Improving diagnostic staging laparoscopy using intraperitoneal lavage of [delta ]-aminolevulinic acid (ALA) for laparoscopic fluorescence diagnosis

Gahlen, Johannes; Stern, J.; Laubach, Hans; Pietschmann, Matthias F.; Herfarth, Christian

doi:10.1067/msy.2099.100264

Cited by 11 publications

(14 citation statements)

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“…The potential for malignant degeneration of some chronic diseases like Barrett's oesophagus, ulcerative colitis and familial polyposis is well known. However, early cancers are difficult to diagnose, as they can hide in normal or unspecifically inflamed mucosa [37,38,39,40,41,42,43,44,45,46,47,48]. At present, assessment of endoscopic findings is subjectively made by the investigator.…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

Fluorescence detection of small gastrointestinal tumours: principles, technique, first clinical experience

Orth

Russ

Steiner

et al. 2000

Langenbeck's Archives of Surgery

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Photodynamic therapy (PDT) is a form of cancer treatment based on the selective accumulation of a photosensitizer in neoplastic tissue. The fluorescent properties of a photosensitizer permit diagnostic localization of primary tumours and/or metastasis. Occult lesions are hard to detect and can easily be missed during routine laparoscopy. Fluorescence observation offers additional optical information and the ability to detect these occult tumours. Clinically, we used 5-aminolevulinic acid for peritoneal staining and tumour demarcation via tumour-specific fluorescence induced by protoporphyrin IX. For laparoscopic observations, a "D-Light" system was used; the conventional white light source was equipped with an optical blocking filter that transmits at the excitation wavelength (380-450 nm) and blocks all other parts of the spectrum. With the aid of a suitable observation filter, the relevant fluorescence was detectable. With the help of this fluorescence we increased the capacity to detect occult tumours, that were missed with white-light observation (9/26). In the gastrointestinal tract, we used a krypton laser at 405 nm for PP IX fluorescence induction. Although there were high sensitivity rates for neoplasms (81% peritoneal carcinomas, 60% gastric cancer), no exact histopathological statement could be achieved at because of false-positive fluorescence, mainly caused by inflammation (6/32). Current clinical goals and the future perspectives of photodynamic diagnostic are discussed.

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Section: Discussion and Future Perspectivesmentioning

confidence: 99%

Fluorescence detection of small gastrointestinal tumours: principles, technique, first clinical experience

Orth

Russ

Steiner

et al. 2000

Langenbeck's Archives of Surgery

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“…Because of the significant difference in the activities of key enzymes in the heme pathway between tumor and normal tissue, the PpIX accumulation induced by ALA in tumor cells is higher than that in normal cells [23,24]. PpIX generates red fluorescence when excited by blue light revealing a distinct contrast to the surrounding normal tissues [25]. ALA-mediated PpIX synthesis allows selective cancer treatment and has been studied extensively because it is a safe and effective photosensitizing agent [26].…”

Section: Introductionmentioning

confidence: 99%

Protoporphyrin IX fluorescence photobleaching is a useful tool to predict the response of rat ovarian cancer following hexaminolevulinate photodynamic therapy

Ascencio

Collinet²,

Farine³

et al. 2008

Lasers Surg Med

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“…Previous investigations have attempted to use fluorescent marker molecules that for metabolic reasons selectively accumulate within malignant cells of subjects with cancer (Gahlen et al, 2002). The selective and progressive accumulation by cancer cells of the fluorescent peptide, d-aminolevulinic acid (ALA), has been examined in the experimental staging of peritoneal carcinomatosis (Gahlen et al, 1999(Gahlen et al, , 2001(Gahlen et al, , 2002. Only 82.5% of peritoneal metastases diagnosed by fluorescent ALA accumulation were detectable with conventional white light alone (Gahlen et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

Oncolytic Herpes Simplex Virus-1 Mutant Expressing Green Fluorescent Protein Can Detect and Treat Peritoneal Cancer

et al. 2004

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NV1066 is a herpes simplex virus-1 (HSV-1) oncolytic mutant that contains the gene for enhanced green fluorescent protein (EGFP). We sought to determine (1) whether NV1066 is effective against human peritoneal cancer, (2) whether EGFP is detectable in an animal model of gastric cancer, and (3) whether EGFP expression can be used to assess oncolytic therapy in a minimally invasive, laparoscopic system. The current study demonstrates that NV1066 is cytotoxic to OCUM human gastric cancer cells in vitro and in an in vivo model of disseminated peritoneal gastric cancer. In vitro this human gastric cancer cell line is sensitive to NV1066. Lysis occurs in a dose-dependent fashion, achieving near-complete lysis even at multiplicities of infection (MOIs) as low as 0.01 by 7 days. NV1066 also replicates within OCUM cells and induces expression of GFP in a dose-dependent manner. At MOIs of 0.01 to 1, EGFP expression is seen by flow cytometry in 100% of OCUM cells within 5 days after infection. NV1066 effectively treats OCUM carcinomatosis in an in vivo model. After intraperitoneal administration of NV1066, macroscopic tumor foci express EGFP by direct laparoscopy with the appropriate fluorescent filtering. Noncancerous organs are not infected and do not express EGFP. We conclude that NV1066 has significant oncolytic activity in vitro and in vivo and reliably induces EGFP expression in infected tumor cells. Furthermore, EGFP expression in intraperitoneal tumors can be visualized laparoscopically, allowing detection and localization of viral gene therapy.

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Improving diagnostic staging laparoscopy using intraperitoneal lavage of [delta ]-aminolevulinic acid (ALA) for laparoscopic fluorescence diagnosis

Cited by 11 publications

References 0 publications

Fluorescence detection of small gastrointestinal tumours: principles, technique, first clinical experience

Fluorescence detection of small gastrointestinal tumours: principles, technique, first clinical experience

Protoporphyrin IX fluorescence photobleaching is a useful tool to predict the response of rat ovarian cancer following hexaminolevulinate photodynamic therapy

Oncolytic Herpes Simplex Virus-1 Mutant Expressing Green Fluorescent Protein Can Detect and Treat Peritoneal Cancer

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