Abstract
Interstitial photodynamic therapy (PDT) using the pegylated photosensitizer PEG-m-THPC was evaluated as a minimally-invasive procedure to selectively debulk unrespectable pelvic ovarian cancer (NuTu-19) in immunocompetent rats. To assess tumour selectivity, PEG-m-THPC at dosages of 0.3, 3.0 and 30 mg kg−1 body weight was administered intravenously to 30 rats 4 weeks following tumour induction. Eight days later laser light at 652 nm and optical doses ranging from 100 to 900 J cm−1 diffuser-length was delivered by an interstitial cylindrical diffusing fibre inserted blindly into the pelvis. Three days following light application, the volume of necrosis was measured and the damage to pelvic organs was assessed histologically on cross sections. For analysis of survival, 20 tumour-bearing rats received PDT using drug doses of 3 or 9 mg kg−1 body weight and an optical dose of 900 J cm−1 diffuser-length, whereas ten untreated tumour-bearing rats served as controls. The histological assessment of PDT induced necrosis showed a non-linear dose–response for both the photosensitizer dose and the optical dose. The lowest drug dose activated with the highest optical dose did not induce more necrosis than seen in tumour-bearing control animals. The same optical dose induced necrosis of 17 mm in diameter using 30 mg kg−1 and 11 mm using 3 mg kg−1 photosensitizer. The optical threshold for induction of significant necrosis was between 100 and 300 J cm−1 diffuser-length for 30 mg kg−1 and between 300 and 500 J cm−1 for 3 mg kg−1 PEG-m-THPC. Significant damage to normal pelvic organs was only seen if 30 mg kg−1 photosensitizer was activated with optical doses of 700 J cm−1 or more. In the survival study, all treated animals survived PDT for at least 2 weeks and the intestinal and urinary tract remained functional. No clinical signs of blood vessel or nerve injury were observed. Mean overall survival of untreated tumour-bearing rats was 25.0 ± 4.5 days compared to 38.4 ± 3.8 days and 40.0 ± 3.6 days for rats treated with 3 mg kg−1 or 9 mg kg−1 PEG-m-THPC mediated PDT respectively (P < 0.05). We conclude that PEG-m-THPC mediated PDT has a favourable therapeutic window and that this minimally-invasive procedure can reduce pelvic cancer bulks effectively and selectively. © 1999 Cancer Research Campaign
Keywords: interstitial photodynamic therapy, ovarian cancer, PEG-m-THPC, minimally invasive, rat
Full Text
The Full Text of this article is available as a PDF (298.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Barr H., Tralau C. J., Boulos P. B., MacRobert A. J., Krasner N., Phillips D., Bown S. G. Selective necrosis in dimethylhydrazine-induced rat colon tumors using phthalocyanine photodynamic therapy. Gastroenterology. 1990 Jun;98(6):1532–1537. doi: 10.1016/0016-5085(90)91086-l. [DOI] [PubMed] [Google Scholar]
- Ben-Hur E., Rosenthal I. The phthalocyanines: a new class of mammalian cells photosensitizers with a potential for cancer phototherapy. Int J Radiat Biol Relat Stud Phys Chem Med. 1985 Feb;47(2):145–147. doi: 10.1080/09553008514550211. [DOI] [PubMed] [Google Scholar]
- Bonnett R., Berenbaum M. Porphyrins as photosensitizers. Ciba Found Symp. 1989;146:40–59. doi: 10.1002/9780470513842.ch4. [DOI] [PubMed] [Google Scholar]
- Bonnett R., White R. D., Winfield U. J., Berenbaum M. C. Hydroporphyrins of the meso-tetra(hydroxyphenyl)porphyrin series as tumour photosensitizers. Biochem J. 1989 Jul 1;261(1):277–280. doi: 10.1042/bj2610277. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Boring C. C., Squires T. S., Tong T., Montgomery S. Cancer statistics, 1994. CA Cancer J Clin. 1994 Jan-Feb;44(1):7–26. doi: 10.3322/canjclin.44.1.7. [DOI] [PubMed] [Google Scholar]
- Brand E., Pearlman N. Electrosurgical debulking of ovarian cancer: a new technique using the argon beam coagulator. Gynecol Oncol. 1990 Nov;39(2):115–118. doi: 10.1016/0090-8258(90)90415-h. [DOI] [PubMed] [Google Scholar]
- Brand E., Wade M. E., Lagasse L. D. Resection of fixed pelvic tumors using the Nd:YAG laser. J Surg Oncol. 1988 Apr;37(4):246–251. doi: 10.1002/jso.2930370408. [DOI] [PubMed] [Google Scholar]
- Chatlani P. T., Nuutinen P. J., Toda N., Barr H., MacRobert A. J., Bedwell J., Bown S. G. Selective necrosis in hamster pancreatic tumours using photodynamic therapy with phthalocyanine photosensitization. Br J Surg. 1992 Aug;79(8):786–790. doi: 10.1002/bjs.1800790826. [DOI] [PubMed] [Google Scholar]
- Curtin J. P., Malik R., Venkatraman E. S., Barakat R. R., Hoskins W. J. Stage IV ovarian cancer: impact of surgical debulking. Gynecol Oncol. 1997 Jan;64(1):9–12. doi: 10.1006/gyno.1996.4550. [DOI] [PubMed] [Google Scholar]
- DeLaney T. F., Sindelar W. F., Tochner Z., Smith P. D., Friauf W. S., Thomas G., Dachowski L., Cole J. W., Steinberg S. M., Glatstein E. Phase I study of debulking surgery and photodynamic therapy for disseminated intraperitoneal tumors. Int J Radiat Oncol Biol Phys. 1993 Feb 15;25(3):445–457. doi: 10.1016/0360-3016(93)90066-5. [DOI] [PubMed] [Google Scholar]
- DeLaney T. F., Smith P. D., Thomas G. F., Tochner Z. A., Sindelar W. F., Pass H. I., Harrington F. S., Bonner R. F., Mitchell J. B. A light-diffusing device for intraoperative photodynamic therapy in the peritoneal or pleural cavity. J Clin Laser Med Surg. 1991 Oct;9(5):361–366. doi: 10.1089/clm.1991.9.361. [DOI] [PubMed] [Google Scholar]
- Delaney T. F., Glatstein E. Photodynamic therapy of cancer. Compr Ther. 1988 May;14(5):43–55. [PubMed] [Google Scholar]
- Deppe G., Malviya V. K., Boike G., Hampton A. Surgical approach to diaphragmatic metastases from ovarian cancer. Gynecol Oncol. 1986 Jun;24(2):258–260. doi: 10.1016/0090-8258(86)90034-x. [DOI] [PubMed] [Google Scholar]
- Deppe G., Malviya V. K., Malone J. M., Jr, Christensen C. W. Debulking of pelvic and para-aortic lymph node metastases in ovarian cancer with the cavitron ultrasonic surgical aspirator. Obstet Gynecol. 1990 Dec;76(6):1140–1142. [PubMed] [Google Scholar]
- Gabizon A., Catane R., Uziely B., Kaufman B., Safra T., Cohen R., Martin F., Huang A., Barenholz Y. Prolonged circulation time and enhanced accumulation in malignant exudates of doxorubicin encapsulated in polyethylene-glycol coated liposomes. Cancer Res. 1994 Feb 15;54(4):987–992. [PubMed] [Google Scholar]
- Gabizon A., Papahadjopoulos D. Liposome formulations with prolonged circulation time in blood and enhanced uptake by tumors. Proc Natl Acad Sci U S A. 1988 Sep;85(18):6949–6953. doi: 10.1073/pnas.85.18.6949. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gershenson D. M. Primary cytoreduction for advanced epithelial ovarian cancer. Obstet Gynecol Clin North Am. 1994 Mar;21(1):121–140. [PubMed] [Google Scholar]
- Goff B. A., Blake J., Bamberg M. P., Hasan T. Treatment of ovarian cancer with photodynamic therapy and immunoconjugates in a murine ovarian cancer model. Br J Cancer. 1996 Oct;74(8):1194–1198. doi: 10.1038/bjc.1996.516. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Goff B. A., Hermanto U., Rumbaugh J., Blake J., Bamberg M., Hasan T. Photoimmunotherapy and biodistribution with an OC125-chlorin immunoconjugate in an in vivo murine ovarian cancer model. Br J Cancer. 1994 Sep;70(3):474–480. doi: 10.1038/bjc.1994.330. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gomer C. J., Dougherty T. J. Determination of [3H]- and [14C]hematoporphyrin derivative distribution in malignant and normal tissue. Cancer Res. 1979 Jan;39(1):146–151. [PubMed] [Google Scholar]
- Gomer C. J. Preclinical examination of first and second generation photosensitizers used in photodynamic therapy. Photochem Photobiol. 1991 Dec;54(6):1093–1107. doi: 10.1111/j.1751-1097.1991.tb02133.x. [DOI] [PubMed] [Google Scholar]
- Kimel S., Tromberg B. J., Roberts W. G., Berns M. W. Singlet oxygen generation of porphyrins, chlorins, and phthalocyanines. Photochem Photobiol. 1989 Aug;50(2):175–183. doi: 10.1111/j.1751-1097.1989.tb04145.x. [DOI] [PubMed] [Google Scholar]
- Lilge L., Molpus K., Hasan T., Wilson B. C. Light dosimetry for intraperitoneal photodynamic therapy in a murine xenograft model of human epithelial ovarian carcinoma. Photochem Photobiol. 1998 Sep;68(3):281–288. [PubMed] [Google Scholar]
- Lowdell C. P., Ash D. V., Driver I., Brown S. B. Interstitial photodynamic therapy. Clinical experience with diffusing fibres in the treatment of cutaneous and subcutaneous tumours. Br J Cancer. 1993 Jun;67(6):1398–1403. doi: 10.1038/bjc.1993.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moan J., Berg K. Photochemotherapy of cancer: experimental research. Photochem Photobiol. 1992 Jun;55(6):931–948. doi: 10.1111/j.1751-1097.1992.tb08541.x. [DOI] [PubMed] [Google Scholar]
- Molpus K. L., Kato D., Hamblin M. R., Lilge L., Bamberg M., Hasan T. Intraperitoneal photodynamic therapy of human epithelial ovarian carcinomatosis in a xenograft murine model. Cancer Res. 1996 Mar 1;56(5):1075–1082. [PubMed] [Google Scholar]
- Munkarah A. R., Hallum A. V., 3rd, Morris M., Burke T. W., Levenback C., Atkinson E. N., Wharton J. T., Gershenson D. M. Prognostic significance of residual disease in patients with stage IV epithelial ovarian cancer. Gynecol Oncol. 1997 Jan;64(1):13–17. doi: 10.1006/gyno.1996.4540. [DOI] [PubMed] [Google Scholar]
- Parker S. L., Tong T., Bolden S., Wingo P. A. Cancer statistics, 1996. CA Cancer J Clin. 1996 Jan-Feb;46(1):5–27. doi: 10.3322/canjclin.46.1.5. [DOI] [PubMed] [Google Scholar]
- Pass H. I. Photodynamic therapy in oncology: mechanisms and clinical use. J Natl Cancer Inst. 1993 Mar 17;85(6):443–456. doi: 10.1093/jnci/85.6.443. [DOI] [PubMed] [Google Scholar]
- Peng Q., Moan J., Ma L. W., Nesland J. M. Uptake, localization, and photodynamic effect of meso-tetra(hydroxyphenyl)porphine and its corresponding chlorin in normal and tumor tissues of mice bearing mammary carcinoma. Cancer Res. 1995 Jun 15;55(12):2620–2626. [PubMed] [Google Scholar]
- Ris H. B., Altermatt H. J., Inderbitzi R., Hess R., Nachbur B., Stewart J. C., Wang Q., Lim C. K., Bonnett R., Berenbaum M. C. Photodynamic therapy with chlorins for diffuse malignant mesothelioma: initial clinical results. Br J Cancer. 1991 Dec;64(6):1116–1120. doi: 10.1038/bjc.1991.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ris H. B., Altermatt H. J., Nachbur B., Stewart J. C., Wang Q., Lim C. K., Bonnett R., Althaus U. Effect of drug-light interval on photodynamic therapy with meta-tetrahydroxyphenylchlorin in malignant mesothelioma. Int J Cancer. 1993 Jan 2;53(1):141–146. doi: 10.1002/ijc.2910530126. [DOI] [PubMed] [Google Scholar]
- Ris H. B., Altermatt H. J., Stewart C. M., Schaffner T., Wang Q., Lim C. K., Bonnett R., Althaus U. Photodynamic therapy with m-tetrahydroxyphenylchlorin in vivo: optimization of the therapeutic index. Int J Cancer. 1993 Sep 9;55(2):245–249. doi: 10.1002/ijc.2910550213. [DOI] [PubMed] [Google Scholar]
- Ris H. B., Im Hof V., Stewart C. M., Mettler D., Altermatt H. J. Endobronchial photodynamic therapy: comparison of mTHPC and polyethylene glycol-derived mTHPC on human tumor xenografts and tumor-free bronchi of minipigs. Lasers Surg Med. 1998;23(1):25–32. doi: 10.1002/(sici)1096-9101(1998)23:1<25::aid-lsm4>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
- Rose G. S., Tocco L. M., Granger G. A., DiSaia P. J., Hamilton T. C., Santin A. D., Hiserodt J. C. Development and characterization of a clinically useful animal model of epithelial ovarian cancer in the Fischer 344 rat. Am J Obstet Gynecol. 1996 Sep;175(3 Pt 1):593–599. doi: 10.1053/ob.1996.v175.a73595. [DOI] [PubMed] [Google Scholar]
- Rosenthal I. Phthalocyanines as photodynamic sensitizers. Photochem Photobiol. 1991 Jun;53(6):859–870. doi: 10.1111/j.1751-1097.1991.tb09900.x. [DOI] [PubMed] [Google Scholar]
- Schwartz P. E. Cytoreductive surgery for the management of stage IV ovarian cancer. Gynecol Oncol. 1997 Jan;64(1):1–3. doi: 10.1006/gyno.1996.4586. [DOI] [PubMed] [Google Scholar]
- Sindelar W. F., DeLaney T. F., Tochner Z., Thomas G. F., Dachoswki L. J., Smith P. D., Friauf W. S., Cole J. W., Glatstein E. Technique of photodynamic therapy for disseminated intraperitoneal malignant neoplasms. Phase I study. Arch Surg. 1991 Mar;126(3):318–324. doi: 10.1001/archsurg.1991.01410270062011. [DOI] [PubMed] [Google Scholar]
- Testa J. R., Getts L. A., Salazar H., Liu Z., Handel L. M., Godwin A. K., Hamilton T. C. Spontaneous transformation of rat ovarian surface epithelial cells results in well to poorly differentiated tumors with a parallel range of cytogenetic complexity. Cancer Res. 1994 May 15;54(10):2778–2784. [PubMed] [Google Scholar]
- Tochner Z., Mitchell J. B., Harrington F. S., Smith P., Russo D. T., Russo A. Treatment of murine intraperitoneal ovarian ascitic tumor with hematoporphyrin derivative and laser light. Cancer Res. 1985 Jul;45(7):2983–2987. [PubMed] [Google Scholar]
- Tochner Z., Mitchell J. B., Hoekstra H. J., Smith P., DeLuca A. M., Barnes M., Harrington F., Manyak M., Russo D., Russo A. Photodynamic therapy of the canine peritoneum: normal tissue response to intraperitoneal and intravenous photofrin followed by 630 nm light. Lasers Surg Med. 1991;11(2):158–164. doi: 10.1002/lsm.1900110210. [DOI] [PubMed] [Google Scholar]
- Tochner Z., Mitchell J. B., Smith P., Harrington F., Glatstein E., Russo D., Russo A. Photodynamic therapy of ascites tumours within the peritoneal cavity. Br J Cancer. 1986 Jun;53(6):733–736. doi: 10.1038/bjc.1986.126. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Veenhuizen R. B., Ruevekamp-Helmers M. C., Helmerhorst T. J., Kenemans P., Mooi W. J., Marijnissen J. P., Stewart F. A. Intraperitoneal photodynamic therapy in the rat: comparison of toxicity profiles for photofrin and MTHPC. Int J Cancer. 1994 Dec 15;59(6):830–836. doi: 10.1002/ijc.2910590620. [DOI] [PubMed] [Google Scholar]
- Weishaupt K. R., Gomer C. J., Dougherty T. J. Identification of singlet oxygen as the cytotoxic agent in photoinactivation of a murine tumor. Cancer Res. 1976 Jul;36(7 Pt 1):2326–2329. [PubMed] [Google Scholar]
- Westerman P., Glanzmann T., Andrejevic S., Braichotte D. R., Forrer M., Wagnieres G. A., Monnier P., van den Bergh H., Mach J. P., Folli S. Long circulating half-life and high tumor selectivity of the photosensitizer meta-tetrahydroxyphenylchlorin conjugated to polyethylene glycol in nude mice grafted with a human colon carcinoma. Int J Cancer. 1998 Jun 10;76(6):842–850. doi: 10.1002/(sici)1097-0215(19980610)76:6<842::aid-ijc13>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
- Wierrani F., Fiedler D., Grin W., Henry M., Dienes E., Gharehbaghi K., Krammer B., Grünberger W. Clinical effect of meso-tetrahydroxyphenylchlorine based photodynamic therapy in recurrent carcinoma of the ovary: preliminary results. Br J Obstet Gynaecol. 1997 Mar;104(3):376–378. doi: 10.1111/j.1471-0528.1997.tb11472.x. [DOI] [PubMed] [Google Scholar]
- Wouters B. G., Brown J. M. Cells at intermediate oxygen levels can be more important than the "hypoxic fraction" in determining tumor response to fractionated radiotherapy. Radiat Res. 1997 May;147(5):541–550. [PubMed] [Google Scholar]