Photodynamic therapy for polyps in familial adenomatous polyposis—a pilot study

MIkvy, Peter; Messmann, Helmut; Debinski, Henry; Reguła, Jarosław; Conio, Mássimo; MacRobert, Alexander J.; Spigelman, Allan D.; Phillips, R. K. S.; Bown, Stephen G.

doi:10.1016/0959-8049(95)00276-o

Cited by 51 publications

(36 citation statements)

References 24 publications

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“…Only one pilot study has examined this technique in FAP. Of four patients with duodenal disease, two had a reduction in adenoma size 1 month after therapy, but polyp tissue was not eradicated; no long-term follow-up data were presented 38 . The long period of photosensitivity following PDT and the duration of the endoscopic procedure may make it unacceptable to many individuals.…”

Section: Discussionmentioning

confidence: 88%

Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis

Gallagher

Shankar

Groves

et al. 2004

British Journal of Surgery

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Section: Discussionmentioning

confidence: 88%

Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis

Gallagher

Shankar

Groves

et al. 2004

British Journal of Surgery

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“…67 Photodynamic therapy is a method used to destroy the superficial layer of mucosa by light delivered by laser after the administration of photosensitizing agents. 68 Since localized necrosis is limited to within the surface of the mucosa, the risk of perforation is low. Therefore, this method may be effective for treating patients with carpeted polyposis.…”

Section: Treatmentmentioning

confidence: 99%

Gastroduodenal lesions in familial adenomatous polyposis

Kashiwagi

Spigelman

2000

Surg Today

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Prophylactic colectomy is generally recommended for patients with familial adenomatous polyposis (FAP) who are inevitably affected with large bowel cancer. After prophylactic colectomy has been performed, gastrointestinal malignancy is the leading cause of death. Duodenal adenomas are found in patients with FAP and the adenoma-carcinoma sequence exists in the FAP duodenum, suggesting that treatment of duodenal polyps might be beneficial. Several methods of treatment for duodenal lesions in patients with FAP have been reported, but the current treatment options are not ideal. The nonsteroid anti-inflammatory drugs, sulindac and aspirin, are used for chemoprevention, while recently developed cyclooxygenase-2 inhibitors may be of some use in the future. Endoscopic polypectomy has been attempted for duodenal polyps and open surgical polypectomy has proven to be effective for selected patients. Photodynamic therapy and Argon plasma coagulation may be suitable to treat carpeted polyposis. New methods of duodenal resection, such as pancreas-preserving duodenectomy and pylorus-preserving pancreaticoduodenectomy, might be considered for severe duodenal polyposis; however, because prophylactic duodenal surgery has been considered too aggressive, surveillance duodenoscopy is usually performed to detect duodenal cancer at an early stage.

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“…The human duodenum is much thicker than that in the hamster and is likely to be much more resistant to perforation. Two preliminary clinical reports using PDT with Photofrin to treat duodenal and ampullary tumours showed an encouraging response with no perforations (Abulafi et al, 1995;Mlkvy et al, 1995). This suggests that it is likely to be safe to treat lesions in the human pancreas.…”

Section: Discussionmentioning

confidence: 93%

Photodynamic therapy of a transplanted pancreatic cancer model using meta-tetrahydroxyphenylchlorin (mTHPC)

MIkvy

Messman²,

MacRobert³

et al. 1997

Br J Cancer

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Summary Pancreatic cancer is difficult to treat, even for tumours localized to the pancreas. Photodynamic therapy (PDT) is a non-thermal technique for producing localized tissue necrosis with light after prior administration of a photosensitizing drug and it could have a role in the local treatment of these cancers. We studied PDT in a transplanted cancer in the hamster pancreas using the photosensitizer mTHPC (metatetrahydroxyphenylchlorin). Fluorescence microscopy showed maximum levels of mTHPC in normal pancreas 2-4 days after sensitization and in tumour at 4-5 days. For PDT, animals were given 0.1 or 0.3 mg kg-' mTHPC and the tumour was treated at laparotomy 2 or 4 days later with red light (50 J at 650 nm, continuous or fractionated) delivered via a single fibre touching the tumour surface. The maximum zone of tumour necrosis (seen 3 days after PDT) was 8.7 mm in diameter with continuous irradiation, increasing to 12.4 mm with light fractionation (four equal fractions with 3 min between fractions). The main complication was sealed duodenal perforation, seen in 3 of 16 animals, probably due to inadequate shielding of the duodenum from the light. The duodenal problems seen in hamsters are unlikely to cause trouble in the much thicker human duodenum. PDT tumour necrosis in this animal model has now been shown with a range of photosensitizers, but mTHPC is attractive as it is likely to produce the largest volumes of necrosis around each treatment point with short light exposure times. This technique could have a role in the treatment of localized cancers of the pancreas in patients unsuitable for surgery and can now be considered for preliminary clinical trials.

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Photodynamic therapy for polyps in familial adenomatous polyposis—a pilot study

Cited by 51 publications

References 24 publications

Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis

Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis

Gastroduodenal lesions in familial adenomatous polyposis

Photodynamic therapy of a transplanted pancreatic cancer model using meta-tetrahydroxyphenylchlorin (mTHPC)

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