Clinical applications of 5-aminolevulinic acid-mediated fluorescence for gastric cancer.
5-aminolevulinic acid (ALA) is a naturally occurring amino acid that is a protoporphyrin IX (PpIX) precursor and a next-generation photosensitive substance. After exogenous administration of ALA, PpIX specifically accumulates in cancer cells owing to the impaired metabolism of ALA to PpIX in mitochondria, which results in a red fluorescence following irradiation with blue light and the formation of singlet oxygen. Fluorescence navigation by photodynamic diagnosis (PDD) using ALA provides good visualization and detection of gastric cancer lesions and is a potentially valuable diagnostic tool for gastric cancer for evaluating both the surgical resection margins and extension of the lesion. Furthermore, PDD using ALA might be used to detect peritoneal metastases during preoperative staging laparoscopy, where it could provide useful information for the selection of a therapeutic approach. Another promising application for this modality is in the evaluation of lymph node metastases. Photodynamic therapy (PDT) using ALA to cause selective damage based on the accumulation of a photosensitizer in malignant tissue is expected to be a non-invasive endoscopic treatment for superficial early gastric cancer. ALA has the potential to be used not only as a diagnostic agent but also as a therapeutic drug, resulting in a new strategy for cancer diagnosis and therapy. Here, we review the current use of PDD and PDT in gastric cancer and evaluate its future potential beyond conventional modalities combined with a light energy upconverter, a light-emitting diode and near-infrared rays as light sources.
Tsutomu Namikawa, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan.
Tsutomu
T
Namikawa
Tsutomu Namikawa, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan.
Tomoaki
T
Yatabe
Tsutomu Namikawa, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan.
Keiji
K
Inoue
Tsutomu Namikawa, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan.
Taro
T
Shuin
Tsutomu Namikawa, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan.
Kazuhiro
K
Hanazaki
D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D005456:Fluorescent Dyes / Q000008:administration & dosage*; D006801:Humans; D010535:Laparoscopy; D008163:Luminescent Measurements; D009367:Neoplasm Staging; D061848:Optical Imaging / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000556:secondary* / Q000628:therapy; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D013274:Stomach Neoplasms / Q000473:pathology* / Q000628:therapy; D014741:Video Recording
D005456:Fluorescent Dyes; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid
5-aminolevulinic acid; Fluorescence imaging; Gastric cancer; Photodynamic diagnosis; Photodynamic therapy