Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy.
Orthopaedic Pathophysiology and Regenerative Medicine Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy.
Biomed Res Int. 2019 Jul 8;2019:8275935. doi: 10.1155/2019/8275935. eCollection 2019.
Musculoskeletal sarcomas are rare and aggressive human malignancies affecting bones and soft tissues with severe consequences, in terms of both morbidity and mortality. An innovative technique that combines photodynamic surgery (PDS) and therapy (PDT) with acridine orange has been recently suggested, showing promising results. However, due to the low incidence of sarcoma in humans, this procedure has been attempted only in pilot studies and stronger evidence is needed. Naturally occurring tumors in cats are well-established and advantageous models for human cancers. Feline injection-site sarcoma (FISS) shares with human musculoskeletal sarcomas a mesenchymal origin and an aggressive behavior with a high relapse rate. Furthermore, wide surgical excision is not always possible due to the size and site of development. We assessed the feasibility and the effectiveness of PDS and PDT with acridine orange to prevent FISS recurrence by treating a short case series of cats. For PDS, the surgical field was irrigated with an acridine orange solution and exposed to UV light to enlighten the residual tumor tissue, and the resultant fluorescent areas were trimmed. For PDT, before wound closure, the field was again irrigated with acridine orange solution and exposed to visible light to get the antitumoral cytocidal effect. The procedure was easy to perform and well tolerated, we did not observe any major complications, and all the surgical resection margins were free of disease. Finally, at follow-up, all treated patients did not show evidence of tumor recurrence and had a significantly higher event-free survival rate in respect to a control group treated only by surgery. In conclusion, by this study we demonstrated that, in FISS, PDS and PDT with acridine orange may improve local tumor control, granting a better outcome, and we laid the foundation to validate its effectiveness for the treatment of human musculoskeletal sarcomas.
肌肉骨骼肉瘤是一种罕见且侵袭性的人类恶性肿瘤，主要影响骨骼和软组织，具有严重的发病率和死亡率后果。最近提出了一种将光动力手术（PDS）和治疗（PDT）与吖啶橙相结合的创新技术，显示出有希望的结果。然而，由于人类肉瘤的发病率低，该方法仅在试点研究中进行了尝试，因此需要更强的证据。猫身上的自然发生的肿瘤是建立良好的、有利于人类癌症的模型。猫的注射部位肉瘤（FISS）与人类肌肉骨骼肉瘤具有间充质起源和侵袭性行为，复发率高。此外，由于肿瘤的大小和位置，广泛的手术切除并不总是可行的。我们评估了用吖啶橙进行 PDS 和 PDT 预防 FISS 复发的可行性和有效性，对一系列短病例的猫进行了治疗。对于 PDS，用吖啶橙溶液冲洗手术区域，并暴露在紫外线下照亮残留的肿瘤组织，然后切除荧光区域。对于 PDT，在伤口闭合之前，再次用吖啶橙溶液冲洗该区域，并暴露在可见光下，以获得抗肿瘤细胞毒性作用。该程序易于操作且耐受性良好，我们未观察到任何重大并发症，所有手术切除边缘均无疾病。最后，在随访中，所有接受治疗的患者均未显示肿瘤复发的迹象，与仅接受手术治疗的对照组相比，无事件生存率显著提高。总之，通过这项研究，我们证明在 FISS 中，用吖啶橙进行 PDS 和 PDT 可能改善局部肿瘤控制，从而获得更好的结果，并为验证其治疗人类肌肉骨骼肉瘤的有效性奠定了基础。
