Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Chest. 2019 Sep;156(3):571-578. doi: 10.1016/j.chest.2019.04.010. Epub 2019 Apr 26.
Phototherapy is an alternative treatment for patients with localized non-small cell lung cancer who are unable to undergo surgical resection. However, phototherapy is currently limited to treatment of centrally located lung cancer, with the much larger proportion of peripheral lesions remaining inaccessible. There are also concerns over the accuracy of targeted laser treatment because of the need to exchange visualization and irradiation fibers during therapy, preventing the operator from confirming the final location of the irradiation fiber.
A newly developed parallel-type ultrasmall composite optical fiberscope (Laser-eYe Ultrathin fiberscope [LYU]), which enables simultaneous white-light imaging and phototherapy, was evaluated in preclinical lung cancer models. Three models were used: human lung cancer xenografts (A549) in mice, orthotopic VX2 lung tumors in rabbits, and ex vivo pig lungs into which A549 tumor tissue was transplanted. A multifunctional porphyrin-phospholipid nanoparticle (porphysome) was used as a photosensitizer to evaluate fluorescence-guided photothermal therapy.
The LYU's 0.97 mm diameter and hydrophilic coating allowed easy passage through the working channel of all types of bronchoscopes and controlled guidance of the LYU tip in any desired direction. The LYU could visualize the peripheral bronchus and porphysome-laden peripheral tumors. The LYU could also perform photothermal therapy with simultaneous imaging.
The LYU enables simultaneous imaging and phototherapy that allows accurate irradiation of peripheral lung cancers. This new laser device may enable ultraminimally invasive transbronchial treatment of peripheral lung cancer.
对于无法进行手术切除的局限性非小细胞肺癌患者，光疗是一种替代治疗方法。然而，光疗目前仅限于治疗中央型肺癌，而更大比例的周围病变仍然无法治疗。由于在治疗过程中需要交换可视化和照射光纤，因此无法确认照射光纤的最终位置，这也使得人们对靶向激光治疗的准确性产生了担忧。
一种新开发的平行型超小型复合光学纤维镜（Laser-eYe Ultrathin fiberscope [LYU]），可同时进行白光成像和光疗，在肺癌临床前模型中进行了评估。使用了三种模型：小鼠中的人肺癌异种移植物（A549）、兔的原位 VX2 肺肿瘤和移植了 A549 肿瘤组织的离体猪肺。多功能卟啉-磷脂纳米颗粒（porphysome）被用作光敏剂，以评估荧光引导光热治疗。
LYU 的 0.97 毫米直径和亲水涂层使其能够轻松通过各种支气管镜的工作通道，并能够控制 LYU 尖端在任何所需方向上的引导。LYU 可以可视化外周支气管和载有 porphysome 的外周肿瘤。LYU 还可以进行同时成像的光热治疗。
LYU 能够实现同时成像和光疗，从而实现对周围肺癌的精确照射。这种新的激光设备可能使经支气管的超微创治疗周围型肺癌成为可能。
