biophBiomedical PhotonicsBiomedical Photonics2413-9432Non-profit partnership for development of domestic photodynamic therapy and photodiagnosis10.24931/2413-9432-2022-11-4-19-24bioph-564Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФотодинамическая терапия при раке полости рта у соматически отягощенных больныхPhotodynamic therapy treatment of oral cavity cancer in patients with comorbiditiesПанасейкинЮ. А.PanaseykinY. A.

Обнинск

Obninsk

deus2@bk.ruКапинусВ. Н.KapinusV. N.

Обнинск

Obninsk

ФилоненкоЕ. В.FilonenkoE. V.

Москва

Moscow

ПолькинВ. В.PolkinV. V.

Обнинск

Obninsk

СеврюковФ. Е.SevrukovF. E.

Обнинск

Obninsk

ИсаевП. А.IsaevP. A.

Обнинск

Obninsk

ИвановС. А.IvanovS. A.

Обнинск

Obninsk

КапринА. Д.KaprinA. D.

Москва

Moscow

МРНЦ им. А.Ф. Цыба – филиал ФГБУ «НМИЦ радиологии» Минздрава РоссииРоссияA. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian FederationRussian FederationМНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава РоссииРоссияP. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian FederationRussian FederationМРНЦ им. А.Ф. Цыба – филиал ФГБУ «НМИЦ радиологии»РоссияA. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian FederationRussian FederationМРНЦ им. А.Ф. Цыба – филиал ФГБУ «НМИЦ радиологии» Минздрава России; ФГАОУ ВО «Российский университет дружбы народов»РоссияA. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation; Рeoples Friendship University of Russia (RUDN University)Russian FederationМНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России; ФГАОУ ВО «Российский университет дружбы народов»; ФГБУ «НМИЦ радиологии» Минздрава РоссииРоссияP. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation; Рeoples Friendship University of Russia (RUDN University); National Medical Research Radiological Center of the Ministry of Health of the Russian FederationRussian Federation2022310120231141924Copyright © Панасейкин Ю.А., Капинус В.Н., Филоненко Е.В., Полькин В.В., Севрюков Ф.Е., Исаев П.А., Иванов С.А., Каприн А.Д., 20232023Панасейкин Ю.А., Капинус В.Н., Филоненко Е.В., Полькин В.В., Севрюков Ф.Е., Исаев П.А., Иванов С.А., Каприн А.Д.Panaseykin Y.A., Kapinus V.N., Filonenko E.V., Polkin V.V., Sevrukov F.E., Isaev P.A., Ivanov S.A., Kaprin A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pdt-journal.com/jour/article/view/564

В настоящей работе продемонстрирован опыт радикального лечения соматически отягощенных пациентов с плоскоклеточным раком слизистой оболочки полости рта при помощи фотодинамической терапии. Проведено лечение двух соматически отягощенных пациентов (ВИЧ инфекция с ассоциированной легочной гипертензией высокой степени и выраженной кардиальной патологией), которым было не показано выполнение обширных хирургических вмешательств и/или проведение агрессивной химиолучевой терапии в связи с наличием выраженной сопутствующей патологии. У обоих пациентов был диагностирован плоскоклеточный рак слизистой оболочки полости рта, распространенность опухолевого процесса соответствовала стадии I сT1N0M0. Пациентам была выполнена фотодинамическая терапия с фотосенсибилизатором хлоринового ряда в дозе 1,0 мг/кг. Параметры облучения: выходная мощность – 1,5 Вт, плотность мощности – 0,31 Вт/см2, световая доза – 300 Дж/см2. После одного курса фотодинамической терапии у обоих пациентов диагностирована полная резорбция первичного опухолевого очага (по RECIST 1.1), но в первом клиническом случае был проведен повторный курс фотодинамической терапии в связи с сочетанной патологией слизистой оболочки полости рта – множественными очагами лейкоплакии. В результате лечения так же была отмечена полная регрессия всех очагов лейкоплакии. Основным нежелательным явлением являлась боль в течение первых 5-7 дней после вмешательства, успешно купируемая ненаркотическими анальгетиками. Период наблюдения (IQR) пациентов составил 12 и 18 мес соответственно, без признаков рецидива и метастазов. Благодаря использованию методики фотодинамической терапии у пациентов удалось избежать проведения обширных хирургических вмешательств, а также отказаться от агрессивной схемы химиолучевой терапии, как альтернативы хирургической методике. Фотодинамическая терапия является малоинвазивной методикой радикального лечения локализованного плоскоклеточного рака полости рта с минимальным количеством осложнений, поэтому особенно актуальной эта методика является у пациентов с выраженной сопутствующей патологией.

We report the experience of radical treatment by photodynamic therapy of patients with squamous cell carcinoma of oral cavity with serious side diseases. Completed treatment of two patients with serious side diseases (HIV infection with associated pulmonary hypertension of high degree and cardiac pathology) suffered from cancer of oral cavity. Extensive surgical treatment and/or aggressive course of chemoradiation therapy were not indicated to them due to concomitant pathology. Both patients were diagnosed with squamous cell carcinoma of oral cavity, with appropriate stage Ist. сT1N0M0. Patients received treatment by photodynamic therapy with chorine photosensitizer in dose 1 mg/kg. Options of photodynamic were: output power – 1.5W, power density – 0.31 W/cm2, light dose – 300 J/cm2. After one time session of photodynamic therapy, in both cases full response was diagnosed (according to RECIST 1.1). In one case the second session of photodynamic therapy was performed due to concomitant disease of oral cavity – multiply lesions of leukoplakia and after was diagnosed full remission of all lesions. Major adverse event was pain during the first 5-7 days after treatment, curable by painkillers. Follow-up (IQR) was 12 and 18 month respectively with no evidence of progression. It is available to avoid extensive surgical treatment and aggressive course of chemoradiation therapy (as an alternative) with the use of photodynamic therapy. Photodynamic therapy is minimally invasive method of radical treatment of localized squamous cell carcinoma of oral cavity with minimal adverse events, and could be especially relevant in patients with serious concomitant diseases.

рак полости ртаВИЧ инфекцияфотодинамическая терапиялейкоплакияoral cavity cancerHIV infectionphotodynamic therapyleukoplakiaReferencesNCCN Clinical Practice Guidelines in Oncology // Cancer of the Oral Cavity. – 2022 – Version 2.NCCN Clinical Practice Guidelines in Oncology, Cancer of the Oral Cavity, 2022, Version 2.Bernier J., Domenge C., Ozsahin M., Matuszewska K., Lefèbvre J.L., Greiner R.H., Giralt J. et al. European Organization for Research and Treatment of Cancer Trial 22931 Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer // N Engl J Med. – 2004 – Vol. 350(19). – P. 1945-1952. doi: 10.1056/NEJMoa032641. PMID: 15128894.Bernier J., Domenge C., Ozsahin M., Matuszewska K., Lefèbvre J.L., Greiner R.H., Giralt J. et al. European Organization for Research and Treatment of Cancer Trial 22931 Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer, N Engl J Med, 2004, vol. 350(19), pp. 1945-1952. doi: 10.1056/NEJMoa032641. PMID: 15128894.Cooper J.S., Zhang Q., Pajak T.F., Forastiere A.A., Jacobs J., Saxman S.B. et al. Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck // Int J Radiat Oncol Biol Phys. – 2012 – Vol. 84(5). – P. 1198-1205. doi: 10.1016/j.ijrobp.2012.05.008. Epub 2012 Jun 30 PMID: 22749632; PMCID: PMC3465463.Cooper J.S., Zhang Q., Pajak T.F., Forastiere A.A., Jacobs J., Saxman S.B. et al. Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck, Int J Radiat Oncol Biol Phys, 2012, vol. 84(5), рр. 1198-1205. doi: 10.1016/j.ijrobp.2012.05.008. Epub 2012 Jun 30 PMID: 22749632; PMCID: PMC3465463.Bachaud J.M., Cohen-Jonathan E., Alzieu C., David J.M., Serrano E., Daly-Schveitzer N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: nal report of a randomized trial // Int J Radiat Oncol Biol Phys. – 1996 . – Vol. 36(5). – P. 999-1004. doi: 10.1016/s0360-3016(96)00430-0. PMID: 8985019.Bachaud J.M., Cohen-Jonathan E., Alzieu C., David J.M., Serrano E., Daly-Schveitzer N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: nal report of a randomized trial, Int J Radiat Oncol Biol Phys, 1996, vol. 36(5), рр. 999-1004. doi: 10.1016/s0360-3016(96)00430-0. PMID: 8985019.Wu Q., Mohan R., Morris M. et al. Simultaneous integrated boost intensitymodulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results // Int J Radiat Oncol Biol Phys. – 2003 – Vol. 56 – P. 573-585.Wu Q., Mohan R., Morris M. et al. Simultaneous integrated boost intensitymodulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results, Int J Radiat Oncol Biol Phys, 2003, vol. 56, рр. 573-585.Панасейкин Ю.А., Севрюков Ф.Е., Исаев П.А., Васильков С.В., Дербугов Д.Н., Семин Д.Ю., Медведев В.С., Полькин В.В., Каприн А.Д., Иванов С.А. Способ лечения начальных стадий рака полости рта // Патент №2713940 11.02.2020 Бюл.5.Panaseikin Yu.A., Sevryukov F.E., Isaev P.A., Vasilkov S.V., Derbugov D.N., Semin D.Yu., Medvedev V.S., Polkin V.V., Kaprin A.D., Ivanov S.A. Method of treatment of the initial stages of oral cancer, 2003, Patent No. 2713940 11.02.2020 Byul.5.Mazeron J.J., Ardiet J.M., Haie-Meder C. et al. GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas // Radiother Oncol. – 2009 – Vol. 91(2) . – P. 150-156.Mazeron J.J., Ardiet J.M., Haie-Meder C. et al. GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas, Radiother Oncol, 2009, vol. 91(2). рр. 150-156.Ye W., Schmitt N.C. Pembrolizumab for recurrent/metastatic head and neck cancer: equally promising for Asian patients? // Annals of Translational Medicine. – 2019 – Vol. 7(S1). – P. 14.Ye W., Schmitt N.C. Pembrolizumab for recurrent/metastatic head and neck cancer: equally promising for Asian patients? Annals of Translational Medicine, 2019, vol. 7(S1). – P. 14.Chow L.Q., Haddad R., Gupta S. et al. Antitumor activity of pembrolizumab in biomarker– unselected patients with recurrent and or metastatic head and neck squamous cell carcinoma: results from the phase Ib KEYNOTE-012 expansion cohort // J Clin Oncol . – 2016 – Vol. 34 – P. 3838-3845.Chow L.Q., Haddad R., Gupta S. et al. Antitumor activity of pembrolizumab in biomarker– unselected patients with recurrent and or metastatic head and neck squamous cell carcinoma: results from the phase Ib KEYNOTE-012 expansion cohort, J Clin Oncol, 2016, vol. 34, рр. 3838-3845.Hsu C., Lee S.H., Ejadi S. et al. Safety and antitumor activity of pembrolizumab in patients with programmed death-ligand 1-positive nasopharyngeal carcinoma: results of the KEYNOTE-028 study // J Clin Oncol. – 2017 – Vol. 35 – P. 4050-4056.Hsu C., Lee S.H., Ejadi S. et al. Safety and antitumor activity of pembrolizumab in patients with programmed death-ligand 1-positive nasopharyngeal carcinoma: results of the KEYNOTE-028 study, J Clin Oncol, 2017, vol. 35, рр. 4050-4056.Lebedev M.V., Abdullina Yu.A., Zakharova I.Yu. Specialized medical care for patients with malignant neoplasms of the maxillofacial area in the Penza region of Russia // Biomedical Photonics. – 2021 – Vol. 10(3). – P. 23-31. https://doi.org/10.24931/2413-9432-2021-10 -3-23-31.Lebedev M.V., Abdullina Yu.A., Zakharova I.Yu. Specialized medical care for patients with malignant neoplasms of the maxillofacial area in the Penza region of Russia, Biomedical Photonics, 2021, vol. 10(3), рр. 23-31. https://doi.org/10.24931/2413-9432-2021-10-3-23-31.Ibarra A.M.C., Cecatto R.B., Motta L.J., Dos Santos Franco A.L. et al. Photodynamic therapy for squamous cell carcinoma of the head and neck: narrative review focusing on photosensitizers // Lasers Med Sci. – 2022 – Vol. 37(3). – P. 1441-1470. doi: 10.1007/s10103-021-03462-3. Epub 2021 Dec 2 PMID: 34855034.Ibarra A.M.C., Cecatto R.B., Motta L.J., Dos Santos Franco A.L. et al. Photodynamic therapy for squamous cell carcinoma of the head and neck: narrative review focusing on photosensitizers, Lasers Med Sci, 2022, vol. 37(3), рр. 1441-1470. doi: 10.1007/s10103-021-03462-3 Epub 2021 Dec 2 PMID: 34855034.Filonenko E.V. The history of development of fluorescence diagnosis and photodynamic therapy and their capabilities in oncology // Russian Journal of General Chemistry. – 2015 – Vol. 85(1). – P. 211-216 doi: 10.1134/S1070363215010399.Filonenko E.V. The history of development of fluorescence diagnosis and photodynamic therapy and their capabilities in oncology, Russian Journal of General Chemistry, 2015, vol. 85(1), рр. 211-216. doi: 10.1134/S1070363215010399.Lebedev M.V., Kerimova K.I. Optimization of provision of specialized medical care for patients with maxillofacial neoplasms in the Penza region of Russia // Biomedical Photonics. – 2021 – Vol. 10(1). – P. 32-38. doi: 10.24931/2413-9432-2021-10-1-32-38.Lebedev M.V., Kerimova K.I. Optimization of provision of specialized medical care for patients with maxillofacial neoplasms in the Penza region of Russia, Biomedical Photonics, 2021, vol. 10(1), рр. 32-38. doi: 10.24931/2413-9432-2021-10-1-32-38.Huang Z. A. Review of Progress in Clinical Photodynamic Therapy // Technol. Cancer Res. Treat. – 2005 – Vol. 4(3). – P. 283-293.Huang Z. A. Review of Progress in Clinical Photodynamic Therapy, Technol. Cancer Res. Treat, 2005, vol. 4(3), рр. 283-293.D’Cruz A., Wenig B., Iqbal A. et al.: Foscan-mediated photodynamic therapy in the palliative treatment of advanced head and neck cancer // Poster presentation Fifth International Congress on Head and Neck Oncology; San Francisco, USA. – 2000.D’Cruz A., Wenig B., Iqbal A. et al.: Foscan-mediated photodynamic therapy in the palliative treatment of advanced head and neck cancer, Poster presentation Fifth International Congress on Head and Neck Oncology; San Francisco, USA, 2000.Panaseykin Y.A., Filonenko E.V., Sevrukov F.E., Kapinus V.N., Polkin V.V., Isaev P.A., Kaprin A.D., Ivanov S.A. Possibilities of photodynamic therapy in the treatment of malignant tumors of the oral cavity // Biomedical Photonics. – 2021 – Vol. 10(3). – P. 32-38.Panaseykin Y.A., Filonenko E.V., Sevrukov F.E., Kapinus V.N., Polkin V.V., Isaev P.A., Kaprin A.D., Ivanov S.A. Possibilities of photodynamic therapy in the treatment of malignant tumors of the oral cavity, Biomedical Photonics, 2021, vol. 10(3), рр. 32-38.

The authors declare that there are no conflicts of interest present.