Akimoto Jiro, Fukami Shinjiro, Ichikawa Megumi, Mohamed Awad, Kohno Michihiro
Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
Department of Neurosurgery, Kohsei Chuo General Hospital, Tokyo, Japan.
Front Surg. 2019 Mar 21;6:12. doi: 10.3389/fsurg.2019.00012. eCollection 2019.
The aim of this study was to demonstrate the clinical feasibility of intraoperative photodiagnosis (PD) of malignant brain tumor using talaporfin sodium (TPS), which is an agent used in photodynamic therapy (PDT) for cancers. Forty-seven patients diagnosed with malignant gliomas by preoperative imaging (42 patients with gliomas and 5 patients with other brain tumors) received an intravenous injection of TPS at 40 mg/m 24 h before resection. During surgery, these patients were irradiated with diode laser light at 664 nm, and tumor fluorescence was observed. The fluorescence intensity was visually rated on a 3-point rating scale [strong fluorescence, weak fluorescence and no fluorescence]. TPS concentrations in 124 samples from 47 cases were measured by HPLC (High performance liquid chromatography). The fluorescence intensity was confirmed to be weak in all patients with Grade II gliomas and strong in almost all patients with Grade III or IV gliomas, reflecting the histological grade of malignancy. In patients with non-glioma brain tumors except for 1 patient with a metastatic brain tumor, the fluorescence intensity was strong. The mean TPS concentration in tissues was 1.62 μg/g for strong fluorescence areas, 0.67 μg/g for weak fluorescence areas and 0.19 μg/g for no fluorescence areas. Establishment of an appropriate fluorescence observation system enabled fluorescence-guided resection of malignant brain tumors using TPS, and the fluorescence intensity of tumors correlated with the TPS concentrations in tissues. These results suggest that TPS is a useful photosensitizer for both intraoperative fluorescence diagnosis and photodynamic therapy.
本研究的目的是证明使用替拉泊芬钠（TPS）对恶性脑肿瘤进行术中光诊断（PD）的临床可行性，替拉泊芬钠是一种用于癌症光动力疗法（PDT）的药物。47例术前影像学诊断为恶性胶质瘤的患者（42例胶质瘤患者和5例其他脑肿瘤患者）在切除术前24小时接受了40mg/m²的TPS静脉注射。手术过程中，用664nm的二极管激光照射这些患者，并观察肿瘤荧光。荧光强度通过三点评分量表进行视觉评分[强荧光、弱荧光和无荧光]。采用高效液相色谱法（HPLC）测定了47例患者124份样本中的TPS浓度。所有II级胶质瘤患者的荧光强度均为弱，几乎所有III级或IV级胶质瘤患者的荧光强度均为强，反映了恶性组织学分级。在非胶质瘤脑肿瘤患者中，除1例脑转移瘤患者外，荧光强度均为强。强荧光区域组织中的平均TPS浓度为1.62μg/g，弱荧光区域为0.67μg/g，无荧光区域为0.19μg/g。建立合适的荧光观察系统能够使用TPS对恶性脑肿瘤进行荧光引导切除，肿瘤的荧光强度与组织中的TPS浓度相关。这些结果表明，TPS是一种用于术中荧光诊断和光动力治疗的有用光敏剂。
