Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Photodiagnosis Photodyn Ther. 2010 Jun;7(2):76-85. doi: 10.1016/j.pdpdt.2010.02.002. Epub 2010 Mar 20.
GBM is the comment glioma. GBM-outcome had not changed much over two decades despite leaps in medical technology. Fewer than 25% survive 2 years. There is no jacket that fits all GBMs. This paper reviews the evidence for PDT in GBMs.
Maximum safe resection is supported by level-II evidence. PDT-technology (PDTT) provides means to maximize safe resection. PDTT paints GBM red in contrast to brain because of selective uptake and retention of photosensitizers. Exposure to specific light wave produces cytotoxic singlet oxygen. PDT-APPLICATIONS: (1) Fluorescence image guided biopsy to sample high grade components of what looks like low grade glioma on MRI, 89% sensitive. (2) Fluorescence image guided surgery for maximum safe surgical resection is >84% sensitive, achieves complete resection in >65% and prolongs tumor free survival (1 observational and 2 RCT, p < 0.001). (3) Photodynamic treatment supported by several observational studies with combined total of >1000 patients and 3 RCT used PDT in GBMs. PDT was highly selective, safe, significantly improved good quality survival, and delayed tumor relapse (p < 0.001).
PDT had a very high safety track record, thromboembolism 2%, brain-oedema 1.3%, and skin photosensitivity complications 1-3%.
PDT in GBMs is safe, selective, and sensitive and leads to significant prolongation of good quality survival, delay in tumor relapse and significant reduction of further interventions. It would be impractical, impossible and probably unethical to randomize patients between PDT and placebo, in the same way it would be unethical to carry out a RCT to prove that the parachute saves lives.
GBM 是指胶质母细胞瘤。尽管医学技术取得了飞跃，但在过去的二十年中，GBM 的预后并没有太大改善。不到 25%的患者能存活 2 年。没有一种方法适用于所有 GBM。本文综述了 PDT 在 GBM 中的应用。
最大限度的安全切除得到了 II 级证据的支持。PDT 技术（PDTT）提供了最大限度安全切除的手段。PDTT 使 GBM 在对比脑时呈现红色，这是由于光敏剂的选择性摄取和保留。暴露于特定的光波会产生细胞毒性单线态氧。PDT 应用：（1）荧光图像引导活检，用于对 MRI 上看起来像是低级别胶质瘤的高级别成分进行取样，敏感性为 89%。（2）荧光图像引导手术用于最大限度的安全切除，敏感性>84%，实现完全切除>65%，并延长无肿瘤生存期（1 项观察性研究和 2 项 RCT，p<0.001）。（3）在几项观察性研究中，结合了超过 1000 名患者和 3 项 RCT 的综合数据，PDT 被用于 GBM。PDT 高度选择性、安全，显著提高了良好生存质量，并延迟肿瘤复发（p<0.001）。
PDT 具有非常高的安全性记录，血栓栓塞 2%，脑水肿 1.3%，皮肤光敏性并发症 1-3%。
GBM 中的 PDT 安全、选择性和敏感性，显著延长了良好生存质量，延迟了肿瘤复发，并显著减少了进一步的干预。将 PDT 和安慰剂随机分配给患者，就像进行 RCT 来证明降落伞能救命一样不切实际、不可能，而且可能不道德。
