barrett's mucosa. There was no operative or 30-day mortality and no serious complications. Adverse effects were noted in 10 patients including 2 with skin photosensitivity and 3 with mild stricture requiring one dilatation. The median follow up was 76.1 (range 36–150 months). In this period 24 patients have died between 2 and 150 months (median 41 months). 16 patients are alive in between 36 and 110 months. 3 and ≥5 years or more survival (absolute) were 72.5% and 53.8%, respectively. Conclusion Endoscopic PDT should be considered as the treatment of choice in patients with EOCa who are ineligible for surgical resection. We suggest that a carefully designed study of a cohort of patients with EOCa comparing surgical resection with endoscopic PDT is warranted.

Summary Background: The Yorkshire Laser Centre team have been engaged in photodynamic therapy (PDT) since 1990. In this article we review our experience in bronchoscopic PDT for lung cancer and outline our current indications and results. Methods: 160 patients in 2 groups entered into a prospective study: Group A ( N = 144) were symptomatic with advanced inoperable disease and with presence of >50% bronchial obstruction. Group E ( N = 16) with early stage cancer and presence of superficial lesion confined to bronchial tree. All patients had standard investigation and work-up bronchoscopy and biopsy confirmation of cancer by cyto-histology. PDT method was intravenous administration of 2 mg/kg BW of Photofrin (Porfimer Sodium) followed by bronchoscopic illumination of 630 nm laser light. Results: There was no treatment-related mortality. Nine patients (5.6%) presented with skin photosensitivity reaction and another eight with respiratory complication. Group A: Symptom relief was achieved in all. This was matched by significant improvement in bronchial opening (58.1%). Survival was 9.6 months (mean) and 5 months (median), respectively. This was greater in patients with better performance status and lower stage of disease. Group E: Every patient had a complete response to treatment, some after two treatments. Survival in this group was 75.4 months (mean) and 69 months (median). Conclusions: Bronchoscopic PDT is indicated in both advanced and early stage lung cancer. In the former it provides symptomatic relief in all and survival benefit in some; in the latter it achieves long survival and potential cure.

Summary Background Photodynamic therapy (PDT) combined with stenting is an effective treatment modality for palliation of nonresectable cholangiocarcinoma (CC). A drawback of standard PDT using Photofrin® as photosensitizer is the long lasting skin photosensitivity of up to 3 months. The aim of this study was to show the outcome of PDT of CC, potential side effects and to determine the best drug light interval (DLI) using mTHPC (Foscan®) at a low dose. Methods 13 patients with nonresectable CC were treated with stenting and PDT (3 mg Foscan® per treatment, 0.032–0.063 mg/kg body weight, 652 nm, 50 J/cm). Fluorescence measurements were performed with a single bare fiber for 5/13 patients prior to PDT at the tumor site to determine the fluorescence contrast. For another 7/13 patients, long-term fluorescence-kinetics were measured on the oral mucosa to determine the time of maximal relative fluorescence intensity. Results The results so far indicate a median survival time of 13 months. Side effects such as perforations or skin phototoxicity could not be observed. Foscan® fluorescence within the tumor site was clearly detectable but a significant fluorescence contrast of tumor to adjacent healthy tissue could not be found. The fluorescence kinetics measured in the oral mucosa showed a maximum at 3.85 days (median) after drug administration. Conclusion Combined stenting and PDT performed with a low Foscan® dose results in equal and potentially longer survival times compared to standard Photofrin® PDT, while lowering the risk of side effects strongly. Thus it may improve the quality of life.

Summary Introduction GBM is the comment glioma. GBM-outcome had not changed much over two decades despite leaps in medical technology. Fewer than 25% survive 2 years. There is no jacket that fits all GBMs. This paper reviews the evidence for PDT in GBMs. Rationale Maximum safe resection is supported by level-II evidence. PDT-technology (PDTT) provides means to maximize safe resection. PDTT paints GBM red in contrast to brain because of selective uptake and retention of photosensitizers. Exposure to specific light wave produces cytotoxic singlet oxygen. PDT-applications (1) Fluorescence image guided biopsy to sample high grade components of what looks like low grade glioma on MRI, 89% sensitive. (2) Fluorescence image guided surgery for maximum safe surgical resection is >84% sensitive, achieves complete resection in >65% and prolongs tumor free survival (1 observational and 2 RCT, p (3) Photodynamic treatment supported by several observational studies with combined total of >1000 patients and 3 RCT used PDT in GBMs. PDT was highly selective, safe, significantly improved good quality survival, and delayed tumor relapse ( p Safety PDT had a very high safety track record, thromboemolism 2%, brain-oedema 1.3%, and skin photosensitivity complications 1–3%. Conclusion PDT in GBMs is safe, selective, and sensitive and leads to significant prolongation of good quality survival, delay in tumor relapse and significant reduction of further interventions. It would be impractical, impossible and probably unethical to randomize patients between PDT and placebo, in the same way it would be unethical to carry out a RCT to prove that the parachute saves lives.

2.0 2.5mg/kg. Cervix was irradiated superficially with light dose 50 J/cm2 (5 patients) or 100 J/cm2 in other 54 cases. Quality of ectocervix irradiation was monitored by the fluorescence imaging device. Endocervix was irradiated by fiberoptic light delivery system with cylindrical diffuser with active diffusive lengths of 2 3 cm and outer diameters of 1mm with light dose 100 300 J/cm of diffuser length. The PDT outcome was estimated every 3 month after treatment by the expanded colposcopy, proven by morphological and cytological study. HPV presence was detected by PCR (polymerase chain reaction) test. Results: After undergoing the PDT treatment 21 patients have been observed between 6 months and 1 year, 13 patients between 1 and 2 years and 25 patients for 2 years and more. Complete response to PDT, proven by cytological and histological study was observed in case of 53 patients (93%). Moderate skin photosensitivity was observed first 2 days after PDT as systematic side effect. No cervix deformation or scarring occurred due to PDT. HPV was detected in 52 out of 59 observed patients (88%). Followup at three months after PDT revealed that HPV was eradicated in 46 patients (80%). Conclusion: CIN-PDT with chlorin e6-polyvinylpyrrolidone formulation is an effective modality for the treatment of cervical intraepithelial neoplasia. CIN-PDT is effective not only in treating CIN but also for eradicating associated cervical HPV.