Photodynamic Therapy in Oncology Photodynamic therapy is also called phototherapy, photochemotherapy, FTD. This method kills cancer cells using a drug called a photosensitizer, which increases the sensitivity of cells to laser light. FTD - a fairly new procedure, approved for use in 90-ies.

Indications for photodynamic therapy:

  • Treatment of tumors located at certain organs mucosa.
  • Removal of blocking caused tumors in the esophagus or in the lungs.

Photodynamic therapy is usually carried out in several stages:

  1. Enter the photosensitizer that is absorbed by all the cells in the body, but remains within the malignant longer than in healthy people.
  2. After a certain time, the cancer cells are exposed to laser light of low intensity. The photosensitizer absorbs light, triggering a chemical reaction that destroys the abnormal cells without damaging healthy.

Before photodynamic therapy in Israel carried out a series of tests, the selection of which is due to the area being treated. Procedures may be needed, or similar endoscopic surgical standard. Photosensitizers make the skin and eyes sensitive to strong internal and external light for 4-6 weeks or more, and therefore requires certain precautions.

Photodynamic therapy may be combined with other cancer treatments - surgery, chemotherapyor radiation. It happens that the tumor resumed its growth, so the procedure can be repeated.

FTD advantage in that it does not seriously damage the healthy tissue. There are a number of adverse effects, but the degree of their manifestation is quite mild. Some people have nausea and a metallic taste in your mouth on the day of administration.

The principles of photodynamic therapy in oncology

PDT is based on finding chemicals that destroy cells under the influence of a particular type of light. This method destroys the malignant cells by means of laser light and the drug - photosensitizer sensitizing cells to light.

Also, doctors believe that PDT is effective in reducing tumor volume. A photosensitizing drug may damage the vascular tumors, stop the supply of nutrients. In addition, photodynamic therapy can stimulate the immune system to attack cancer cells.

For carrying out this treatment requires light, the photosensitizer and oxygen. The procedure is carried out in two stages:

  • The patient is given a drug that is absorbed by all the cells in the body, but is retained in the pathological. After a while the drug is concentrated only in cancer cells, it is removed from the most healthy, except liver and skin.
  • Cells were exposed to laser light of low intensity, which sets in motion the photosensitizer. The light causes the drug to enter into a chemical reaction with oxygen. Kills cancer cells in tissues that are affected by the laser without damaging healthy. Laser exposure times depend on the type and size of the treated area.

Selection of photosensitizer and light source driven by a zone which is to be treated. Increased sensitivity in the patient persists for - 4 - 6 weeks or longer.

The indications for photodynamic therapy in Israel

This is a fairly new method of treatment of cancer, which combines the photosensitizing chemical and laser light. Since light can not pass through more than a few millimeters of tissue - about 1 cm, FTD is mainly used to treat areas of the skin and directly below the skin or mucosa of some internal organs - in the area of ​​head and neck, esophagus, and bronchi.

Sometimes the cancer causes blockage in the esophagus or lung. Photodynamic therapy is used to combat these problems, or to relieve symptoms - eliminate difficulties in swallowing or breathing.

Currently, the method of photodynamic therapy in oncology is used to treat certain types of cancer and stages.

Malignant tumors of the esophagus.

  1. To destroy or reduce the spread of the tumor within the body, causing blockage.
  2. PDT was recently approved for the treatment of Barrett's esophagus in people who may not be candidates for esophagectomy surgery. Barrett's esophagus is a precancerous condition, which develops in the mucosa of the body for long-acid reflux or heartburn.
  3. Photodynamic therapy is also used in malignant esophageal tumors in the initial stages to ensure a full recovery.

Lungs' cancer

  1. For FTD treated at a very early stage endobronchial non-small cell lung cancer, with superficial tumors that develop in the lining of the bronchial tubes with a minimum spread ( "carcinoma in situ" and microinvasive tumors). Photodynamic therapy is used if the patient does not give consent to normal operation, or have a contraindication to surgery (tumors in both lungs; you can not use general anesthesia, the disease recurs after previous surgery).
  2. PDT is performed in order to facilitate disease symptoms caused by the blocking of non-small cell lung cancer.

This procedure is also carried out in conjunction with other treatments. There arises the need, carried out repeated PDT.

Bladder Cancer

Sometimes a method of photodynamic therapy is used in the surface, transitional cell bladder cancer - papillary, resistant to standard treatment.

Photodynamic therapy in skin cancer

This method is used to treat certain types of non-melanoma skin cancer - basal cell carcinoma, Bowen's disease and actinic keratosis.

FTD also applies when a large volume of surgical intervention. The procedure is performed mainly for large tumors, not deep-seated, or where there are multiple cancers in one area.

The patient is prescribed a cream containing the photosensitizing drug. They cover the tumor and located next to the field. Sometimes prescribe pills or injections. Some time later, the treated area direct light for 45 minutes. It destroys the cells that have absorbed drug.

Contraindications to PDT for skin cancer are basal cell carcinoma, or deeply located squamous cell skin cancer, because the light can not penetrate deep enough into the cover.

Forms PDT

This method uses a laser or other light sources with a photosensitizer. The choice of the drug due to type of cancer and the overall situation of the disease. There are various types of drugs, each of which is activated by light of a certain wavelength.

Photosensitizers for photodynamic therapy in Israeli hospitals:

  • Photofrin - the most commonly used drug that activates a low-intensity laser light.
  • Aminolevulinic acid - is applied directly to the skin. It is also used to treat precancerous skin condition - actinic keratosis. Most often activated by fluorescent lighting, but sometimes uses a laser. It may be cited as the tsitolyuminestsentnaya therapy or treatment with blue light.

How is the photodynamic therapy of cancer in Israel?

treatment procedure involves several stages, let us consider each of them separately.

Training

In some cases, treatment is done on an outpatient basis, but may require hospitalization, as long as the patient does not recover enough to go home. It depends on the area of ​​impact and overall health.

The preparation process due zone which will be subjected treatment. In some cases, it does not require any surgical or endoscopic procedures. Frequently used local anesthetic.

a series of tests carried out before PDT. Their task is to find out whether the patient will be able to move this treatment, and the degree of development of the disease. In addition, the doctor identifies possible contraindications to PDT. Selection of survey depends on the area to be exposed. These may include:

  • Physical examination.
  • medical imaging tests to determine the size and location of the tumor in order to accurately direct the laser to the pathological zone.

The patient signs a consent form for carrying out the procedure.

If the treatment is performed in the esophagus, for 4-6 hours, you must stop eating and drink, except water.

How long lasts FTD?

The procedure involves two steps. The patient was given a photosensitizer. Various photosensitizing drugs often Photofrin. The drug is administered intravenously or is applied to the skin at applique actinic keratosis. It is absorbed by all cells in the body, staying longer in the pathological. The waiting time depends on the medicament used - from several hours to 3 days.

After 24-72 hours the cancer cells are exposed to low-intensity laser light that activates the photosensitizer. Less waiting time required for the treatment of the skin.

Photodynamic therapy treatment in Israel

FTD procedure performed in a hospital or in a special unit operating depends on the area being treated. Before the start of the anesthetic may be given.

After the photosensitizer has been introduced into the body is absorbed on malignant tumor affected by the laser. By this time the drug is derived from healthy cells and is only affected.

Applicable fiber laser aiming beam through a very thin, flexible, transparent thread, intended to act on a tumor.

The photosensitizer is activated by light, causing a chemical reaction that destroys cancer cells while not impacting on the majority of healthy cells.

If the tumor is located, inside the body uses a narrow, flexible endoscope (instrument with light and lenses and used for purposes of examination and treatment).

When the diagnosis of cancer, head and neck endoscope is introduced through the nose or throat to conduct treatment.

When lung cancer with the use of a local anesthetic or general anesthesia is performed bronchoscopy. PDT reduces swelling by damage to blood vessels which supply it. The researchers believe that this method is able to activate the immune system to fight with cancer. After the procedure, the patient remains in the hospital for the night. After 48 hours, another bronchoscopy is performed to remove damaged tissue from the tumor. This procedure is called debridement.

When the diagnosis of actinic keratosis, a special blue light.

Part of the treatment, when light exposure is performed, is carried out under local or general anesthesia.

How many hours lasts procedure FTD?

Immediately light exposure lasts from 5 to 45 minutes, depending on the size and type of area to be treated.

Recovery after photodynamic therapy in Israel

How quickly will pass rehabilitation, it depends on a number of components:

  • localization of the area of ​​influence;
  • the type of anesthetic;
  • general state of health of the person;
  • how easily the patient was able to move the treatment procedure.

In general, you can cancel a number of points:

  • Doctors carefully monitor the patient's condition.
  • The duration of recovery is largely due to the impact area.
  • Usually it takes a short time for the rehabilitation and hospitalization.

Photofrin increases the sensitivity of the skin and eyes to strong inner and outer light for a period of 4 to 6 weeks or more after treatment. Therefore, patients are advised to avoid exposure to direct sunlight and stay in bright light indoors, taking timely precautions. New photosensitizers, such as 5-aminolevulinic acid (ALA), provide enhanced sensitivity for a much shorter time - several days.

Subsequent visits to the doctor are needed to:

  • check for photosensitivity reactions;
  • watch the growth of tumors arising in connection with this problem;
  • if the disease resumes its development, may re-FTD.

The consequences of PDT

Side effects may occur with any type of treatment. Although photodynamic therapy has some unwanted effects, they are less severe than with other treatments. They depend mainly on:

  • from the area of ​​the body, which is subjected to treatment;
  • type photosensitizing agent;
  • sensitivity level after treatment.

Side effects may occur at any period of time during the treatment and after it.

Sensitivity to light

Photosensitivity eyes and the skin is observed during the month - one and a half or more. The duration of the unwanted consequences is specific to each person, the preparation used caused views. Subdued light, eg, light from the TV may help mitigate the reaction. Sam reaction only takes a few minutes, so it is important to protect at this time of the eyes and skin from exposure.

Precautionary measures:

  • Avoid direct sunlight or bright light to prevent adverse reactions for at least 30 days.
  • Not use curtains or blinds on the windows in direct sunlight.
  • During his stay in the street you need to cover the maximum area of ​​the body, even on cloudy days and while driving. Wear protective clothing - wide-brimmed hats, gloves, sweaters with long sleeves, pants, socks, shoes and sunglasses. It should look at the clothes in bright light in order to ascertain that the rays do not penetrate through it. You should use sunscreen, but do not rely solely on it. It is necessary to limit the time to stay outdoors, especially between 11 am and 4 o'clock in the afternoon, when the sun's rays are particularly strong.
  • You must use a hair dryer on a low heat setting to avoid scalp burns. It is not necessary to use a hair dryer-type helmet, which is used in beauty salons.
  • The doctor will advise how to check the skin for sensitivity. This is done typically after about 30 days after the start of the photosensitizing drug.

It is necessary to inform the doctor if there are blisters, redness or swelling.

Pain

Analgesics are used if necessary. If pain persists, consult a specialist.

swelling

Swelling may occur, their appearance depends on the treatment area. They can cause problems such as chest pain and abdominal pain, shortness of breath. Such drugs as corticosteroids, anti-inflammatory, edema-reducing effect of reducing the immune system to the presence of foreign substances can be used.

Be sure to inform the doctor about the pain in the chest or abdominal pain, the appearance of shortness of breath.

The consequences of PDT in the treatment of esophagus

During the first 4-6 hours after the procedure, you can not eat or drink anything. The patient first enters on a soft food and then the usual. A nutritionist will give specific recommendations.

The throat pain can be observed, taking painkillers for a few days will facilitate the state.

FTD esophagus can cause the following symptoms:

  • nausea;
  • vomiting;
  • fever;
  • difficulty swallowing;
  • infection.

To eliminate the nausea, vomiting, infections, medications are used. You must notify the physician of the continuing and increasing difficulties with swallowing.

Perhaps a little bleeding in the esophagus, which gives a metallic taste in the mouth. Condition will improve in a few days.

Very rare undesirable consequence is damage to or perforation of the esophagus. It requires surgery to correct the defect.

If during the first three days of the following symptoms, you should notify your doctor immediately:

  • Difficulty breathing.
  • Severe chest pain.
  • Vomit with blood.

Several days later, the doctor will need to remove dead cells. This is done using an endoscope.

If the cancer comes back again, the possibility of re-FTD, or your doctor may suggest other treatments.

The consequences of photodynamic therapy in the treatment of lung cancer

FTD lungs can cause:

  • fever;
  • infections (bronchitis, pneumonia)

Last eliminate side effects by using drugs. On the shortness of breath, fever, cough or permanent it is necessary to inform the specialist.

After the endoscopic procedure and the effects of solar radiation can be observed a certain discomfort or pain in the area of ​​treatment. The doctor will prescribe painkillers. Also need to avoid strenuous activity for several days. In addition, possible pain during swallowing. With cough may extend a small amount of blood and mucus.

The consequences of photodynamic therapy of bladder

FTD bladder capable of provoking;

  • Body irritation;
  • pain during urination.

At occurrence of difficulties with urination or blood in the urine should inform your doctor.

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