Phototherapy of tumors

Abstract

Lasers provide a means of delivering high intensity light to small well-defined areas under precise control. The biological response depends on the light wavelength and intensity and the absorption characteristics of the target organ. The most important effects are thermal and include tissue vaporization, necrosis with later sloughing, and necrosis stimulating an inflammatory response which may lead to local fibrosis. The Carbon Dioxide Laser can cut or vaporize neoplastic tissue in areas accessible to rigid endoscopy, but the more penetrating Nd YAG and Argon laser beams can be transmitted via flexible fibers and have greater potential for destroying larger tumors without unacceptable damage to surrounding areas. More selective tumor phototherapy is possible in some organs by sensitization with HpD (hematoporphyrin derivative) and subsequent treatment with a dye laser. This effect is non-thermal and depends on the production of singlet oxygen by activated HpD. The precision possible for local treatment of solid tumors with lasers is greater than for almost any other techniques, but careful quantitative studies are needed to establish the appropriate treatment parameters in any particular situation.

Résumé

C'est seulement en 1960, 3 ans après la première publication concernant l'action du laser que les communications à propos de son emploi pour traiter les tumeurs apparurent. McGuff et ses collaborateurs rapportèrent d'abord la guérison par photothérapie (laser Rubis) de mélanomes transplantés sur la joue des hamsters. Minton et ses collaborateurs publièrent ensuite des cas de destruction de mélanomes et de sarcomes transplantés chez la souris par le laser Néodymium et démontrèrent que la destruction du processus tumoral était plus complète quand les lasers à hautes énergies étaient employés. Les premiers essais cliniques parurent prometteurs, puis après une période d'enthousiasme un certain scepticisme se fit jour. Ce phénomène était dû d'une part à la difficulté d'employer des lasers adequats, d'autre part à la difficulté d'atteindre par le rayonnement les parties du corps à traiter. L'amélioration ultérieure de l'appareillage devait entraîner le développement de la photothérapie tumorale. Les nouveaux lasers en effet grâce à leur souplesse permettent de transmettre un rayonnement intense et étroit à la zone à atteindre (grâce aux fibres en quartz, aux fibres en verre flexible) ou aux appareils articulés qui s'opposent aux appareils anciens rigides.

Cet article a pour but de définir les interactions entre le rayonnement des lasers et les différents systèmes biologiques ainsi que de discuter les indications de la photothérapie tumorale par rapport aux autres méthodes de traitement des tumeurs.

Resumen

El efecto biológico de la energía del laser depende de la intensidad de la luz, de las características de absorción de los tejidos, de la longitud de la onda y de la respuesta biológica a la energía absorbida. Los tejidos neoplásicos y los traumatizados poseen afinidad por las porfirinas. La captación selectiva por parte de los tejidos malignos puede ser incrementada mediante la utilización de un derivado de la hematoporfirina conocido como el derivado hematoporfirínico (HpD). El mecanismo del efecto citotóxico se basa en la activación del HpD por el haz de laser; el HpD activado convierte el oxígeno, cuyos electrones en su último orbital se encuentran en forma de tripleta, para convertirlos en oxígeno en donde, en sus últimos orbitales se encuentran sueltos o en forma de singleta. El oxiǵeno en forma de singleta es citotóxico para la membrana celular. El efecto es de tipo local, porque el oxígeno en forma de singleta posee una vida media corta y no puede moverse por más de una distancia correspondiente a unos pocos diámetros celulares a partir del lugar de su producción. El potencial de destrucción es máximo en los neoplasmas que tienen elevada afinidad por el HpD, en contraste con los tejidos normales de alrededor. Los estudios experimentales utilizando esta tecnología han demostrado un futuro promisorio, y esta modalidad terapéutica está siendo evaluada clínicamente.

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Correspondence to S. G. Bown M.D..

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Bown, S.G. Phototherapy of tumors. World J. Surg. 7, 700–709 (1983). https://doi.org/10.1007/BF01655209

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Keywords

  • High Intensity Light
  • Hematoporphyrin
  • Carbon Dioxide Laser
  • Rigid Endoscopy
  • Selective Tumor