Phototheranostics of Cervical Neoplasms with Chlorin e6 Photosensitizer

Abstract

(1) Purpose: Improving the treatment effectiveness of intraepithelial neoplasia of the cervix associated with human papillomavirus infection, based on the application of the method of photodynamic therapy with simultaneous laser excitation of fluorescence to clarify the boundaries of cervical neoplasms. (2) Methods: Examination and treatment of 52 patients aged 22 to 53 years with morphologically and cytologically confirmed mild to severe intraepithelial cervix neoplasia, preinvasive, micro-invasive, and squamous cell cervix carcinoma. All patients were carriers of human papillomavirus infection. The patients underwent photodynamic therapy with simultaneous laser excitation of fluorescence. The combined use of video and spectral fluorescence diagnostics for cervical neoplasms made it possible to control the photodynamic therapy process at all stages of the procedure. Evaluation of the photodynamic therapy of intraepithelial cervical neoplasms was carried out with colposcopic examination, cytological conclusion, and morphological verification of the biopsy material after the photodynamic therapy course. The success of human papillomavirus therapy was assessed based on the results of the polymerase chain reaction. (3) Results. The possibility of simultaneous spectral fluorescence diagnostics and photodynamic therapy using a laser source with a wavelength of 660 nm has been established, making it possible to assess the fluorescence index in real-time and control the photobleaching of photosensitizers in the irradiated area. The treatment of all 52 patients was successful after the first photodynamic therapy procedure. According to the PCR test of the discharge from the cervical canal, the previously identified HPV types were not observed in 48 patients. Previously identified HPV types were absent after repeated PDT in four patients (CIN III (n = 2), CIS (n = 2)). In 80.8% of patients, regression of the lesion was noted. (4) Conclusions. The high efficiency of photodynamic therapy with intravenous photosensitizer administration of chlorin e6 has been demonstrated both in relation to eradication therapy of human papillomavirus and in relation to the treatment of intraepithelial lesions of the cervix.

Which cell death modality wins the contest for photodynamic therapy of cancer?

“…Among the most important advantages of PDT is low systemic toxicity because the cytotoxic effect of the PS in the absence of light irradiation is several orders of magnitude lower than in the irradiated cancer tissue. But a current limitation is the mode of light delivery, which is currently restricts treatment to superficial tumors or tumors accessible with an endoscope: non-melanoma skin cancer [ 206 ], retina and ocular malignancies [ 207 ], cancer of the digestive tract [ 208 ], urinary system malignancies [ 209 , 210 ], tracheobronchial malignancies [ 211 ], and cervical cancer [ 212 ]. Also, PDT was shown to be effective in improving patient prognosis when used after surgical resection of glioblastoma [ 213 , 214 ].…”

Analysis of the Results of Severe Intraepithelial Squamous Cell Lesions and Preinvasive Cervical Cancer Phototheranostics in Women of Reproductive Age

“…A targeted biopsy of the affected areas of the cervical mucosa was performed using video fluorescence imaging. A two-channel fluorescent video system was used to perform video fluorescence diagnostics [ 20 ]. The video system provides real-time color imaging over which a fluorescent image is superimposed with a fluorescence display in green ( Figure 1 ), which allows determining the boundaries of neoplasms.…”

“…According to the results of a previous study on the effectiveness of intraepithelial cervical lesions and neoplasia treatment, including preinvasive, microinvasive, and squamous CC associated with HPV infection, based on the use of the phototheranostics method, a high clinical efficacy and safety of this approach was demonstrated [ 20 ]. Considering these data, it seems appropriate to conduct further research on the in-depth study of the possibilities of using phototheranostics in the forecited pathology.…”

Nanotherapeutic Intervention in Photodynamic Therapy for Cancer

“…For instance, concurrent PDT and magnetic resonance imaging of stomach cancer was performed by Huang et al using Ce6-coupled magnetic NPs . Another new nanovehicle preparation of chlorins involves a novel platform known as “upconversion NPs.” This formulation of chlorins has been researched by a few different groups for the purpose of PDT for breast, cervical, and glioma malignancies. , Upconversion is a process that involves the successive absorption of numerous photons, which may then result in the emission of light at wavelengths that are shorter than the excitation wavelength . Typically, the excitation occurs in the infrared range, and the resulting emission occurs in the visible range.…”

“…This formulation of chlorins has been researched by a few different groups for the purpose of PDT for breast, cervical, and glioma malignancies. 87,88 Upconversion is a process that involves the successive absorption of numerous photons, which may then result in the emission of light at wavelengths that are shorter than the excitation wavelength. 89 Typically, the excitation occurs in the infrared range, and the resulting emission occurs in the visible range.…”