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Photodynamic Therapy of Malignant Brain Tumours

Published online by Cambridge University Press:  18 September 2015

Paul J. Muller  and
Brian C. Wilson
Paul J. Muller*
Affiliation:
Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto
Brian C. Wilson
Affiliation:
Department of Medical Physics, Ontario Cancer Foundation, and McMaster University, Hamilton
*
Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, 38 Shuter Street, Toronto, Ontario, Canada M5B 1A6
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Abstract:

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Fifty patients with malignant supratentorial tumours were treated with intra-operative photodynamic therapy (PDT); in 33 cases the tumour was recurrent. In 45 patients the tumour was a cerebral glioma and in 5 cases a solitary cerebral metastasis. All patients received a porphyrin photosensitizer 18-24 hours pre-operatively. Photoillumination was carried out at 630 nm to a tumour cavity created by radical tumour resection and/or tumour cyst drainage. The light energy density ranged from 8 to 175 J/cm2. In 8 patients additional interstitial light was administered. The operative mortality was 4%. Follow up has ranged from 1 to 30 months. The median survival for the 45 primary malignant tumours was 8.6 months with a 1 and 2 year actuarial survival rate of 32% and 18%, respectively. In 12 patients a complete or near complete CT scan response was identified post PDT. These patients tended to have a tumour geometry (eg. cystic) that allowed complete or near complete light distribution to the tumour. The median survival for this group was 17.1 months with a 1 and 2 year actuarial survival of 62% and 38%, respectively. In the 33 cases who did not have a complete response the median survival was 6.5 months with a 1 and 2 year actuarial survival of 22% and 11%, respectively. Photodynamic therapy of malignant brain tumours can be carried out with acceptable risk. Good responses appear to be related to adequate light delivery to the tumour.

Résumé:

RÉSUMÉ:

Cinquante patients atteints de tumeurs malignes sus-tentorielles ont été traités par thérapie photodynamique (TPD) peropératoire; dans 33 cas, il s'agissait d'une récidive. Chez 45 patients, la tumeur était un gliome cérébral et chez 5 cas, une métastase cérébrale unique. Tous les patients ont reçu une porphyrine photosensibilisatrice 18 a 24 heures avant l'opération. On a procédé à la photoillumination à 630 nm au niveau d'une cavité tumorale créée par résection radicale de la tumeur et/ou par drainage d'une tumeur kystique. La densité de l'énergie lumineuse variait de 8 à 175 J/cm2. Chez 8 patients on a administré de la lumière interstitielle additionnelle. La mortalité opératoire a été de 4%. Le suivi de ces patients varie de 1 à 30 mois. La survie médiane pour les 45 tumeurs malignes primitives était de 8.6 mois avec un taux de survie actuariel à 1 et 2 ans de 32% et 18% respectivement. Chez 12 patients, une réponse complète ou presque complète a été identifée au CT scan post PDT. Ces patients avaient en général une tumeur dont la géométrie (ex. kystique) permettait une distribution complète ou presque complète de la lunière à la tumeur. La survie médiane de ce groupe était de 17.1 mois avec un taux de survie actuariel à 1 et 2 ans de 62% et de 38% respectivement. Chez les 33 cas qui n'ont pas eu une réponse complète, la survie médiane était de 6.5 mois avec un taux de survie actuariel à 1 et 2 ans de 22% et 11% respectivement. La thérapie photodynamique des tumeurs malignes du cerveau peut être effectuée avec un niveau de risque acceptable. Les bonnes réponses semblent être liées à une distribution adéquate de la lumière à la tumeur.

Type
Neurosurgical Symposium - William S. Keith, Visiting Professorship in Neurosurgery
Information
Canadian Journal of Neurological Sciences , Volume 17 , Issue 2 , May 1990 , pp. 193 - 198
Copyright
Copyright © Canadian Neurological Sciences Federation 1990

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