Summary It has been proposed that the generation of 102 during photodynamic therapy (PDT) may lead to photochemical depletion of ambient tumour oxygen, thus causing acute hypoxia and limiting treatment effectiveness. We have studied the effects of fluence rate on P02, in the murine RIF tumour during and after PDT using 5 mg kg-' Photofrin and fluence rates of 30, 75 or 150 mW cm-2. Median P02 before PDT ranged from 2.9 to 5.2 mmHg in three treatment groups. Within the first minute of illumination, median tumour P02 decreased with all fluence rates to values between 0.7 and 1.1 mmHg. These effects were rapidly and completely reversible if illumination was interrupted. During prolonged illumination (20-50 J cm-2) P02 recovered at the 30 mW cm-2 fluence rate to a median value of 7.4 mmHg, but remained low at the 150 mW cm-2 fluence rate (median P02 1.7 mmHg). Fluence rate effects were not found after PDT, and at both 30 and 150 mW cm-2 median tumour P02 fell from control levels to 1.0-1.8 mmHg within 1-3 h after treatment conclusion. PDT with 100 J cm-2 at 30 mW cm-2 caused significantly (P= 0.0004) longer median tumour regrowth times than PDT at 150 mW cm-2, indicating that lower fluence rate can improve PDT response. Vascular perfusion studies uncovered significant fluence rate-dependent differences in the responses of the normal and tumour vasculature. These data establish a direct relationship between tumour P02, the fluence rate applied during PDT and treatment outcome. The findings are of immediate clinical relevance.

Photodynamic therapy (PDT), carried out at low fluence rates, may enhance tumor response as well as affect treatment selectivity. We have studied the effects of fluence rate on the response of the murine radiation-induced fibrosarcoma (RIF) to PDT using Photofrin (5 mg/kg). Tumor response was tested over a large range of fluence rates (10-200 mW/cm2) and fluences (25-378 J/cm2). Low fluence rates were more efficient; approximately 60 J/cm2 at 10 mW/cm2 was needed to achieve the same tumor growth delay as approximately 100 J/cm2 at 150 mW/cm2 and approximately 150 J/cm2 at 200 mW/cm2. Despite this increased efficiency, lower fluence rates still required longer treatment times for equivalent anti-tumor effects: 95 min for 57 J/cm2 at 10 mW/cm2 versus 11 min for 100 J/cm2 at 150 mW/cm2. Effects of fluence rate on the PDT toxicity to normal tissue were examined through the response of the murine (C3H) foot to Photofrin PDT. Treatment with conditions that produced equivalent tumor responses, i.e. 57 J/cm2 at 10 mW/cm2 and 100 J/cm2 at 150 mW/cm2, resulted in a more severe foot response at the higher fluence rate (median peak response: 0.9 at 10 mW/cm2, 1.5 at 150 mW/cm2) with more time required for tissue to return to normal (8 days at 10 mW/cm2, at least 30 days at 150 mW/cm2). However, when feet were treated with an equal fluence of 100 J/cm2 at various fluence rates, longer healing times accompanied the lower fluence rate treatments. Overall, this paper demonstrates that lower PDT fluence rates are associated with increased efficiency of tumor response. If this increased efficiency is accounted for by lowering treatment fluence, lower fluence rates also may result in a more favorable normal tissue response to treatment.

Photodynamic therapy (PDT), carried out at low fluence rates, may enhance tumor response as well as affect treatment selectivity. We have studied the effects of fluence rate on the response of the murine radiation-induced fibrosarcoma (RIF) to PDT using Photofrin (5 mg/kg). Tumor response was tested over a large range of fluence rates (10-200 mW/cm2) and fluences (25-378 J/cm2). Low fluence rates were more efficient; approximately 60 J/cm2 at 10 mW/cm2 was needed to achieve the same tumor growth delay as approximately 100 J/cm2 at 150 mW/cm2 and approximately 150 J/cm2 at 200 mW/cm2. Despite this increased efficiency, lower fluence rates still required longer treatment times for equivalent anti-tumor effects: 95 min for 57 J/cm2 at 10 mW/cm2 versus 11 min for 100 J/cm2 at 150 mW/cm2. Effects of fluence rate on the PDT toxicity to normal tissue were examined through the response of the murine (C3H) foot to Photofrin PDT. Treatment with conditions that produced equivalent tumor responses, i.e. 57 J/cm2 at 10 mW/cm2 and 100 J/cm2 at 150 mW/cm2, resulted in a more severe foot response at the higher fluence rate (median peak response: 0.9 at 10 mW/cm2, 1.5 at 150 mW/cm2) with more time required for tissue to return to normal (8 days at 10 mW/cm2, at least 30 days at 150 mW/cm2). However, when feet were treated with an equal fluence of 100 J/cm2 at various fluence rates, longer healing times accompanied the lower fluence rate treatments. Overall, this paper demonstrates that lower PDT fluence rates are associated with increased efficiency of tumor response. If this increased efficiency is accounted for by lowering treatment fluence, lower fluence rates also may result in a more favorable normal tissue response to treatment.

Abstract— The therapeutic effect of photodynamic therapy (PDT: photodynamic sensitizer + light) is partly due to vascular damage. This report describes a new vascular photodamage assay for PDT agents and a validation of the assay. The method described here quantitates changes in tissue blood perfusion based on the relative amount of injected fluorescein dye in treated and untreated tissues. A specially designed fluorometer uses chopped monochromatic light from an argon laser as a source for exciting fluorescein fluorescence. The fluorescent light emitted from the tissue is collected by a six element fiberoptic array, filtered and delivered to a photodiode detector coupled to a phase‐locked amplifier for conversion to a voltage signal for recording. This arrangement permits a rather simple, inexpensive construction and allows for the simultaneous use of the argon laser by other investigators. The routine assay for characterizing a specific photosensitizer at a standard dose consists of the sequential allocation of eight mice to a set of different light doses designed to span the dose‐response range of fluorescein fluorescence exclusion (measured 8–10 min after fluorescein injection). The assay validation experiment used an anionic photosensitizer, 2‐[l‐hexyloxyethyl]‐2‐devinyl pyropheophorbide‐a at a dose of 0.4 μmol/kg. The parameter estimates (n = 34 mice) from fitting the standard Hill dose‐response model to the data were: median fluorescence exclusion light dose FE50= 275 ± 8.3 J/cm2 and Hill sigmoidicity parameter m =−3.66 ± 0.28. Subsets of the full data set randomly selected to simulate a standard eight mice experiment yielded similar parameter estimates. The new assay provides reliable estimates of PDT vascular damage with a frugal sequential experimental design.

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