Photodynamic therapy for intracranial neoplasms: development of an image-based computer-assisted protocol for photodynamic therapy of intracranial neoplasms.
Photodynamic therapy is being studied as an adjuvant therapy for malignant gliomas. Therapeutic efficacy is based on photosensitizer uptake kinetics and the ability to deliver adequate light doses to an appropriate treatment volume at the optimal time. Our laboratory has developed an image-based, computer-assisted treatment-planning protocol to study the treatment variables leading to optimizing photodynamic therapy for intracranial neoplasms. Fifteen patients with recurrent malignant glial tumors underwent 16 treatments in the developmental phase of the project in which light treatment volume was progressively expanded. Group I (n = 4) received postresection intracavitary photoillumination only, Group II (n = 3) received limited interstitial/intracavitary photoillumination, and Group III (n = 9) received multiple interstitial/intracavitary photoillumination. Between 3 and 18 interstitial fiber probes were placed through optically lucent tumor access catheters. Computed three-dimensional image-based treatment planning provided reproducible data-based tumor volumes, treatment volumes, and stereotactic accuracy for tumor volume resection and interstitial light fiber insertion. Initial observations include: 1) treatment failures occur outside of the effective light treatment volumes; 2) effective light volumes can be expanded safely with multiple stereotactically implanted interstitial light fibers; and 3) optimal treatment involves individualized tailoring of light dose volume and geometry. This protocol allows standardized scientific study of the variables affecting the application of photodynamic therapy for intracranial neoplasms.
Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
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D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D004360:Drug Therapy, Computer-Assisted; D004864:Equipment and Supplies; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009837:Oligodendroglioma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D010778:Photochemotherapy / Q000295:instrumentation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome