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Urologiia (Moscow, Russia : 1999) Mar 2023Determining and evaluation of predictors of biochemical recurrence (BCR) is one of the essential aim, which may help to achieve the most effective treatment of prostate...
Determining and evaluation of predictors of biochemical recurrence (BCR) is one of the essential aim, which may help to achieve the most effective treatment of prostate cancer. Obviously, positive surgical margins represent an independent risk factor for BR following radical prostatectomy. The development of methods determining the status of the surgical margin during surgery is an important direction which can upgrade the effectiveness of prostate cancer treatment.Moreoverit is relevant to review modern methods for diagnosing the status of the surgical margin during radical prosta-tectomy. This article presents a systematic review carried out at the Department of Urology and Andrology of Pirogov Russian National Research Medical University. In September 2021, we performed a PubMed/ Web of Science search to include articles published in 1995-2020 evaluating the key words "prostate cancer", "surgical margin", "radical prostatectomy", "biochemical recurrence", "methods for determining the surgical margin". Nowadays the following technologies have been developed and being actively studied: the usage of aminolevulinic acid, optical coherence tomography, optical spectroscopy, confocal laser microscopy, 3D augmented reality, 3D modeling, the study of frozen samples.
Topics: Male; Humans; Prostate; Margins of Excision; Prostatectomy; Prostatic Neoplasms; Prostate-Specific Antigen; Neoplasm Recurrence, Local
PubMed: 37401692
DOI: No ID Found -
Photodiagnosis and Photodynamic Therapy Sep 2023To systematically review the efficacy of photodynamic therapy (PDT) in the treatment of cutaneous leishmaniasis (CL). (Review)
Review
OBJECTIVE
To systematically review the efficacy of photodynamic therapy (PDT) in the treatment of cutaneous leishmaniasis (CL).
METHODS
PubMed, Embase and Cochrane Library databases were searched for articles published by November 16, 2022, with no time restrictions. 'Cutaneous leishmaniasis' and 'photodynamic therapy' were searched using predefined search strings.
INCLUSION CRITERIA
(i) Randomized control trials; (ii) controlled clinical trials; (iii) case series; (iv) case reports; (v) participants were humans; (vi) clinical diagnosis was CL; (vii) treatment method used was PDT; and (viii) articles published in English.
RESULTS
In total, 303 articles were identified, including 14 papers meeting the criteria. The number of patients in each study ranged from 1 to 60 and the age ranged from 1 to 82 years. Aminolevulinic acid and methyl aminolevulinate were used as photosensitizers. Red light and sunlight were used as light sources. All reported satisfactory clinical effects. Side effects of treatment included burning sensation, pain and pigmentation after treatment. However, they were tolerable and temporary. The follow-up time ranged between 9 weeks and 24 months. A total of two patients recurred, but one did not recur after another round of PDT during the follow-up period.
CONCLUSIONS
The present study suggests that PDT is a safe and effective method for the treatment of CL, with tolerable side effects and good efficacy. As an alternative treatment method of CL, PDT has great potential. However, to verify the efficacy and specific mechanism of PDT for the optimal treatment strategy of CL, further research with larger sample sizes and longer follow-up times are needed.
Topics: Humans; Infant; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Photosensitizing Agents; Photochemotherapy; Aminolevulinic Acid; Leishmaniasis, Cutaneous; Randomized Controlled Trials as Topic
PubMed: 37245683
DOI: 10.1016/j.pdpdt.2023.103627 -
Brain Sciences Jan 2023Glioblastoma multiforme (GBM) represents the most common and aggressive central nervous system tumor associated with a poor prognosis. The aim of this study was to... (Review)
Review
Glioblastoma multiforme (GBM) represents the most common and aggressive central nervous system tumor associated with a poor prognosis. The aim of this study was to depict the role of intraoperative imaging techniques in GBM surgery and how they can ensure the maximal extent of resection (EOR) while preserving the functional outcome. The authors conducted a systematic review following PRISMA guidelines on the PubMed/Medline and Scopus databases. A total of 1747 articles were identified for screening. Studies focusing on GBM-affected patients, and evaluations of EOR and functional outcomes with the aid of advanced image-guided techniques were included. The resulting studies were assessed for methodological quality using the Risk of Bias in Systematic Review tool. Open Science Framework registration DOI 10.17605/OSF.IO/3FDP9. Eighteen studies were eligible for this systematic review. Among the selected studies, eight analyzed Sodium Fluorescein, three analyzed 5-aminolevulinic acid, two evaluated IoMRI imaging, two evaluated IoUS, and three evaluated multiple intraoperative imaging techniques. A total of 1312 patients were assessed. Gross Total Resection was achieved in the 78.6% of the cases. Follow-up time ranged from 1 to 52 months. All studies assessed the functional outcome based on the Karnofsky Performance Status scale, while one used the Neurologic Assessment in Neuro-Oncology score. In 77.7% of the cases, the functional outcome improved or was stable over the pre-operative assessment. Combining multiple intraoperative imaging techniques could provide better results in GBM surgery than a single technique. However, despite good surgical outcomes, patients often present a neurocognitive decline leading to a marked deterioration of the quality of life. Advanced intraoperative image-guided techniques can allow a better understanding of the anatomo-functional relationships between the tumor and the surrounding brain, thus maximizing the EOR while preserving functional outcomes.
PubMed: 36831759
DOI: 10.3390/brainsci13020216 -
Photobiomodulation, Photomedicine, and... Feb 2023The purpose of this study is to evaluate the effectiveness and safety of photodynamic therapy (PDT) in treating superficial fungal infections, and provide reference for... (Meta-Analysis)
Meta-Analysis Review
The purpose of this study is to evaluate the effectiveness and safety of photodynamic therapy (PDT) in treating superficial fungal infections, and provide reference for clinical application. In accordance with Population, Intervention, Comparator, and Outcome (PICO), the research question and keywords were formulated. Records published in English by PubMed, Embase, Cochrane Library, and Web of Science as of November 14, 2022 were retrieved, including the keywords "mycoses," "tinea," "photochemotherapy," etc. Besides, meta-analysis performed by STATA and PROSPERO registration code was CRD42022363448. One thousand four hundred eighty-four records were identified and 18 articles involving 343 patients with superficial fungal infections were enrolled. The overall mycological cure rate of PDT is 55% [95% confidence interval (CI): 0.46-0.65]. The fungal cure rate using methylene blue (MB) as photosensitizer (PS) is 67% (95% CI: 0.55-0.79); using 5-aminolevulinic acid is 34% (95% CI: 0.21-0.47); and using methyl aminolevulinate is 56% (95% CI: 0.33-0.78). The fungal cure rate of moderate-to-severe onychomycosis according to Onychomycosis Severity Index is 60% (95% CI: 0.47-0.73) and that of moderate onychomycosis is 66% (95% CI: 0.56-0.76). It was observed that the treatment parameters did not follow the same standard across studies. The majority of the included studies were moderate to low biased. PDT, particularly using MB as PS, has a certain mycological cure rate and safety at treating superficial mycoses. Due to the insufficient number of studies on PDT in the treatment of superficial fungal infections and the small sample size of some studies, more studies with standardized PDT parameters, large sample size, and long follow-up periods are needed to prove that PDT has the potential to become an alternative to traditional antifungal therapy or to find a better combination between them.
Topics: Humans; Onychomycosis; Photosensitizing Agents; Photochemotherapy; Antifungal Agents; Ultraviolet Therapy
PubMed: 36780576
DOI: 10.1089/photob.2022.0117 -
Frontiers in Medicine 2023Photodynamic therapy (PDT) is increasingly used for the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). However, it is unknown whether...
BACKGROUND
Photodynamic therapy (PDT) is increasingly used for the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). However, it is unknown whether photodynamic therapy is more effective than other commonly used treatment modalities for these cancers.
PURPOSE
The aim of this study was to determine the relative efficacy and safety of PDT compared with placebo or other interventions for the treatment of skin carcinomas.
METHODS
Searches were performed in PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases. We included randomized controlled trials comparing the PDT with other interventions in adults skin BCC or SCC that reported on lesion response, recurrence, cosmetic appearance, or safety outcomes.
RESULTS
Seventeen unique randomized controlled trials, representing 22 study arms from 21 publications were included. The included trials included 2,166 participants, comparing methyl aminolevulinic (MAL) PDT (six studies) or aminolevulinic acid (ALA) PDT (two studies). Comparators included placebo, surgery, hexaminolevulinic (HAL) PDT, erbium: yttrium-aluminum-garnet ablative factional laser (YAG-AFL) PDT, fluorouracil, and imiquimod. There were few studies available for each comparison. Mantel-Haenszel fixed effects risk ratios were calculated for response, recurrence, cosmetic outcomes, and adverse events. MAL-PDT had similar response rates to surgery, ALA-PDT, fluorouracil and imiquimod at 3- and 12 months post-intervention. The rate of recurrence was similar, showing few differences at 12 months, but at later time points (24-60 months), fewer lesions recurred with surgery and imiquimod than with PDT. PDT also caused more adverse events and pain than other interventions. However, PDT treatment was more likely to receive a "good" or "excellent" rating for cosmetic appearance than surgery or cryotherapy.
CONCLUSION
This systematic review and meta-analysis demonstrates that the choice of treatment modality for BCC or SCC is best chosen in the context of the location and size of the lesion, the socioeconomic circumstances of the patient, as well as the patient's preferences. We call for more high quality studies to be done, in order to enable more reliable interpretations of the data.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=368626, identifier CRD42022368626.
PubMed: 36744141
DOI: 10.3389/fmed.2023.1089361 -
Photodiagnosis and Photodynamic Therapy Mar 2023We systematically reviewed the effectiveness of hexaminolevulinic acid (HAL) after traditional light cystoscopy vs. only white light cystoscopy (WLC) on... (Meta-Analysis)
Meta-Analysis Review
Comparison of hexaminolevulinate (HAL) -guided versus white light transurethral resection for NMIBC: A systematic review and meta-analysis of randomized controlled trials.
PURPOSE
We systematically reviewed the effectiveness of hexaminolevulinic acid (HAL) after traditional light cystoscopy vs. only white light cystoscopy (WLC) on nonmuscle-invasive bladder cancer (NMIBC) clinical outcomes.
METHODS
Systematic literature searches of PubMed, Embase, Web of Science, and the Cochrane database and reference lists were performed. A total of 12 randomized controlled trials (RCTs) of HAL fluorescent cystoscopy (FC) and WLC vs. white light cystoscopy alone for the diagnosis of initial or recurrent bladder cancer that reported bladder cancer recurrence, progression, recurrence-free survival (RFS), and other effects were selected for review.
RESULTS
Our results included 2,775 patients identified for analysis and showed that the HAL group had a lower recurrence rate than the white light cystoscopy group with a statistically significant difference (RR=0.77, 95% CI 0.69-0.85. P < 0.05), and this advantage still existed for patients receiving intravesical chemotherapy. There was also a statistically significant difference in favour of fluorescent cystoscopy in recurrence-free survival and progression rate (HR=0.79, 95% CI 0.67-0.92. P < 0.05, RR = 0.63, 95% CI 0.43-0.94. P < 0.05, respectively). The time to first recurrence was not significantly different from that in the WLC group (SMD=0.73, 95% CI, -0.39-1.85. P = 0.2). And the HAL group did not have a significantly reduced residual tumor rate (RR=0.59, 95% CI 0.23-1.51. P = 0.27).
CONCLUSIONS
Fluorescent cystoscopy was associated with a reduced risk of bladder cancer recurrence and reduced progression rate; it also has advantages for RFS. However, there was no significant difference in the rate of residual tumor and the time of first recurrence. More studies are needed to better understand the effects of the photosensitizer used on NMIBC patients.
Topics: Humans; Photosensitizing Agents; Neoplasm, Residual; Neoplasm Recurrence, Local; Photochemotherapy; Randomized Controlled Trials as Topic; Urinary Bladder Neoplasms; Aminolevulinic Acid; Cystoscopy
PubMed: 36462704
DOI: 10.1016/j.pdpdt.2022.103220 -
Journal of Neuro-oncology Dec 20225-aminolevulinic acid (5-ALA) has demonstrated its utility as an intraoperative imaging adjunct during fluorescence guided resection of malignant gliomas. However,... (Review)
Review
PURPOSE
5-aminolevulinic acid (5-ALA) has demonstrated its utility as an intraoperative imaging adjunct during fluorescence guided resection of malignant gliomas. However, literature regarding 5-ALA-guided resection for brain metastases is limited. We conducted a systematic review to evaluate the efficacy of 5-ALA fluorescence for resection of metastatic brain tumors.
METHODS
PubMed was queried for studies involving 5-ALA and brain metastases, and results were screened following PRISMA guidelines. Articles related to 5-ALA and brain metastasis were further assessed based on inclusion and exclusion criteria and results were analyzed for 5-ALA fluorescence rates stratified by tumor primary sites and histological subtypes.
RESULTS
Of 421 identified search results, 10 studies were included and a total of 631 patients analyzed. Of these studies, 60% were retrospective in design. The reported rates of 5-ALA fluorescence in included brain metastases ranged from 27.6 to 86.9%, with variability across and within tumor types. No studies concluded improved operative outcomes or survival outcomes related to 5-ALA use.
CONCLUSIONS
Current studies regarding 5-ALA fluorescence in brain metastases are limited and do not confirm efficacy for improving extent of resection or post-operative survival. Fluorescence is variable across and within tumor types. Further studies are necessary to evaluate whether specific tumors may benefit from 5-ALA FGS or if changes in delivery protocols or fluorescence quantification may affect intraoperative utility.
Topics: Humans; Aminolevulinic Acid; Retrospective Studies; Brain Neoplasms; Glioma; Neuronavigation; Surgery, Computer-Assisted
PubMed: 36370294
DOI: 10.1007/s11060-022-04188-0 -
World Neurosurgery Dec 2022Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms and their management involves tumors resection in most cases. Regarding the surgical procedure, adequate... (Review)
Review
BACKGROUND
Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms and their management involves tumors resection in most cases. Regarding the surgical procedure, adequate identification of tumor boundaries is paramount to achieve an extensive tumor resection. Fluorescence image-guided surgery (FIGS) has become an increasing popular intraoperative technique used in spine neuro-oncology surgery. However, evidence is lacking of their usefulness and their safety in spinal tumors. Therefore, the aim of the present study is to give an update of the existing literature and systematically review all studies that focus on the most-used fluorophores (5 aminolevulinic acid [5-ALA], sodium fluorescein, and indocyanine green [ICG]) in IMSCTs.
METHODS
Using PubMed and Scopus, we performed a systematic review in accordance with the PRISMA protocol and screened all original studies involving humans treated for neurosurgical conditions and studies evaluating FIGS application in IMSCTs.
RESULTS
After the screening phase, 27 articles were found to be relevant. The literature results were grouped according to the used fluorophores, resulting in 3 groups: 5-ALA (10 studies); fluorescein (5 studies), and ICG (12 studies).
CONCLUSIONS
In intramedullary tumor surgery, 5-ALA has shown its usefulness in identifying the tumor margins and in searching for residues because of its properties as a tumor-specific metabolic marker. Sodium fluorescein and ICG video angiography have shown promising application in ependymoma and hemangioblastomas surgery, respectively. However, the evolving role of fluorescent dyes in guiding surgical strategies in intramedullary spinal tumor has yet to be shown by randomized clinical trials.
Topics: Humans; Fluorescein; Feasibility Studies; Spinal Cord Neoplasms; Neurosurgical Procedures; Indocyanine Green; Aminolevulinic Acid; Fluorescent Dyes
PubMed: 36195181
DOI: 10.1016/j.wneu.2022.09.117 -
Neurosurgical Review Oct 2022Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is used to assist brain tumor resection, especially for high-grade gliomas but also for low-grade gliomas,... (Review)
Review
Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is used to assist brain tumor resection, especially for high-grade gliomas but also for low-grade gliomas, metastasis, and meningiomas. With the increasing use of this technique, even to assist biopsies, high-grade glioma-mimicking lesions had misled diagnosis by showing 5-ALA fluorescence in non-neoplastic lesions such as radiation necrosis and inflammatory or infectious disease. Since only isolated reports have been published, we systematically review papers reporting non-neoplastic lesion cases with 5-ALA according with the PRISMA guidelines, present our series, and discuss its pathophysiology. In total, 245 articles were identified and 12 were extracted according to our inclusion criteria. Analyzing 27 patients, high-grade glioma was postulated as preoperative diagnosis in 48% of the cases. Microsurgical resection was performed in 19 cases (70%), while 8 patients were submitted to biopsy (30%). We found 4 positive cases in demyelinating disease (50%), 4 in brain abscess (80%), 1 in neurocysticercosis (33%), 1 in neurotoxoplasmosis, infarction, and hematoma (100%), 4 in inflammatory disease (80%), and 3 in cortical dysplasia (100%). New indications are being considered especially in benign lesion biopsies with assistance of 5-ALA. Using fluorescence as an aid in biopsies may improve procedure time, number of samples, and necessity of intraoperative pathology. Further studies should include this technology to encourage more beneficial uses.
Topics: Aminolevulinic Acid; Brain; Brain Neoplasms; Fluorescence; Glioma; Humans; Meningeal Neoplasms
PubMed: 35972631
DOI: 10.1007/s10143-022-01843-y -
Cureus Jun 2022Actinic keratoses (AKs) are the most common neoplastic lesions and are recognized as a precursor to squamous cell skin cancer. Photodynamic therapy (PDT) is a... (Review)
Review
Actinic keratoses (AKs) are the most common neoplastic lesions and are recognized as a precursor to squamous cell skin cancer. Photodynamic therapy (PDT) is a therapeutic option for multiple AKs in line with field cancerization. The aim of this study was to assess the effectiveness of PDT on patients with AKs using a meta-analysis, in order to evaluate the possible superiority of one treatment over the others. For this purpose, the PubMed, MEDLINE, Scopus, OVID, Science Direct, British Journal of Dermatology, Research Gate, and Embase databases were searched in March 2022. The search terms used were 'photodynamic therapy' and 'actinic keratosis'. We utilized the random-effects meta-analysis model to compare methyl aminolevulinate PDT (MAL-PDT) and the combination of a nanoscale-lipid vesicle formulation with the prodrug 5-aminolevulinic acid (BF-200 ALA) on a complete response (CR) of the lesions. Our meta-analysis indicated that the comparison of BF-200 ALA versus MAL-PDT showed marginally higher CRs than MAL-PDT.
PubMed: 35911353
DOI: 10.7759/cureus.26390