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Arthroplasty is the most widely used surgical technique for bone tumors of the upper limbs. However, it should be noted that the functional outcomes after endoprosthetic reconstruction for malignant bone tumors of the upper limb does not always satisfy patients and often lead to impaired working capacity of patients, and their disability. The need to improve functional outcomes determines the practical and socio-economic significance of the research. The purpose of the study was to evaluate the impact of a complex of rehabilitation measures on the quality of life of patients after surgery with endoprosthetic reconstruction for malignant bone tumors of the upper limb. Material and Methods. The treatment and rehabilitation outcomes in 146 patients were analyzed. There were 88 (60 %) men and 58 (40 %) women with an average age of 47 years (range, 19–75 years). The tumor was localized in the proximal humerus in 98 (67 %) patients, in the diaphysis in 18 (12 %), in bones that make up the elbow joint in 16 (11 %) and in the distal radius in 14 (9.6 %) patients. Results. Our rehabilitation technique improved functional outcomes after endoprosthetic reconstruction for all tumor localizations. The musculoskeletal Tumor Society (MSTS) score was improved by 10 % (75 vs 65 %) for arthroplasty of the shoulder joint, for the wrist joint by 8 (80 vs 72 %). The rehabilitation technique allowed significant improvement of MSTS score for arthroplasty of the humeral diaphysis and bones making up the elbow joint (from 76 to 95 % and from 68 to 82 %, respectively). Conclusion. Rehabilitation measures play an important role in optimizing quality of life of patients after surgical treatment of bone tumors of the upper limb with arthroplasty, helping to improve functional outcomes.

Features of the expression of membrane importers of 5-ALA, as well as transporters involved in the removal of photoactive precursors of protoporphyrin IX (PPIX) (uro-, copro- and protoporphyrinogens), may cause differences in the effectiveness of photodynamic therapy of malignant neoplasms using 5-aminolevulinic acid (5-ALA). Increased expression of ALA transporters is associated with an increase in the intensity of PPIX synthesis. When the expression of PPIX exporters increases, there is a decrease in PPIX concentration. The review describes the main transporters of 5-ALA, uro-, copro- and protoporphyrinogens, provides data on their expression in various tissues, and discusses the possibility of predicting the effectiveness of photodynamic therapy considering the expression of the corresponding transport proteins in malignant tissues.

Photodynamic therapy is an effective method for treating superficial forms of malignant neoplasms, characterized by a minimal risk of damage to normal tissues. In this study, we presented our experience of treating cancer of the oral mucosa using photodynamic therapy, and analyzed the immediate and long-term results of treatment. 38 patients with squamous cell carcinoma of oral cavity mucosa, with a depth of invasion no more than 7 mm, were included in the study. All patients underwent photodynamic therapy with chlorine e6 based photosensitizer. Photosensitizers were administered intravenously 3 hours before irradiation, at a dosage of 1 mg/kg of the patient’s weight. Photodynamic therapy was performed with the following parameters: P – 1.0 W, Ps – 0.31 W/cm2, E – 300 J/cm2. The area of one irradiation field ranged 1.0-2.0 cm2. Treatment effect was evaluated by RECIST 1.1. Overall survival, cancer-specific survival, and disease-free survival were calculated using Kaplan-Meier curves. Evaluation of adverse events was made by .TCAE 5.0 criteria. At 35 (92.1%) out of 38 cases, complete regression was observed after photodynamic therapy. Among them in 3 out of 35 patients relapse was diagnosed in 11.5 to 43.2 months. The total number of patients who didn’t respond to treatment was 6 (15.8%). Follow-up period was 4.2-87.3 months. (mean 42.9). 34 (89.5%) out of 38 patients are alive, 1 (2.6%) died from progression, and three died from other causes. The 5-year overall survival rate was 82.1%, cancer-specific survival rate was 97.0%, and disease-free survival rate was 81.1%. Among the factors significantly (p < 0.05) influencing relapse-free survival: depth of invasion < 5 mm (p – 0.013) and the presence of leukoplakia (p – 0.007). When assessing cancer-specific survival, factors worsening the prognosis were: age >70 years (p – 0.034) and the presence of leukoplakia (p – 0.007). Photodynamic therapy is an alternative treatment method of oral cancer superficial lesions, in case of proper assessment of primary lesion and in case of possibility of full irradiation of the tumor. Moreover, after using photodynamic therapy, the underlying connective-muscular structures are preserved, which promotes rapid healing with minimal scarring, the functions of the affected organ remain intact, and cosmetic defects do not form.

Skin tumors occupy the first place in terms of incidence in the structure of oncological neoplasms. The WHO estimates that 60,000 people die each year from malignant neoplasms of the skin: 48,000 from melanoma and 12,000 from skin cancer. Timely diagnosis of skin cancer makes it possible to achieve a cure for cancer patients with long periods of relapse-free follow-up after the completion of specialized treatment. The introduction of high-tech optical methods for diagnosing skin neoplasms into clinical practice has significantly increased the specificity, sensitivity, and accuracy of diagnostics. The review is devoted to a discussion of such methods for diagnosing skin neoplasms as fluorescent diagnostics, digital dermatoscopy, SIA-scopy, and confocal microscopy. The features of the application of each of the methods are discussed, the results of the most significant Russian and foreign studies in this field are presented, as well as our own results of the practical application of a number of high-tech optical diagnostic methods at the P.A. Herzen Moscow Oncology Research Center

Bowen’s disease is a form of non-invasive (in situ) squamous cell skin cancer localized in the non-genital area. Russian and European clinical guidelines include photodynamic therapy (PDT) in the standard of care for patients with Bowen’s disease. In the present review, the efficacy and safety profile of different PDT regimens for Bowen’s disease are analyzed according to the available literature data. PDT can be used to treat large Bowen’s disease lesions localized in areas of the body characterized by severe healing and in cases where surgery is not feasible. Analysis of the results of studies shows that PDT is superior in efficacy and cosmetic results to traditional local treatments such as 5-fluorouracil or cryotherapy. In all analyzed studies in patients with Bowen’s disease, PDT achieved a significant clinical effect. Complete regression of pathologic foci was achieved in 67-100% of patients. In studies evaluating the recurrence rate of Bowen’s disease after PDT, this value ranged from 2-28% with the range of 6-18% in most of the studies. Most often, 5-aminolevulinic acid and its methyl ester are used for PDT in Bowen’s disease. According to some researchers, aminolevulinic acid allows to achieve a more long-term positive clinical effect with a lower incidence of painful reactions during treatment

The article provides an example of successful treatment of a patient with basal cell skin cancer of the lower eyelid of the right eye, stage IB cT2aN0M0, with the presence of concomitant pathology – a decrease in the activity of plasma factor XII of blood coagulation (Hageman disease). The patient’s medical history is associated with long-term ineffective treatment of the tumor with Curaderm ointment. After diagnosis and further examination at the Moscow Research Institute named after. P.A. Herzen, at the Center for Laser and Photodynamic Diagnostics and Therapy of Tumors, the patient underwent organ-preserving treatment using photodynamic therapy. 1 course of photodynamic therapy with the photosensitizer chlorin e6 was carried out. Complete tumor regression was obtained; relapse-free follow-up period was 1 year

Acne is one of the most common skin conditions in the world. A number of studies have shown that photodynamic therapy (PDT) is safe and effective for both inflammatory and non-inflammatory acne and can significantly improve skin conditions in this disease. The effectiveness of PDT against acne is mainly due to a decrease in the amount of sebum produced by the sebaceous glands due to a decrease in their activity as a result of direct photodynamic damage to the sebaceous glands, eradication of Cutibacterium acnes, and a decrease in the level of hyperkeratosis. Compared with systemic drug therapy, PDT treatment of severe acne has the following advantages: fast results, high efficiency, high selectivity, no systemic adverse reactions and drug resistance, and low recurrence rate. Most often for PDT in patients with acne, drugs based on 5-aminolevulinic acid (5-ALA) and its methyl ester (ME-ALA) are used. At the moment, there are no unified recommendations on PDT regimens for the treatment of this skin pathology. Various studies demonstrate the high efficiency of PDT with a wide range of doses of 5-ALA (3-20%) and ME-ALA (4-16%), light doses (15-120 J/cm2 ), and exposure time (30-90 min). The general trend in studies by different authors is that gentle low-intensity PDT regimens for acne demonstrate the same high efficiency with a significant reduction in pain during irradiation and local skin reactions (erythrema, edema, and hyperpigmentation).

Photodynamic therapy (PDT) in the treatment of psoriasis remains the subject of much debate. There is no consensus in the scientific community about effective and safe PDT regimens for psoriasis. Described in the published materials doses and concentrations of photosensitizers for psoriasis, as well as light doses, differ by dozens of times. The purpose of this review is to analyze the efficacy and safety profile of various PDT regimens for psoriasis. Some studies demonstrate 100% effectiveness of the method in certain modes (complete or partial clearance of psoriasis foci after PDT). In particular, such efficiency was obtained with the application of 20% 5-ALA (light dose 15 J/cm2) and 0.1% methylene blue (light dose 15 J/ cm2). The main factor limiting the use of PDT in psoriasis, and in some cases even being the reason for treatment interruption, is severe pain during the irradiation procedure. This requires careful development of PDT regimens in patients with psoriasis.

Fluorescent diagnostics is a promising method for diagnosing non-melanocytic skin tumors, which makes it possible to identify clinically undetectable skin cancer foci and clarify the margin of the tumor lesion. The main drugs for fluorescent diagnostics are drugs based on 5-aminolevulinic acid and its methyl ester. Sensitivity indicators of fluorescent diagnostics in basal cell, squamous cell carcinoma and extramammary Paget’s disease reach 79.0-100.0%, speci city – 55.6-100%. But the effectiveness of this method may be reduced due to hyperkeratinization, keratinization, and the presence of necrotic tissue on the surface of tumor foci. Comparative studies of the results of fluorescent diagnostics and histological mapping during tumor removal using Mohs micrographic surgery showed approximately equal results in the determining of the tumor edges by these methods, which indicates that safe and technically easily performed fluorescent diagnostics can serve as a good alternative to Mohs micrographic surgery, one of the most accurate, but rather labor-intensive and technically complex method for determining the margin of skin cancer foci.

We report the experience of radical treatment by photodynamic therapy of patients with squamous cell carcinoma of oral cavity with serious side diseases. Completed treatment of two patients with serious side diseases (HIV infection with associated pulmonary hypertension of high degree and cardiac pathology) suffered from cancer of oral cavity. Extensive surgical treatment and/or aggressive course of chemoradiation therapy were not indicated to them due to concomitant pathology. Both patients were diagnosed with squamous cell carcinoma of oral cavity, with appropriate stage Ist. сT1N0M0. Patients received treatment by photodynamic therapy with chorine photosensitizer in dose 1 mg/kg. Options of photodynamic were: output power – 1.5W, power density – 0.31 W/cm2, light dose – 300 J/cm2. After one time session of photodynamic therapy, in both cases full response was diagnosed (according to RECIST 1.1). In one case the second session of photodynamic therapy was performed due to concomitant disease of oral cavity – multiply lesions of leukoplakia and after was diagnosed full remission of all lesions. Major adverse event was pain during the first 5-7 days after treatment, curable by painkillers. Follow-up (IQR) was 12 and 18 month respectively with no evidence of progression. It is available to avoid extensive surgical treatment and aggressive course of chemoradiation therapy (as an alternative) with the use of photodynamic therapy. Photodynamic therapy is minimally invasive method of radical treatment of localized squamous cell carcinoma of oral cavity with minimal adverse events, and could be especially relevant in patients with serious concomitant diseases.

Aim of the study: to conduct a systematic analysis of the data available in the modern literature, prognostic factors, and modern methods of rehabilitation of cancer patients after endoprosthetic reconstruction following resection of the lower extremity long bones. Material and methods. We assessed reports of clinical trials published over the past 10 years, which evaluated prognostic factors, rehabilitation programs for cancer patients who underwent endoprosthetic reconstruction following resection of the lower extremity long bones, depending on the location and size of the implant and the age of the patient. The review also evaluated various prognostic factors that affected functional recovery following resection of the lower extremity long bones. Results. Findings that helped in choosing the best option for surgical treatment, thus providing the best quality of life in the postoperative period, were published. Conclusion. Further studies are needed to optimize rehabilitation techniques and develop new algorithms for the treatment of cancer patients who underwent endoprosthetic reconstruction following resection of the lower extremity long bones.

The article describes a clinical example of timely, safe and effective photodynamic therapy (PDT) in a patient diagnosed with human papillomavirus (HPV) CIN I-associated cervical cancer after ineffective vaccination with 4-valent Gardasil vaccine. Clinical case demonstrates the low effectiveness of HPV vaccination in patients with established HPV infection. In this patient, the lack of adequate treatment for about 1.5 years led to the development of HPV associated CIN I of the cervix. Center for Laser and Photodynamic Diagnostics and Therapy of Tumors and MRI P.A. Herzen, the patient underwent a course of antiviral PDT with the achievement of complete regression of dysplasia and complete eradication of HPV viruses. The patient tolerated the treatment well, without complications. The period of relapse-free follow-up is 19 months.

Extramammary Paget’s disease (EMPD) is a rare tumor that predominantly affects the skin containing apocrine glands. Due to insufficient data on the effectiveness of different methods, there is no single therapeutic approach to the treatment of patients with EMPD and their subsequent management. The use of surgical methods, laser therapy and local cytotoxic drugs has a number of limitations. The advantages of using photodynamic therapy (PDT) in EMPD are the absence of systemic toxicity, non-invasiveness, selectivity of action, the absence of carcinogenic potential, the possibility of conducting several courses of treatment, and good cosmetic results. In our review, we analyzed those published in 2000-2022 data on the results of PDT treatment of 114 patients with EMPD. As a result of treatment, complete regression of tumor foci was achieved in 40% of patients. Most authors note that PDT is more effective for small areas (up to 4 cm2).

The review highlights the current understanding of the epidemiology, etiology, pathogenesis, existing classifications of mycosis fungoides. Methods for diagnosis and treatment of the pathology are described, among which photodynamic therapy (PDT) plays an important role. The main advantages of PDT for mycosis fungoides include the absence of systemic toxicity, non-invasiveness, selectivity, absence of carcinogenic potential, the possibility of repeated courses of treatment, and good cosmetic results. This review collects and analyzes the results of clinical trials of PDT in patients with mycosis fungoides. The analysis showed high efficiency of PDT in patients with mycosis fungoides with isolated or limited spots and plaques. PDT can be considered as the therapy of choice in patients with facial lesions when a good cosmetic result is one of the main requirements, and radiation therapy, nitrogen mustard or carmustine can leave permanent and visible scars. Plaques located in the axillary or inguinal skin folds that are inaccessible to phototherapy can also be treated with PDT.

Actinic keratosis is an important medical and social problem, the correct diagnosis and treatment of which will help to avoid the development of invasive forms of cutaneous squamous cell carcinoma. With the further development of the early diagnosis of cancer, including skin cancer, the increase in human life expectancy, and the popularization of travel to exotic countries, the number of cases of actinic keratosis among the population will continue to grow. In this regard, it is important to discuss the causes and pathogenesis of the disease, the varied clinical picture of the disease, methods of non-invasive diagnostics, as well as methods of treatment, of which there are a great many in the treatment of actinic keratosis today. However, each of the methods has both advantages and disadvantages, and in the global trend towards a personalized approach to treatment, it is important to choose from the standpoint of evidence-based medicine the most suitable for each individual patient. Moreover, after treatment of actinic keratosis, relapses often occur, which are the result of insufficient diagnosis and the development of incorrect treatment tactics. The review article provides the clinical picture of actinic keratosis, diagnostic and therapeutic methods, and their comparison with each other in terms of efficacy and safety

In recent years, the development of methods of photodynamic therapy (PDT) and photodynamic photodiagnostics (PD) in Russia is characterized by an intensive rise, steadily growing interest of specialists from various medical specialties in the method of specialists from various medical specialties, an increase in the level of equipment number of hospitals with the necessary equipment for performing PD and PDT, the and the emergence of new photosensitizers on the pharmaceutical market, and an increasing increase in the level of patients’ confidence in these methods. This study analyzes the dynamics of the development of the clinical application and scientific developments of PD and PDT over the past decade in Russia in terms of the volume of public procurement of photosensitizers, as well as the activity of research work in the field of PD and PDT, the number of candidate and doctoral dissertations theses on this topic and the number of scientific publications in the RSCI. 688 contracts for the supply of photosensitizers for clinical use were analyzed. The analysis showed a stable annual growth in the volume of public procurement of photosensitizers, an increase in the number of subjects of the Russian Federation and clinical centers that purchase photosensitizers through the portal www.zakupki.gov.ru. From 2014 to 2020, the total volume of public procurement of all photosensitizers increased by 8 times (from 36.42 million rubles (3.58 thousand packages) to 307.37 million rubles (18.99 thousand packages)). The annual increase in the volume of public procurement in numerical terms over the previous 6 years ranged from 9.4% to 63.2% in different years. The main share of state purchases of photosensitizers falls on Moscow and St. Petersburg, h. However, in recent years there has been a noticeable trend towards an increase in sales of photosensitizers in the regions. Thus, in recent years, the share of purchases of photosensitizers in the constituent entities of the Russian Federation with a population of less than 1 million people has significantly increased (from 2.9% of the total number of purchases in 2014 to 25.3% in 2020). Also, in recent years, there has been a significant increase in the activity of research work activity in the field of PD and PDT. The number of defended candidate and doctoral dissertations theses defended in the field of PD and PDT photodynamic therapy and fluorescent diagnostics has been steadily high in recent years and, in some scientific specialties, reaches 2-3% of the total number of defended dissertations theses defended in these specialties. The increase in the total number of publications over 10 years according to the RSCI was 224% (from 218 publications in 2014 to 489 publications in 2019), according to the RSCI. The results obtained confirm the growing demand for photosensitizers for photodynamic therapy and fluorescence diagnostics in clinical practice, the expansion of the geography of the use of methods, as well and the stable interest in this topic in the research environment.

Oral mucosa cancer is a common disease with relatively low survival rates. The standard for the treatment of malignant neoplasms (MNO) of the oral mucosa is the surgical method, chemotherapy and / or radiation therapy. With the introduction of modern protocols and the improvement of current treatment methods, the increase in survival is insignificant due to the development of local and distant relapses, the appearance of simultaneous tumors of the oral cavity. Cosmetic and functional results in patients who have undergone complex treatment for oral cancer are often unsatisfactory. There is an obvious need to develop new approaches to treating patients with cancer of the oral mucosa. Photodynamic therapy (PDT) has similar properties. With the development of endoscopic and fiber-optic equipment, the fields of PDT application have significantly expanded. Foci in the oral cavity and oropharynx became available for PDT. The early stages of oral mucosal cancer are optimal for PDT because large surface defects can be treated with minimal complications. Preservation of subepithelial and collagen structures, which is typical for PDT, promotes healing without the formation of scar processes, thereby achieving an ideal cosmetic and functional effect. The use of PDT in the treatment of oral cavity cancer is not limited only to the initial stages in an independent version. It is possible to use PDT in combination with surgical and radiation treatment. In case of massive tumor processes, PDT is used for palliative purposes. The influence of the adaptive immune response under the influence of PDT is being studied.

The results of a 13-year clinical observation of a patient after treatment for basal cell carcinoma of the skin of the right cheek Ist cT1N0M0 are presented. The history of the course of the disease is associated with the fact that the patient underwent radiation therapy in early childhood for hemangioma of the lower eyelid of the right eye and right cheek. In 2008, against the background of post-radiation changes in the area of the right cheek, basal cell carcinoma was diagnosed at the Moscow Oncological Research Institute. P.A. Herzen. At the Center for Laser and Photodynamic Diagnostics and Tumor Therapy, the patient underwent organ-preserving PDT treatment. A course of photodynamic therapy (PDT) with 5-aminolevulic acid was carried out. Subsequently, the patient was followed up until 2021 without relapse in the PDT area. In 2016, the patient was diagnosed with a relapse of the disease in the form of a new focus of basal cell carcinoma of the upper eyelid skin on the right Iast cT1N0M0. The patient underwent a course of PDT with a chlorin e6-based photosensitizer. Complete regression of the tumor was achieved, the period of relapse-free follow-up was 5 years.

The article presents a clinical observation. The patient, 72 years old, applied to the MNII them. P.A. Herzen with complaints about the presence of an ulcerated tumor of the left ear. After further examination, a diagnosis was made - basal cell carcinoma of the ear skin with spread to the skin of the parotid region T3N0M0. On July 9, 2021, the patient underwent a course of photodynamic therapy (PDT) using a photosensitizer based on chlorin e6 and a diode laser with a wavelength of 662 nm. After one course of PDT, complete regression of the tumor was recorded.

In the present review the authors analyzed the effectiveness of treatment of intraepithelial neoplasia I-II-III of the cervix (CIN), vulva (VIN) and vagina (VaIN) using photodynamic therapy (PDT). PDT is a method based on exposure to light after preliminary introduction of a photosensitizer into the body with the formation of singlet oxygen, which has a cytotoxic effect. The results of research on the use of PDT with various photosensitizers in the complex of therapeutic measures in patients with CIN, VIN, VaIN are presented. These data on the effectiveness and safety of PDT, ease of use allow this medical technology to be attributed to one of the most promising areas in the treatment of pathological intraepithelial changes of the cervix, vulva and vagina. The presented information allows focusing the attention on the PDT method and informing doctors and researchers about the broad prospects for applying this treatment method in clinical practice.

The article presents the experience of surgical treatment of 57 patients with peritoneal pseudomyxoma of appendicular genesis. In 32 (56.1%) patients, the operation was supplemented with intraoperative photodynamic therapy (IOPDT). In the other 25 (43.9%) patients, hyperthermic intraperitoneal chemotherapy (HIPEC) was performed. The analysis according to the value of the peritoneal carcinomatosis index, completeness of cytoreduction, the volume of operations performed, postoperative complications and hospital mortality, as well as long-term treat- ment results in two groups is presented. It was shown that with significantly worse results in terms of cytoreduction completeness obtained in the IOPDT group compared to the HIPEC group, the 5-year survival rate in the HIPEC group was 86.6%, with IOPDT - 65.2%. At the same time, in the IOPDT group, the rate of postoperative complications was significantly lower (11.1%), and there was no mortality; in the HIPEC group, these indicators were 23.8% and 12.0%, respectively. The results obtained indicate that the IOPDT method is an effective and promising direction in the surgical treatment of peritoneal pseudomyxoma.

The review is dedicated to the analysis of the effectiveness of the treatment of erythroplasia of Queyrat (EQ) using photodynamic therapy (PDT). Particular attention is paid to the relationship between EQ and human papillomavirus (HPV) infection. The data of various researchers are presented, confirming the correlation between the development of the EQ and the HPV infection, however, it is noted that due to the small number of studies it is difficult to draw reliable conclusions on the presence and strength of this connection. The mechanisms of PDT involved in the implementation of both the antitumor effect in the treatment of EQ and the antiviral effect against HPV are considered. The data of 12 clinical studies and observations of the results of PDT of the EQ conducted in recent years are analyzed. An analysis of literature data showed that in the treatment of EQ, one of the two photosensitizers is usually used locally: 5-aminolevulinic acid or 5-aminolevulinic acid methyl ester. The treatment parameters in all the analyzed studies were similar: exposure to the ointment for 3–5 hours followed by irradiation with a light dose of 37–105 J/cm2. The number of PDT courses in different studies varied from 1 to 19. The effectiveness of treatment varied widely in different studies and clinical observations. Most studies have demonstrated high efficacy of PDT with complete regression in 36–83% (100% in one study) and a relapse-free follow-up period of up to 51 months. However, there were also individual clinical observations of patients in whom the treatment with the method of PDT was ineffective. It is possible that the described results were associated with improperly selected regimes of PDT or a large lesion area. Most authors especially note a very good cosmetic effect and a complete absence of scars after the treatment. Thus, PDT is an effective and promising method for the treatment of EQ that requires, however, a more thorough development of the application regimen and a deeper study of the antitumor and antiviral components of the mechanism of action.

The results of an 11-year clinical observation and treatment of a patient with stage II basal cell carcinoma of the face (Т2N0M0) are presented. History of the illness is associated with a long (from 2001 to 2008) inadequate treatment, due to the incorrect diagnosis. After the proper diagnosis was established, from 2008 to 2019 at the Center for Laser and Photodynamic Diagnostics and Tumor Therapy of P.A. Herzen Moscow Oncology Research Center, the patient underwent organ-preserving treatment using the multi-course photodynamic therapy (PDT) and drug targeted therapy. In total, 23 courses of PDT were conducted with photosensitizers of the chlorin series and 5-aminolevulinic acid during this period. Since 2018, the patient is in the process of targeted drug treatment with Vismodegib. In the course of targeted drug treatment, a follow-up examination in 2019 revealed continued growth of the residual tumor, and another course of PDT was carried out. Throughout the observation period, the patient tolerated the treatment well, without complications, with a good quality of life and satisfactory cosmetic effect.

Current approaches to diagnostics and treatment of patients with pleural metastases complicated by malignant pleuritis are reviewed. The method of intrapleural photodynamic therapy with photosens developed in P.A.Herzen MCRI for primary and metastatic pleural diseases complicated by malignant pleuritis is represented; for 66 patients there were good efficacy as pleurodesis in 92.4% of cases. The case of intrapleural photodynamic therapy in female patient with pleural mesothelioma complicated by malignant pleuritis with good short- and longterm results and significantly improved quality of life is reported.

Photodynamic therapy (PDT) is a worthy alternative to surgical esophageal resection or endoscopic mucosal resection and dissection (EMR, ESD) in patients with superficial esophageal cancer with severe concomitant diseases as well as in patients with a common form of esophageal cancer with severe malignant dysphagia. Patients with superficial (7) and advanced (15) esophageal cancer received PDT as an independent method and as a supplement to complex treatment. Radachlorin was used as a photosensitizer at a dose of 0.6–0.8 mg/kg, administered intravenously 3 hours before irradiation. A PDT session was carried out using a laser with a wavelength of 662 nm. The light dose used was 150–300 J/cm2 . The use of PDT made it possible to achieve the full effect in 7 (100%) patients in the group of superficial (T1a-T1b) esophageal cancer where PDT was either the only method of treatment or in combination with radiation therapy. In the group of patients with stenotic cancer the use of PDT made it possible to achieve full recovery of food intake after recanalization for 20% of patients, and partial – for 66.7%. Thus, complete natural food intake was restored for 86.7% of patients which improved their quality of life. PDT is also a method of choice for cancer of the upper esophagus as esophageal stenting in this situation can cause unwanted subjective sensations.

In 1903, on the basis of Morozov Institute of the Moscow Imperial University (currently, P. Herzen Moscow Oncology Research Center, a branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation), the first specialized unit in Russia was opened – department of radiation therapy of oncological diseases, in which scientific research in the field of medical radiology was officially launched in our country for the first time. The first studies in the field of radiation therapy can be attributed to this period.The article presents a brief summary of the historical development of radiotherapy in the world and in Russia; provides information on the achievements of global importance, fundamental for this scientific field. The activities of leading Russian organizations in the field of radiation therapy are reviewed; names of scientists, doctors and other specialists who have made a significant contribution to its development are provided. The main literature sources relevant to the field are given.The data in this article may be of interest and be useful for biomedical scientists, practicing radiologists and radiotherapists, oncologists, medical and graduate students, interns and other specialists.

This article presents the results of a clinical study that examined the diagnostic efficacy of fluorescent diagnostics (FD) of non-muscularinvasive bladder cancer using a photosensitizer of FD of malignant neoplasms – 5-aminolevulinic acid hexyl ester (5-ALA HE) compared with standard cystoscopy. The study involved 110 patients. The study began with intravesical administration of 50 ml of 0.2% solution of 5-ALA HE, the exposure time was 1 hour, after which the drug was removed from the organ. During the next hour, the mucous membranes were examined in two cystoscopy modes, followed by a standard transurethral resection of all urothelium sites with suspicion for tumor lesion based on white light and visible red fluorescence, and a control blind biopsy from the visually unchanged and non-fluorescent mucous tissue in each patient. The results of the study indicate the high effectiveness of the developed FD methodology with 5-ALA HE in detecting non-muscularinvasive bladder cancer during intravesical administration of the drug, due to selective accumulation of hexasens-induced PPIX in the tumor tissue compared with healthy mucosa. Compared with the results of standard cystoscopy, fluorescence diagnostics significantly increased diagnostic sensitivity by 24.4% (from 75.1% to 99.5%), diagnostic accuracy – by 15.8% (from 82.4% to 98.2%) and a negative predictive value – by 33.2% (from 65.8% to 99%) (p≤0.05). Additionally, a total of 37 (33.6%) patients was found to have 63 foci of fluorescence with a diameter of 2.5 to 3.0 mm. 59 of these were morphologically confirmed to contain cancer cells.

A comparative experimental study of the specific activity of drugs based on 5-aminolevulinic acid (5-ALA) and its hexyl ester (5-ALA HE) was carried out. Their ability to induce the synthesis of photoactive protoporphyrin IX in the healthy tissues of the rabbit bladder when instilling the drug solutions at various concentrations has been estimated. It was shown that 5-ALA HE results in the induction and accumulation of PPIX in the rabbit bladder epithelium at much lower concentrations than 5-ALA. Thus, a significant increase in the fluorescence intensity in comparison with the control was achieved by instillation of 5-ALA HE solution in the rabbit’ bladder at a concentration of only 0.0001% (fluorescence intensity 2.20±0.60 a.u.), and for 5-ALA – only when using a solution at a concentration of 0.3% (fluorescence intensity 2.60±1.02 a.u.).

Results of intraoperative photodynamic therapy (IOPDT) in patients with gastric cancer are represented in the article. The study included 240 patients with gastric cancer stage II-IV (Т3-4N0-3M0-1) with evident or suspected peritoneal dissemination who underwent examination and treatment in P.Herzen Moscow Oncology Research Institute. The group 1, the study group, included 140 patients who underwent nominally curative or palliative surgery for locally advanced and disseminated gastric cancer with IOPDT as additional intraoperative intervention for antiblastics and cancer treatment. The group 2, the control group, included 100 patients who also underwent nominally curative or palliative surgery (equal to extent of surgery in patients from the study group) for locally advanced and disseminated gastric cancer and no intraoperative implication of physical or chemical treatment methods. IOPDT did not worsen a course of early post-operative period, did not impact on severity of post-operative complications and was not associated with increase of post-operative mortality. IOPDT allowed for improvement of 1-year and 3-year disease-specifi c survival rates: by 16.1% and 16.7%, respectively. For nominally curative resections, median survival, 1- year and 3-year disease-specifi c survival rates were improved by 14 months, 17.8% and 31.3%, respectively. For R1, R2 resections, IOPDT improved 1-year disease-specifi c survival rates by 16.4%. Additionally, for nominally curative resections IOPDT did not increase the recurrence rate and improved median recurrence-free survival, 1-year and 3-year recurrence-free survival rates by 16 months, 27.2% and 25.4%, respectively.

Clinical observation of a patient with an orphan disease (mucinous peritoneal carcinomatosis) after 2 courses of intraoperative photodynamic therapy with photogem photosensitizer is presented. During the first course of photodynamic therapy, photogem was administered at a dose of 2.5 mg/kg, the energy density of the laser radiation was 10 J/cm2. The duration of stabilization after the first course of treatment was 2 years, after which the progression of the disease was registered. The second course of photodynamic therapy was carried out in the same way. The duration of stabilization after the first course of treatment was 2.5 years. The patient died as a result of an accident unrelated to the disease.

Abstract Results of application of a new technology of intraoperative photodynamic therapy (IOFDT) in patients with peritoneal mesothelioma developed at P. Herzen Moscow Oncology Research Institute are presented. The study included 8 patients. 3 patients underwent surgery in various amount: 1 – limited peritonectomy in the volume of tumor foci resection and resection of a large omentum, 1 – limited peritonectomy in the volume of tumor foci resection and atypical resection of the right lobe of the liver, 1 – only resection of the large omentum due to the fact that the tumor was located only in a large omentum and no signs of lesions of the parietal peritoneum was revealed by intraoperative revision. Surgical intervention in these patients was concluded by IOPDT. The remaining 5 patients underwent only IOPDT. After the treatment, two patients underwent additional courses of laparoscopic IOPDT. Of the 8 patients enrolled in the study, 4 died from the underlying disease, 1 from cardiovascular disease with recurrence of the disease, 1 from cardiovascular disease without signs of recurrence, 2 were monitored for 6 months and 146 months (12 years). Thus, in the group of patients with peritoneal mesothelioma, the maximum observation period was 146.44 months, the median survival was 48.4 months, the total specific 1-year survival was 85.7±13.2%, the three-year survival was 68.5±18.6%, the 5-year survival was 45.7 ± 22.4 %. The average life expectancy after treatment of patients with repeated courses of laparoscopic IOPDT was 87 months, without repeated courses – 35.8 months. Thus, life expectancy was higher in patients with repeated courses of laparoscopic IOPDT. Small sample size caused to the rarity of this pathology does not allow for statistically significant conclusions. However, the results of the study indicate the prospects of multi-course intraoperative photodynamic therapy in patients with peritoneal mesothelioma.

Cationic bacteriochlorins are promising as antibacterial photosensitizers (PS) for antibacterial photodynamic therapy. Current work is devoted to the study of properties of new nanostructured cationic photosensitizer based on cyclodextrin dispersion of bacteriochlorine derivative – 133-N-(N-methylnicotinyl)-bacteriopurpurinimide methyl ester, for optimization of dispersion composition and selection of time interval between administration of the PS and photodynamic ttherapy of infected septic wounds. Specifics of absorption and fluorescence of PS in dependence of its concentration and proportions of components in dispersion was assessed. Pharmacokinetics and biodistribution of PS were studies in vivo in organs and tissues of intact mice and septic wounds infected with P. аeruginosa or S. aureus. The preliminary studies have shown high efficiency of antimicrobial photodynamic therapy of septic wounds with cyclodextrin dispersion of 133-N-(N-methylnicotinyl)-bacteriopurpurinimide methyl ester. Results of study of absorption and spectral and fluorescence properties of its drug formulation depending on its composition allowed to recommend the use of weight ratio 133-N-(N-methylnicotinyl)bacteriopurpurinimide methyl ester : cyclodextrin about 1:200 and addition of 0,1% Tween 80 to reduce aggregation. The study showed that 133-N-(N-methylnicotinyl)-bacteriopurpurinimide methyl ester was rapidly cleared from mouse blood circulation: more than 70% – for 2 h, 95% – for 1 day, more than 99% – for 6 days. About 98% was cleared from skin and muscles for 6 days. The long-term (up to 24 h) persistence of PS were observed in liver and kidneys, however more than 99% was cleared for 6 days. Thus, it may be supposed that elimination of PS form mice body is through kidneys and liver. After 24 h partial PS aggregation in tissues, particularly in skin and muscles, was observed. Thus, it may be supposed that the reduce of fluorescence intensity after 24 hand later was associated not only with its elimination from body but with its aggregation. Spectral and fluorescence studies showed that 133-N-(Nmethylnicotinyl)-bacteriopurpurinimide methyl ester selectively accumulated in septic wounds, fluorescence contrast was in the range of 3–4. The highest values of concentration and selectivity of its accumulation were achieved at 1.5–3 h after intravenous injection. The irradiation 2 h after injection provided high efficacy of the therapy of septic wounds.

The article presents a clinical observation of the patient of 38 y.o. with cancer of the left breast stage IIIC урТ4bN3М0L1V1. On the 1st step of the treatment the patient had 2 courses of CAF neoadjuvant chemotherapy, on the 2nd step – extended radical mastectomy on the left with intraoperative photodynamic therapy and closure of the defect with ТRАМ-flap, on the 3rd step – continuation of the chemotherapy (8 courses), on the 4th step – radiation therapy to the chest wall on the left and zones of regional lymph drainage, targeted therapy with herceptin a (1 year). Four years later a silicone implant was inserted into the left breast. Corrective surgery (reduction mammoplasty on the right side) was performed in april, 2017. Currently, the patient has remission of the disease of the left breast, the period of remission accounts for 8 years.

According to worldwide statistics breast cancer is the most common cancer in women. Despite the success in current methods of treatment post-operative period in major of patients is characterized by post-mastectomy syndrome which leads to impairment in daily activities, difficulties in social adaptation and consequently to dicrease of the quality of life. The specific causes, risk factors, characteristics of clinical and pathogenetic manifestations of post-mastectomy syndrome are described in detail in this review. Different approaches to post-mastectomy syndrome classification, its clinical and instrumental diagnosis are defined. Based on more than 40 publications of Russian and foreign authors, the issue of selection of appropriate treatment tactics for the syndrome is investigated and discussed in detail. A considerable part of the review is focused on the use of physical methods of treating the post-mastectomy syndrome. It is observed that an increasing number of specialists gives preference to methods of conservative treatment special of which are medical gymnastics, complex decongestive therapy and compression therapy. On the other hand, the absence of the unified treatment algorithms is challenging for clinicians. Therefore, its development with the focus on patient-specific approach is a crucial task for modern rehabilitology in breast cancer surgery.

The results of multicenter trial for efficacy of fluorescence diagnosis for bladder cancer with agent hexasens (SSC Scientific Research Institute Organic Intermediates and Dyes, Russia) based on hexyl ester of 5-aminolevulinic acid compared with routine cystoscopy are represented in the article. The study included 124 patients. All patients had intravesical instillation of 50 ml of 0,2% hexasens. The exposure time accounted for 1-2 h. After removal of the drug from bladder standard cystoscopy followed by fluorescence diagnosis was performed in every patient. During the local fluorescence spectroscopy the intravesical instillation of the agent hexasens was shown to induce selective accumulation of photoactive protoporphyrin IX in tumor cells comparing with intact bladder mucosa. During 1 h after intravesical instillation of hexasens solution the level of fluorescence of hexasens-induced protoporphyrin IX in the tumor was higher than that in surrounding intact mucosa at average in 5.8 fold. As compared with results of standard cystoscopy, fluorescence diagnosis improved the sensitivity of the method by 24.4% (from 75.6% to 100%), the accuracy – by 15.2% (from 83.3% to 98.5%) and negative predictive value – by 33.5% (from 66.5% to 100%). Fluorescence diagnosis gave an opportunity to detect additional tumor foci, which were invisible in white light, in 27.4% of patients. For fluorescence diagnosis in 4.0% of patients false-positive fluorescence of bladder mucosa was detected that was probably due to inflammation. None of patients received active dose of the drug hexasens had adverse reactions, changes in general well-being and blood and urine parameters. According to the results of the study fluorescence diagnosis with hexasens for bladder cancer is recommended for use in clinical practice.

This article provides a critical overview of the methods of optical diagnosis of muscular and non-invasive bladder cancer (BC), describes the technologies available so far, their advantages and disadvantages, and reviews the assessment of their effectiveness, both clinical and economic. The results are based on the work of leading scientific societies, such as the European Association of Urology (EAU), the European Organization for Research and Treatment of cancer (EORTC), Сlinical Research Office of the Endourological Society (Croes), etc.

The study of diagnostic efficiency of intraoperative fluorescence diagnosis (IOFD) of peritoneal dissemination in patients with gastric cancer comparing with standard laparoscopy was performed in P.A. Hertsen MCRI (the branch of NMRRC). The study included 114 patients with verified diagnosis of gastric cancer stage III–IV. For IOFD the domestic medication alasens (the active agent – 5-aminolevulinic acid) was used orally at dose of 30 mg/kg body weight 3 h prior to the study procedure. As the result of fluorescence diagnosis 10 (6.9%) patients had peritoneal tumor dissemination verified morphologically and undetected by standard laporoscopy. The sensitivity of peritoneal revision for standard laparoscopy in patients with gastric cancer stage III–IV was 60.8%, the specificity – 75.8%, the overall accuracy – 69.1%. The sensitivity for IOFD in patients with gastric cancer stage III–IV was 91.1%, the specificity – 93.9%, the overall accuracy – 92.7%. Thus, fluorescence study allowed improving the specificity, the sensitivity and the overall accuracy of diagnostic test. In the trial IOFD had the maximal diagnostic value in patients with visually undetectable microdissemination in «whight» light and with solitary visible peritoneal foci (the average number of additionally detected metastatic lesions in one patient – 1.22 and 1.4, respectively). Moreover, in the case of fluorescence diagnosis the number of detected microfoci of peritoneal dissemination was showed to increase with enlargement of area of tumor invasion to gastric serosa (at average of 2.29 additionally detected lesions in one patient with serosal invasion more than 2 cm2). The obtained results confirm the perspective of use of fluorescence diagnosis for detection of peritoneal dissemination, determination of true tumor extent, staging of the tumor and also for adjustment of following treatment tactics for this group of patients.

This review is devoted to the cytoreductive treatment of malignant tumors of the abdominal organs. The actuality of the issue is determined both by increase of the incidence of abdominal cancer in Russia and in majority of developed countries and by high rate diagnosis on late stages of disease. The methods of treatment of peritoneal carcinomatosis, based on possible effects on the secondary peritoneal tumors after surgical cytoreduction to reduce the risk of local recurrence and disease progression are described. These methods of additional intraoperative specific antitumor action include intraoperative radiation therapy, hyperthermic intraperitoneal chemotherapy, intraoperative photodynamic therapy characterized by differences in difficulty of performance, mechanisms of effect on tumor and healthy tissues, efficiency. Benefits, opportunities and possibilities of application of intraoperative photodynamic therapy (IOPDT) for secondary peritoneal tumors are described in details, the results of a number of domestic and foreign clinical studies are shown, the successful application of intraoperative photodynamic therapy in clinical oncology, which allows reducing the risk of secondary tumor lesions of the peritoneum significantly, is demonstrated. Photodynamic therapy – a method with high efficiency and almost no side effects and complications, based on the ability of photosensitizer to accumulate selectively and retain in the high proliferative tissues. The advantages of this type of treatment of patients with peritoneal carcinomatosis are a selective effect on the peritoneal carcinomatosis and on visually detected tumor tissue, high efficiency in patients with malignant tumors of the abdominal cavity and pelvis combined with surgical cytoreduction, minimal effect on normal organs and tissues of the patient, well tolerated procedure.

Writing this article is prompted by growing interest in the technology of high intensity focused ultrasound (high-intensity focused ultrasound, HIFU), which, in turn, is associated with a wide range of potential points of use, minimal invasiveness of this method, minimal impact on the patient’s body, characterized by a short period of rehabilitation. Also, this treatment method has a high reproducibility, which in turn contributes to the rapid spread of HIFU therapy in practice. The review is devoted to the history of development, study and application of the method of ultrasonic ablation, the modern view on how to conduct HIFU therapy, the currently available technical possibilities for non-invasive high-intensity focused ultrasound therapy as well as demonstrate the effectiveness of this treatment in patients with malignant and benign tumors of different localization, as in a standalone version or in combination with other treatment options (surgery, drug therapy, radiation therapy), an attempt to systematize the early and remote results of treatment. The article represents the data of world and national literature. One of the important directions of the study of the described technique is an expansion of possible application in various malignant pathologies, both local and generalized nature of the lesion. A separate item is the application of HIFU therapy in the treatment of chronic pain syndrome.

The results of a fluorescent diagnosis programme in the monitoring of self-administered hormonal therapy using Alasens (3% solution - 10 ml injected into the uterine cavity) have been analyzed in 53 female patients of reproductive age with endometrial precancer or cancer. The time of exposition to Alasens was 2 hours. The fluorescent diagnostic procedure was carried out in this patient cohort at different stages of therapy: oncological and rehabilitative, as well as at one year after discontinuation of hormonal therapy After comparing the fluorescent and morphological examination data, an early relapse or ongoing process was diagnosed in 9 (16,9%) out of 53 patients

The review is on opportunities and possibilities of application of photodynamic therapy in clinical practice. The advantages of this method are the targeting of effect on tumor foci and high efficiency along with low systemic toxicity. The results of the set of recent Russian and foreign clinical trials are represented in the review. The method is successfully used in clinical practice with both radical (for early vulvar, cervical cancer and pre-cancer, central early lung cancer, esophageal and gastric cancer, bladder cancer and other types of malignant tumors), and palliative care (including tumor pleuritis, gastrointestinal tumors and others). Photodynamic therapy delivers results which are not available for other methods of cancer therapy. Thus, photodynamic therapy allows to avoid gross scars (that is very important, for example, in gynecology for treatment of patients of reproductive age with cervical and vulvar cancer), delivers good cosmetic effect for skin tumors, allows minimal trauma for intact tissue surrounding tumor. Photodynamic therapy is also used in other fields of medicine, such as otorhinolaryngology, dermatology, ophthalmology, orthopaedics, for treatment of papilloma virus infection and purulent wounds as antibacterial therapy.

The original method of intraoperative photodynamic therapy for multimodality treatment of primary and recurrent breast cancer for devitalization of malifnant cells at wound surface and for prevention of further cancer dissemination was developed in P.A. Herzen Moscow Cancer Research Institute. The developed method was approved in 79 patients with locally advanced breast cancer stage IIB and IIIA,B,C with poor prognostic factors. For photodynamic therapy the photosensitizer photosens (30 min intravenous infusion at dose of 0.3 mg/kg of body weight 2 h before surgery) was used in 56 patients; alasens (solution in 100 ml of still drinking water, orally at dose of 30 mg/kg of body weight 2 h before general anesthesia) — in 23 patients. The surgical field was irradiated on a single occasion: the dose of laser irradiation on the bed of removed primary or recurrent tumor was 20–30 J/cm2, in the removed regional lymph nodes area – 50 J/cm2. Long-term results of the treatment were assessed in 34 patients: there were no disease progression in 50% of patients, 14.7% of patients had locoregional recurrence, distant metastases were in 35.3% of patients. The level of photosensitizer accumulation in tissue was additionally analyzed in 26 patients by fluorescence intensity in tumor and in normal breast tissue. After injection of alasens the increase in level of alasens-induced protoporphyrin IX fluorescence was recorded in tumor (the average diagnostic parameter was 6.5 a.u.) and in intact breast tissue (an average of 0.47 a.u.), tumor/normal tissue fluorescence contrast varied from 3 to 33. The level of protoporphyrin IX accumulation was noticed to be lower in tumors with pathomorphological response after neoadjuvant therapy. For photosens value of the average diagnostic parameter in normal breast tissue was 5.6 a.u., in tumor – 34.3 a.u., tumor/normal tissue fluorescence contrast – from 2 to 9.

The results of 4-year clinical follow-up in the patient with obstructive inoperable retropericardial esophageal cancer are represented. According to cardiac co-morbidity (myocardial infarction, postinfarction cardiosclerosis) the palliative care for patient was managed. To preserve patency of esophagus multiple courses of endoscopic photodynamic therapy by means of the approach developed in P.A. Herzen MCRI were performed. From 2011 to 2014 thirteen courses of photodynamic therapy with photosens were conducted. The patient was under follow-up for 4 years and 3 months to his death in 2015. For follow-up period the patient had oral feeding with no signs of dysphagia, not significant weight loss and with good quality of life.

The main challenge of treating non-muscle invasive bladder cancer is multifocal tumors. Current methods of diagnosis are failed to detect all superficial flat tumor lesions in bladder mucosa. The use of fluorescence imaging with 5-aminolevulinic acid (5-ALA) allows to improve the sensibility of routine cystoscopy, but low specificity decreases its diagnostic accuracy. The method of fluorescence imaging combined with local fluorescence spectroscopy developed in P.A. Herzen MCRI has been shown to increase the specificity from 71% to 84%. Thus, local fluorescence spectroscopy in visible fluorescence of 5-ALA-induced protoporphyrin allows to perform guided biopsy and decrease the rate of diagnostic mistakes.

The results of clinical study for efficacy of photodynamic therapy (PDT) with radachlorine in patients with pre-cancer and cancer of cervix are represented. The study enrolled 30 patients including 4 patients with cervical erosion, 5 patients with cervical intraepithelial neoplasia II, 13 patients with cervical intraepithelial neoplasia III, 4 patients with carcinoma in situ and 4 patients with cervical cancer stage Ia. Radachlorine was administrated as single 30 minute intravenous injection at dose of 1,0 mg/kg of body weight 3 h before irradiation (wavelength of 662 nm, light dose of 300–350 J/cm2). The results of treatment in 26 (86,7%) patients was assessed as complete tumor regression and in 4 (13,3%) patients — as partial regression. In cervical erosion, intraepithelial neoplasia II and carcinoma in situ groups total regression was in all cases. In the cervical intraepithelial neoplasia III group total regression after first course of PDT was achieved in 77% of patients, in cervical cancer stage Ia group – in 75% of patients. From 3 to 6 months after first course of treatment all patients with partial tumor regression underwent the second course of PDT with complete regression. There were no side-effects due to radachorine or PDT in the course of treatment and during follow-up. Thus, PDT with Russian photosensitizer radachlorine showed high efficiency for treatment of pre-cancer and cancer of cervix.

Results of treating 114 skin metastases of melanoma in 21 patients are represented. Melanoma progression with cutaneous metastases after previous treatment was diagnosed in all patients. The method of prolonged photodynamic therapy developed by authors with fotosens administrated intravenously at dose of 0.4 mg/kg of body weight was used in the study. First session of tumor irradiation was performed 2 h after injection of photosensitizer. Patients underwent superfi cial or contact irradiation depending on topography and type of growth of metastatic foci. Course of treatment accounted for 7–10 sessions of photodynamic therapy with 24 h interval, light dose delivered to tumor for one session – 350 J/cm2. Signifi cant clinical effect (complete and partial tumor regression) was obtained in 89% of cases for developed method.

Results of fluorescence diagnosis (FD) with alasens in 237 patients with skin cancer are represented. The average age of patients accounted for 63±11 y.o. The indications for FD were the borders adjustment for skin cancer of different localizations prior to special treatment and also the search for occult foci of malignant lesion. There were two groups of patients: patients with locally advanced head and neck carcinomas, who had FD prior to surgical treatment, and patients with cancer of different localization, who had FD prior to photodynamic therapy (PDT). FD permitted to adjust borders of detected tumor foci in 100% of patients that impacted on extent of resection during surgery in group 1 of patients and helped planning fields of laser irradiation for PDT session in group 2 of patients. Due to FD with alasens 506 foci of additional fluorescence were detected in 118 (53.1%) of 222 patients in group 2, skin cancer was diagnosed morphologically in 63 patients (28.4%) of them.

New medical technology of photodynamic therapy for cancer of hollow organs with photosens determines parameters of irradiation (sites of placement and position of light guide, number of positions and duration of irradiation) to reduce probability of injury during irradiation of intact mucosa in hollow organ due to optimization of light dose. The technology allows to avoid inflammatory and necrotic injury of intact mucosa on the contralateral wall of organ and late complications and to achieve complete tumor regression depending on localization in 73–87% of cases for follow-up period from 1 to 11 years.

The results of multicenter prospective trial for efficacy of combined modality treatment: transurethral resection (TUR) + photodynamic therapy (PDT) with alasens for bladder cancer are represented in the article. Trials were organized by Research Institute of Organic Intermediates and Dyes and conducted according to clinical protocol approved by Ministry of Health of Russia, at the sites of leading Russian cancer clinical centers. The trial included 45 subjects with verified diagnosis of non-muscle-invasive bladder cancer. Patients underwent TUR of bladder with simultaneous PDT as anti-relapse treatment. Alasens was administered to patients as intravesicular instillation of 3% solution in volume of 50 ml with 1.5–2h exposure (prior to TUR). TUR was performed after instillation. PDT session was conducted immediately after the completion of TUR on a single occasion by means of combined local irradiation on tumor bed with diffuse irradiation on whole urinary bladder mucosa (light dose of local irradiation – 100 J/cm2, diffuse irradiation – 20 J/cm2). Good tolerance of the treatment was noticed, there were no complications. Among 45 patients included in the trial, 35 (78%) completed 12 month protocol follow-up without relapse. The recurrence of bladder tumor was registered in 10 (22%) cases 6–12 months after TUR+PDT including 3 patients with recurrence 6 months after treatment, 3–9 months and 4–12 months. These patients underwent repeated TUR, whereafter their follow-up in the settings of the clinical trial was disposed. Thus, PDT with alasens after TUR allowed to decrease the recurrence rate of non-muscle-invasive bladder cancer for 1st year after treatment to 22% versus 40–80% for TUR as monotherapy according to literature data. The obtained results were comparable by efficiency with TUR combined with methods of adjuvant treatment for bladder tumors (the recurrence rates for 1-year follow-up after TUR+chemotherapy – 36–44%, after TUR+BCG – 20–59%).

The technique of fluorescence hysteroscopy with Alasens includes visual assessment of fluorescence of Alasens-induced protoporphyrin IX and local fluorescence spectroscopy. The technique allows to improve the efficacy of early diagnosis for endometrial pathology including early endometrial cancer, to assess definitely an extent of pre-tumor and tumor process. The sensitivity of fluorescence hysteroscopy accounts for 100%, the specificity – 98%.