Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India.
Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiodiagnosis, Aligarh, India.
Photodiagnosis Photodyn Ther. 2022 Jun;38:102843. doi: 10.1016/j.pdpdt.2022.102843. Epub 2022 Mar 31.
Morbidity and mortality due to oral cancer in India are exacerbated by a lack of access to effective treatments amongst medically underserved populations. We developed a user-friendly low-cost, portable fibre-coupled LED system for photodynamic therapy (PDT) of early oral lesions, using a smartphone fluorescence imaging device for treatment guidance, and 3D printed fibreoptic attachments for ergonomic intraoral light delivery.
30 patients with TNM buccal mucosal cancer were recruited from the JN Medical College clinics, Aligarh, and rural screening camps. Tumour limits were defined by external ultrasound (US), white light photos and increased tumour fluorescence after oral administration of the photosensitising agent ALA (60 mg/kg, divided doses), monitored by a smartphone fluorescence imaging device. 100 J/cm LED light (635 nm peak) was delivered followed by repeat fluorescence to assess photobleaching. US and biopsy were repeated after 7-17 days. This trial is registered with ClinicalTrials.gov, NCT03638622, and the study has been completed.
There were no significant complications or discomfort. No sedation was required. No residual disease was detected in 22 out of 30 patients who completed the study (26 of 34 lesions, 76% complete tumour response, 50 weeks median follow-up) with up to 7.2 mm depth of necrosis. Treatment failures were attributed to large tumour size and/or inadequate light delivery (documented by limited photobleaching). Moderately differentiated lesions were more responsive than well-differentiated cancers.
This simple and low-cost adaptation of fluorescenceguided PDT is effective for treatment of early-stage malignant oral lesions and may have implications in global health.
由于医疗资源不足的人群无法获得有效治疗，印度口腔癌的发病率和死亡率居高不下。我们开发了一种用户友好、低成本、便携式的光纤耦合 LED 系统，用于早期口腔病变的光动力疗法 (PDT)，使用智能手机荧光成像设备进行治疗指导，并使用 3D 打印光纤附件进行舒适的口腔内光传输。
从阿拉哈巴德 JN 医学院诊所和农村筛查营地招募了 30 名 TNM 颊黏膜癌患者。肿瘤边界由外部超声 (US)、白光照片和口服光敏剂 ALA（60mg/kg，分剂量）后肿瘤荧光增加来定义，由智能手机荧光成像设备监测。100J/cm 的 LED 光（635nm 峰值）输送后重复荧光以评估光漂白。7-17 天后重复 US 和活检。该试验在 ClinicalTrials.gov 注册，NCT03638622，研究已完成。
无明显并发症或不适。不需要镇静。22 名完成研究的患者（34 个病变中的 26 个，76%的完全肿瘤反应，中位随访 50 周）中没有发现残留疾病，深度达 7.2mm。治疗失败归因于肿瘤较大和/或光传输不足（通过有限的光漂白记录）。中分化病变比高分化癌症更有反应。
这种简单且低成本的荧光引导 PDT 方法对治疗早期恶性口腔病变有效，可能对全球健康产生影响。
