Leroy Henri-Arthur, Baert Gregory, Guerin Laura, Delhem Nadira, Mordon Serge, Reyns Nicolas, Vignion-Dewalle Anne-Sophie
Department of Neurosurgery, CHU Lille, F-59000 Lille, France.
INSERM, CHU-Lille, U1189-ONCOTHAI-Assisted Laser Therapy and Immunotherapy for Oncology, Univ-Lille, F-59000 Lille, France.
Cancers (Basel). 2021 Nov 17;13(22):5754. doi: 10.3390/cancers13225754.
Glioblastomas (GBMs) are high-grade malignancies with a poor prognosis. The current standard of care for GBM is maximal surgical resection followed by radiotherapy and chemotherapy. Despite all these treatments, the overall survival is still limited, with a median of 15 months. For patients harboring inoperable GBM, due to the anatomical location of the tumor or poor general condition of the patient, the life expectancy is even worse. The challenge of managing GBM is therefore to improve the local control especially for non-surgical patients. Interstitial photodynamic therapy (iPDT) is a minimally invasive treatment relying on the interaction of light, a photosensitizer and oxygen. In the case of brain tumors, iPDT consists of introducing one or several optical fibers in the tumor area, without large craniotomy, to illuminate the photosensitized tumor cells. It induces necrosis and/or apoptosis of the tumor cells, and it can destruct the tumor vasculature and produces an acute inflammatory response that attracts leukocytes. Interstitial PDT has already been applied in the treatment of brain tumors with very promising results. However, no standardized procedure has emerged from previous studies. Herein, we propose a standardized and reproducible workflow for the clinical application of iPDT to GBM. This workflow, which involves intraoperative imaging, a dedicated treatment planning system (TPS) and robotic assistance for the implantation of stereotactic optical fibers, represents a key step in the deployment of iPDT for the treatment of GBM. This end-to-end procedure has been validated on a phantom in real operating room conditions. The thorough description of a fully integrated iPDT workflow is an essential step forward to a clinical trial to evaluate iPDT in the treatment of GBM.
胶质母细胞瘤（GBM）是预后较差的高级别恶性肿瘤。目前GBM的标准治疗方案是最大限度的手术切除，随后进行放疗和化疗。尽管采取了所有这些治疗措施，总体生存率仍然有限，中位生存期为15个月。对于患有无法手术切除的GBM的患者，由于肿瘤的解剖位置或患者的一般状况较差，预期寿命甚至更短。因此，管理GBM的挑战在于改善局部控制，特别是对于非手术患者。间质光动力疗法（iPDT）是一种微创治疗方法，依赖于光、光敏剂和氧气之间的相互作用。对于脑肿瘤，iPDT包括在不进行大的开颅手术的情况下，将一根或几根光纤引入肿瘤区域，以照射光敏化的肿瘤细胞。它可诱导肿瘤细胞坏死和/或凋亡，并可破坏肿瘤血管，引发急性炎症反应，吸引白细胞。间质光动力疗法已经应用于脑肿瘤的治疗，取得了非常有前景的结果。然而，以前的研究尚未形成标准化程序。在此，我们提出了一种用于iPDT临床应用于GBM的标准化且可重复的工作流程。该工作流程包括术中成像、专用治疗计划系统（TPS）以及用于立体定向光纤植入的机器人辅助，是将iPDT用于GBM治疗的关键一步。此端到端程序已在真实手术室条件下的模型上得到验证。全面描述一个完全集成的iPDT工作流程是迈向评估iPDT治疗GBM的临床试验的重要一步。
