High-grade gliomas have a diffuse and infiltrative nature of the growth of tumor cells, due to which the achievement of radical resection is difficult. Surgical resection completeness of brain tumors is an important factor in prolonging the life of patients. An accurate definition of tumor boundaries and residual fluorescent regions is impossible due to imperfections of the equipment used for fluorescent imaging. 5-aminolevulinic acid (5-ALA) is a precursor of protoporphyrin IX (PpIX) in humans and is clinically used to detect and treat tumors. Currently, fluorescence-guided surgery with PpIX used a surgical microscope with an excitation wavelength in the blue spectrum range. Because of its low ability to penetrate into biological tissue, blue light is ineffective for providing high-quality fluorescent navigation. Also, when performing an operation using radiation in the blue spectrum range, the photosensitizer’s surface layer (PS) often bleaches out, which leads to frequent errors. The use of red light emission makes it possible to slow down the PS bleaches out due to the absorption properties of PpIX, but this task is technically more complicated and requires highly sensitive cameras and specialized optical filters. The new two-channel video system for fluorescent navigation has a radiation source in the red range of the spectrum, the penetration depth of which is greater than the blue light, which makes it possible to increase the depth of probing into biological tissues. The study’s clinical part involved 5 patients with high grade glioma and 1 patient with low grade glioma: grade III oligodendrogliomas (2), grade IV glioblastomas (3), and grade II diffusion astrocytoma (1).
This review highlights the possibilities of photodynamic therapy (PDT) using drugs based on chlorin e6, aluminum phthalocyanine, methylene blue as photosensitizers for bacterial and fungal pathologies. This method was developed initially to treat tumor diseases, where it had shown its high efficiency and safety. Now photodynamic therapy is actively used in the treatment of cancers of the skin, bronchi, stomach, cervix, larynx, or other regions. However, numerous studies have been carried out for the entire existence of the method, demonstrating new possibilities of its application. This review highlights a number of studies in which the efficacy and safety of antimicrobial and antimycotic PDT were studied in vivo and in vitro. It has been proven to have a positive effect on the reparative processes in the wound. An experimental study was carried out to study the effectiveness of photodynamic therapy in the treatment of peritonitis in mice. Demonstrated anti-inflammatory potential in the treatment of autoimmune diseases.
The problem of treating patients with malignant neoplasms of the extrahepatic bile ducts and the large duodenal papilla remains relevant due to the growing incidence, high mortality, and a pronounced decrease in the quality of life of patients, despite the radical surgery. The purpose of this study was to evaluate the effectiveness of photodynamic therapy (PDT) in inoperable patients with malignant tumors of these localizations.The study is based on the treatment of 79 patients with adenocarcinoma of large duodenal papilla and extrahepatic bile ducts. 29 patients received palliative bile drainage operations with PDT. 50 patients in the control group only had palliative bile drainage operations. Patients in the study group received from 1 to 3 PDT courses in a year. In total, 29 patients received 52 PDT courses. The tolerance to the method and the life expectancy of patients were evaluated. The median survival of patients who underwent PDT was 18 months (11–60 months); in the control group – 11.5 months. PDT, in combination with bile drainage operation, is an effective method for the treatment of inoperable patients with malignant neoplasms of the extrahepatic bile ducts and the large duodenal papilla in the absence of severe complications and with easy tolerance to therapy by patients. For the treatment and prolongation of life of patients whose radical surgical treatment is associated with a high risk of death, PDT seems to be the best treatment option. Results of PDT treatment for cancer of this localization are comparable with the results of radical surgeries and exceed those for palliative surgeries.
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