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Photodiagnosis and Photodynamic Therapy Jun 2022Oral potentially malignant disorders (OPMD) represent a group of lesions with increased risk for malignant transformation. The management of such injuries is based on... (Meta-Analysis)
Meta-Analysis Review
Oral potentially malignant disorders (OPMD) represent a group of lesions with increased risk for malignant transformation. The management of such injuries is based on surgical treatment or detailed follow-up throughout the patient's lifetime. This systematic review and meta-analysis investigated and critically evaluated the use of autofluorescence and fluorescent probes as potential techniques for the early detection of OPMD. A comprehensive search was performed on Pubmed, Scopus, Web of Science and LIVIVO databases. The gray literature was also consulted and included Google Scholar, Proquest and Open gray databases. 2715 articles were retrieved, and after the different stages of critical evaluation, were reduced to 25 articles that fully met the inclusion criteria. VELscope® was the most used equipment for autofluorescence, while aminolevulinic acid (5-ALA) was the main representative of the probes. The meta-analysis performed included 10 articles that used VELscope® as a method to detect oral disorders. A 95% confidence interval (CI) with a p value significance <0.05 was considered as a criterion for the statistical analysis. The combined sensitivity was 74% (CI95 60-76%, p = 0.0001) and the specificity was 57% (CI95 52-60%, p = 0.0000). The inclusion of these adjunct methods in clinical practice is very promising, since they are able to help both the clinician and the specialist in the early detection of potentially malignant oral disorders, favoring a better prognosis. However, it is still necessary to carry out further studies, with the aim of establishing a protocol for use and qualification of results.
Topics: Data Analysis; Early Detection of Cancer; Fluorescent Dyes; Humans; Mouth Diseases; Mouth Neoplasms; Photochemotherapy; Precancerous Conditions
PubMed: 35192945
DOI: 10.1016/j.pdpdt.2022.102764 -
Journal of Neuro-oncology Jan 2022High-grade gliomas (HGG) are the most aggressive and common malignant brain tumors in adults. They have a dismally fatal prognosis. Even if gross total resection of the... (Review)
Review
IMPORTANCE
High-grade gliomas (HGG) are the most aggressive and common malignant brain tumors in adults. They have a dismally fatal prognosis. Even if gross total resection of the enhancing tumor is achieved, inevitably, invading tumor cells that are indistinguishable to the un-aided eye are left behind, which eventually leads to tumor recurrence. 5-aminolevulinic acid (5-ALA) is an increasingly utilized intraoperative fluorescent imaging agent for patients with HGG. It enhances visualization of HGG tissue. Despite early promising randomized clinical trial data suggesting a survival benefit for 5-ALA-guided surgery, the growing body of literature must be analyzed to confirm efficacy on patient outcomes.
OBJECTIVE
To perform a systematic review of the literature to evaluate whether there is a beneficial effect upon survival and extent of resection due to the utilization of 5-ALA in HGG surgery.
EVIDENCE REVIEW
Literature regarding 5-ALA usage in HGG surgery was reviewed according to the PRISMA guidelines. Two databases, PubMed and SCOPUS, were searched for assorted combinations of the keywords "5-ALA," "high-grade glioma," "5-aminolevulinic acid," and "resection" in July 2020 for case reports and retrospective, prospective, and randomized clinical trials assessing and analyzing 5-ALA intraoperative use in patients with HGG. Entailed studies on PubMed and SCOPUS were found for screening using a snowball search technique upon the initially searched papers. Systematic reviews and meta-analyses were excluded from our PRISMA table.
FINDINGS
3756 previously published studies were screened, 536 of which were further evaluated, and ultimately 45 were included in our systematic review. There were no date restrictions on the screened publications. Our literature search was finalized on July 16, 2020. We found an observed increase in the overall survival (OS) and progression-free survival (PFS) of the 5-ALA group compared to the white light group, as well as an observed increase in the OS and PFS of complete resections compared to incomplete resections. Of the studies that directly compared the use of 5-ALA to white light (13 of the total analyzed 45, or 28.9%), 5-ALA lead to a better PFS and OS in 88.4 and 67.5% of patients, respectively. When the studies that reported postoperative neurologic outcomes of surgeries using 5-ALA vs. white light were analyzed, 42.2% of subjects demonstrated 5-ALA use was associated with less post-op neurological deficits, whereas 34.5% demonstrated no difference between 5-ALA and without. 23.3% of studies showed that intraoperative 5-ALA guided surgeries lead to more post-op neurological deficits.
CONCLUSIONS AND RELEVANCE
Utilization of 5-ALA was found to be associated with a greater extent of resection in HGG surgeries, as well as longer OS and PFS. Postop neurologic deficit rates were mixed and inconclusive when comparing 5-ALA groups to white light groups. 5-ALA is a useful surgical adjunct for resection of HGG when patient safety is preserved.
Topics: Brain Neoplasms; Glioma; Humans; Neoplasm Grading; Neurosurgical Procedures; Treatment Outcome
PubMed: 34989964
DOI: 10.1007/s11060-021-03901-9 -
Dermatology and Therapy Jan 2022Microneedling (MN) is a minimally invasive procedure involving the induction of percutaneous wounds with medical-grade needles. In this literature review, we investigate... (Review)
Review
INTRODUCTION
Microneedling (MN) is a minimally invasive procedure involving the induction of percutaneous wounds with medical-grade needles. In this literature review, we investigate clinical data on MN for the treatment of hair loss disorders.
METHODS
A literature search was conducted through PubMed up to November 2021 to identify original articles evaluating the use of MN on hair loss disorders. The database was searched using the following keywords: "microneedling," "micro needling," "micro needle," "microneedle," "needle," "dermaroller" and "alopecia," "hair loss," "alopecia," "areata," "cicatricial," or "effluvium," RESULTS: A total of 22 clinical studies featuring 1127 subjects met our criteria for inclusion. Jadad scores ranged from 1 to 3, with a mean of 2. As an adjunct therapy, MN improved hair parameters across genders and a range of hair loss types, severities, needling devices, needling depths of 0.50-2.50 mm, and session frequencies from once weekly to monthly. Across 17 investigations totaling 911 androgenic alopecia (AGA) subjects, MN improved hair parameters when paired with 5% minoxidil, growth factor solutions, and/or platelet-rich plasma (PRP) topicals, or when introduced to subjects whose hair count changes had plateaued for ≥ 6 months on other treatments. Across four investigations on 201 alopecia areata (AA) subjects, MN improved hair parameters as a standalone therapy versus cryotherapy, as an adjunct to 5-aminolevulinic acid and photodynamic therapy, and equivalently when paired with topical PRP versus carbon dioxide laser therapy with topical PRP. Across 657 subjects receiving MN, no serious adverse events were reported.
CONCLUSIONS
Clinical studies demonstrate generally favorable results for MN as an adjunct therapy for AGA and AA. However, data are of relatively low quality. Significant heterogeneity exists across interventions, comparators, and MN procedures. Large-scale randomized controlled trials are recommended to discern the effects of MN as a standalone and adjunct therapy, determine best practices, and establish long-term safety.
PubMed: 34854067
DOI: 10.1007/s13555-021-00653-2 -
Photodiagnosis and Photodynamic Therapy Dec 2021Interstitial photodynamic therapy (iPDT), inserting optical fibers inside brain tumors, has been proposed for more than 30 years. While a promising therapeutic option,... (Review)
Review
BACKGROUND
Interstitial photodynamic therapy (iPDT), inserting optical fibers inside brain tumors, has been proposed for more than 30 years. While a promising therapeutic option, it is still an experimental treatment, with different ways of application, depending on the team performing the technique.
OBJECTIVE
In this systematic review, we reported the patient selection process, the treatment parameters, the potential adverse events and the oncological outcomes related to iPDT treatment applied to brain tumors.
METHODS
We performed a search in PubMed, Embase and Medline based on the following Mesh terms: "interstitial" AND "photodynamic therapy" AND "brain tumor" OR "glioma" OR glioblastoma" from January 1990 to April 2020. We screened 350 studies. Twelve matched all selection criteria.
RESULTS
251 patients underwent iPDT. Tumors were mainly de novo or recurrent high-grade gliomas (171 (68%) of glioblastomas), located supratentorial, with a median volume of 12 cm. Hematoporphyrin derive agent (HpD) or protoporphyrin IX (PpIX) induced by 5-aminolevulinic acid (5-ALA) was used as a photosensitizer. Up to 6 optical fibers were introduced inside the tumor, delivering 200 mW/cm at a wavelength of 630 nm. Overall mortality was 1%. Transient and persistent morbidity were both 5%. No permanent deficit occurred using 5-ALA PDT. Tumor response rate after iPDT was 92% (IQR, 67; 99). Regarding glioblastomas, progression-free-survival was respectively 14.5 months (IQR, 13.8; 15.3) for de novo lesions and 14 months (IQR, 7; 30) for recurrent lesions, while overall survival was respectively 19 months (IQR, 14; 20) and 8 months (IQR, 6.3; 8.5). In patients harboring high-grade gliomas, 33 (13%) were considered long-term survivors (> 2 years) after iPDT.
CONCLUSION
Regardless of heterogeneity in its application, iPDT appears safe and efficient to treat brain tumors, especially high-grade gliomas. Stand-alone iPDT (i.e., without combined craniotomy and intracavitary PDT) using 5-ALA appears to be the best option in terms of controlling side effects: it avoids the occurrence of permanent neurological deficits while reducing the risks of hemorrhage and sepsis.
Topics: Aminolevulinic Acid; Brain Neoplasms; Humans; Neoplasm Recurrence, Local; Photochemotherapy; Photosensitizing Agents
PubMed: 34419674
DOI: 10.1016/j.pdpdt.2021.102492 -
British Journal of Neurosurgery Jun 2022Glioblastoma cases are often treated with aggressive resection. Recent studies have suggested that extended surgical resection could improve survival. Improved extent of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Glioblastoma cases are often treated with aggressive resection. Recent studies have suggested that extended surgical resection could improve survival. Improved extent of resection could be afforded by the use of fluorescence during surgery. We aimed to examine the effect of fluorescence on the results of gross total resection (GTR) and its impact on the overall survival (OS) and progression-free survival (PFS) rates.
METHODS
We performed a literature search of studies published between 2000 and 2021. The study followed the PRISMA guidelines and focused on newly-diagnosed glioblastoma cases. The collected data were divided into two groups according to the fluorescence use: Group A (standard white-light use) and Group B (fluorescent-light use).
RESULTS
The results showed a superiority of the fluorescence use during surgery for newly diagnosed glioblastoma cases concerning the procurement of GTR. Additionally, we highlighted the importance of GTR on the OS but not on the PFS rate. We found that the use of 5-aminolevulinic acid resulted in better OS rates compared to fluorescein sodium.
CONCLUSION
GTR is a significant factor leading to improved OS; nevertheless, it was an apparently unrelated factor for estimating the PFS rate. Fluorescence use during surgery could lead to higher rates of complete resection and better OS rates.
Topics: Aminolevulinic Acid; Brain Neoplasms; Fluorescein; Glioblastoma; Humans; Survival Rate
PubMed: 34313526
DOI: 10.1080/02688697.2021.1950637 -
Journal of the American Academy of... Jun 2022
Comparison of the safety and efficacy of daylight photodynamic therapy and conventional photodynamic therapy for actinic keratoses: A systematic review demonstrating noninferiority.
Topics: Aminolevulinic Acid; Humans; Keratosis, Actinic; Photochemotherapy; Photosensitizing Agents; Treatment Outcome
PubMed: 34214621
DOI: 10.1016/j.jaad.2021.05.060 -
Pharmaceuticals (Basel, Switzerland) Mar 20215-Aminolevulinic acid (5-ALA) is an amino acid derivative and a precursor of protoporphyrin IX (PpIX). The photophysical feature of PpIX is clinically used in... (Review)
Review
5-Aminolevulinic acid (5-ALA) is an amino acid derivative and a precursor of protoporphyrin IX (PpIX). The photophysical feature of PpIX is clinically used in photodynamic diagnosis (PDD) and photodynamic therapy (PDT). These clinical applications are potentially based on in vitro cell culture experiments. Thus, conducting a systematic review and meta-analysis of in vitro 5-ALA PDT experiments is meaningful and may provide opportunities to consider future perspectives in this field. We conducted a systematic literature search in PubMed to summarize the in vitro 5-ALA PDT experiments and calculated the effectiveness of 5-ALA PDT for several cancer cell types. In total, 412 articles were identified, and 77 were extracted based on our inclusion criteria. The calculated effectiveness of 5-ALA PDT was statistically analyzed, which revealed a tendency of cancer-classification-dependent sensitivity to 5-ALA PDT, and stomach cancer was significantly more sensitive to 5-ALA PDT compared with cancers of different origins. Based on our analysis, we suggest a standardized in vitro experimental protocol for 5-ALA PDT.
PubMed: 33800109
DOI: 10.3390/ph14030229 -
Photodiagnosis and Photodynamic Therapy Jun 2021The benefits of fluorescent light (FL) cystoscopy with 5-aminolevulinic acid (5-ALA) or hexaminolevulinate (HAL) in non-muscle-invasive bladder cancer (NMIBC) have been... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The benefits of fluorescent light (FL) cystoscopy with 5-aminolevulinic acid (5-ALA) or hexaminolevulinate (HAL) in non-muscle-invasive bladder cancer (NMIBC) have been mentioned in many trials. Meanwhile, several problems need to be addressed such as the rate of residual disease following these procedures.
OBJECTIVE
To assess the effects of FL cystoscopy compared with white light (WL) cystoscopy on the rate of residual Ta, T1, and carcinoma in situ (CIS) tumors, recurrence-free survival (RFS) and progression-free survival (PFS).
METHODS
A search in the databases PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) was undertaken. Studies were included if their outcomes included the residual tumor rate, PFS or RFS. The data was analyzed by REVMAN 5.3 and STATA 14.0.
RESULTS
The residual tumor rate of the FL group was lower than that of the WL group (relative risk [RR] 0.42; 95 % confidence interval [CI] 0.26-0.80; P = 0.007), which was consistent with the residual Ta rate (RR 0.44; 95 % CI 0.28-0.69; P = 0.0004), the residual T1 rate (RR 0.42; 95 % CI 0.21-0.83; P = 0.01) and the residual CIS rate (RR 0.39; 95 % CI 0.19-0.80; P = 0.01). RFS at the 12-month follow-up (RR 1.15; 95 % CI 1.08-1.28; P = 0.0002) and 24-month follow-up (RR 1.26; 95 % CI 1.17-1.35; P < 0.00001) in the FL group was significantly higher than that in the WL group. However, no statistically significant differences were found in PFS at the 12-month follow-up (RR 1.01; 95 % CI 0.99-1.03; P = 0.17) or 24-month follow-up (RR 1.00; 95 % CI 0.97-1.03; P = 0.95).
CONCLUSION
FL cystoscopy was related to a reduced residual tumor rate compared with WL cystoscopy in NMIBC, which was also consistent with the Ta, T1 and residual CIS rates. RFS was higher in patients with FL cystoscopy at the 12- to 24-month follow-up.
Topics: Aminolevulinic Acid; China; Cystoscopy; Humans; Neoplasm Recurrence, Local; Photochemotherapy; Photosensitizing Agents; Urinary Bladder Neoplasms
PubMed: 33711534
DOI: 10.1016/j.pdpdt.2021.102248 -
BJU International Sep 2021To assess whether single immediate intravesical chemotherapy (SIIC) adds value to bladder tumour management in combination with novel optical techniques: enhanced... (Meta-Analysis)
Meta-Analysis
Impact of enhanced optical techniques at time of transurethral resection of bladder tumour, with or without single immediate intravesical chemotherapy, on recurrence rate of non-muscle-invasive bladder cancer: a systematic review and network meta-analysis of randomized trials.
OBJECTIVE
To assess whether single immediate intravesical chemotherapy (SIIC) adds value to bladder tumour management in combination with novel optical techniques: enhanced transurethral resection of bladder tumour (TURBT).
METHODS
A systematic search was performed using the PubMed and Web of Science databases in September 2020 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) extension statement for network meta-analyses. Studies that compared recurrence rates among intervention groups (TURBT with photodynamic diagnosis [PDD] ± SIIC, narrow-band imaging [NBI] ± SIIC, or white-light cystoscopy [WLC] + SIIC) and a control group (TURBT with WLC alone) were included. We used the Bayesian approach in the network meta-analysis.
RESULTS
Twenty-two studies (n = 4519) met our eligibility criteria. Out of six different interventions including three different optical techniques, compared to WLC alone, blue-light cystoscopy (BLC) plus SIIC (odds ratio [OR] 0.349, 95% credible interval [CrI] 0.196-0.601) and BLC alone (OR 0.668, 95% CrI 0.459-0.931) were associated with a significantly lower likelihood of 12-month recurrence rate. In the sensitivity analysis, out of eight different interventions compared to WLC alone, PDD by 5-aminolevulinic acid plus SIIC (OR 0.327, 95% CrI 0.159-0.646) and by hexaminolevulinic acid plus SIIC (OR 0.376, 95% CrI 0.172-0.783) were both associated with a significantly lower likelihood of 12-month recurrence rate. NBI with and without SIIC was not associated with a significantly lower likelihood of 12-month recurrence rate (OR 0.385, 95% CrI 0.105-1.29 and OR 0.653, 95% CrI 0.343-1.15).
CONCLUSION
Blue-light cystoscopy during TURBT with concomitant SIIC seems to yield superior recurrence outcomes in patients with non-muscle-invasive bladder cancer. The use of PDD was able to reduce the 12-month recurrence rate; moreover, concomitant SIIC increased this risk benefit by a 32% additional reduction in odds ratio. Although using PDD could reduce the recurrence rate, SIIC remains necessary. Moreover, ranking analysis showed that both PDD and NBI, plus SIIC, were better than these techniques alone.
Topics: Administration, Intravesical; Combined Modality Therapy; Cystectomy; Humans; Neoplasm Recurrence, Local; Network Meta-Analysis; Randomized Controlled Trials as Topic; Urethra; Urinary Bladder Neoplasms
PubMed: 33683778
DOI: 10.1111/bju.15383 -
Photodiagnosis and Photodynamic Therapy Mar 2021Human papilloma virus (HPV) infection is the most common sexually transmitted disease worldwide and the main cause of genital warts. Clear recommendations for the... (Review)
Review
BACKGROUND
Human papilloma virus (HPV) infection is the most common sexually transmitted disease worldwide and the main cause of genital warts. Clear recommendations for the management of urethral warts, which are often hard to detect and difficult to treat, are still lacking.
OBJECTIVE
To summarize all available data describing treatment modalities of urethral warts, compare their efficacy and side effects, and provide physicians a treatment strategy outline.
MATERIAL AND METHODS
Till June 2020, we conducted a systematic review of articles studying the different treatment modalities of urethral condylomas. A chi-square test was used to compare the recurrence rates between treatment modalities, the complete clearance rates at first follow-up and the rates of adverse events.
RESULTS
A total of 26 articles with 1730 patients were included in our review. 61 % of patients were deemed completely cured on the first follow-up while 21 % recurred. 5-aminolevulinic acid (ALA) mediated photodynamic therapy (PDT) was the most common treatment and yielded the lowest recurrence rate (7.5 %) followed by laser therapy (24 %) and topical therapy (31 %) (p < 0.01). ALA-PDT resulted in a higher rate of clearance on follow up (96 %) compared to laser therapy (69 %) and topical therapy (14 %) (p < 0.01). Adverse events were more frequent in the ALA-PDT group (69 %) compared to laser therapy (28 %) and topical treatment (30 %) (p < 0.01).
CONCLUSION
ALA-PDT appears to be the most effective treatment of urethral condylomas in term of clearance and recurrence rate, but with a higher risk of adverse events. Management should be tailored to the type of lesion found at presentation.
Topics: Aminolevulinic Acid; Humans; Neoplasm Recurrence, Local; Papillomavirus Infections; Photochemotherapy; Photosensitizing Agents; Treatment Outcome; Warts
PubMed: 33529745
DOI: 10.1016/j.pdpdt.2021.102204