The results of photodynamic therapy (PDT) for early central lung cancer are represented in the article. The study included 37 patients (52 tumor lesions). For 52 lesions pre-invasive cancer (carcinoma in situ) was determined in 6 cases, squamous cell cancer with invasion within mucosal and submucosal layers of bronchial wall – in 46 cases. 51 tumors were primary lesion, 1 – residual after radiotherapy. 17 of 37 patients underwent previous surgical or combined modality treatment for cancer in other anatomical sites. For PDT we used photosensitizers photogem, photosens and radachlorine. The treatment response was assessed 1 months later by data of endoscopy and morphological study, CT, US and endosonography. Complete regression was achieved in 86,5% of cases, partial regression – in 13,5%. The efficacy of PDT was depended on tumor size. For lesion up to 1 cm in size complete regression was in 100% of cases, from 1.5 cm to 2.0 cm – in 28.6%, for tumors more than 2 cm the complete regression was not achieved. The recurrence of tumor was diagnosed in 2 patients in the period from 1 to 5 years with following successful repeated courses of PDT. Adverse effects included inflammation changes in mucosa at the PDT region with transient (up to 6-7 days) local fibrinous endobronchitis with obturation of segmental bronchial lumen by fibrin membranes (7 patients), scar stenosis of segmental bronchus (2 patients). All patients had increased sensitivity to sun exposure, mild skin burns at exposed areas of body were in 2 patients. The results showed that method was highly efficient and applicable for pre-invasive central lung cancer and in patients with multiple primary bronchial lesions and high risk of surgical complications.

The results of fluorescence laparoscopy in 60 patients with gastric cancer in P.A.Herzen MCRI are represented in the article. All patients had gastric cancer stage III. Undifferentiated cancer was diagnosed in 3 (5%) patients, signet ring cell carcinoma – in 42 (70%), low differentiated adenocarcinoma – in 15 (25%). Fluorescence diagnosis was performed using fluorescence laparoscope by Carl Storz (Germany) with wavelengths 380-460 nm and alasens given per os at a dose of 30 mg/kg body weight 3 h before study. During the investigation the examination of parietal and visceral peritoneum, great omentum with instrumental revision of pelvic organs was made. The technique of fluorescence diagnosis and assessment of its results are described. According to results of the study occult tumor microdissemination over peritoneum was detected in 10 (16.7%) patients. The sensitivity of fluorescence laparoscopy in patients with gastric cancer accounted for 87.5%, specificity – 76%. The data of fluorescence diagnosis allowed to perform staging of tumor process and influenced on following management.

The study of efficacy of thoracoscopy-assisted fluorescence diagnosis with Alasens is described in the article. The results of fluorescence diagnosis in 27 patients with suspicion on pleral tumor are represented. Before thoracoscopy-assisted fluorescence diagnosis in 21 patients according to radiological studies there was a fluid in pleural ca, in 19 patients of them tumor cells were found by cytological study of pleural fluid, in 10 patients differential diagnosis was performed between mesothelioma and adenogenic cancer. For fluorescence diagnosis fluorescence system by company Кarl Storz and xenon lamp with set of light filters was used: fluorescence study was performed by excitation at wavelength 380–460 nm. 3 h before investigation the patient received alasens per os in dose of 30 mg/kg body weight in 100 ml of water. For routine thoracoscopy tumor lesions were determined in 20 (87.0%) patients, other 3 (13.0%) patients had no tumors. In the group of patients with tumor lesions determined by routine thoracoscopy the fluorescence during fluorescence study was registered in all lesions determined in white light, besides this 24 additional foci of fluorescence were noticed, according to morphological study 21 of them had tumor nature, 3 lesions were inflammatory. In 1 of 3 patients with no lesion in white light there was one focus of fluorescence, morphological study proved the metastasis of adenocarcinoma in this area. According to morphological study of pleural biopsy specimens the true-positive results for fluorescence thoracoscopy accounted for 82, false-negative – 10, true-negative – 23, false-positive – 3. The sensitivity of the method was 89,1%, the specificity – 88,4%, the diagnostic accuracy – 88,9%.

The method of fluorescence visualization of bladder tumors combined with fluorescence spectroscopy developed in P.A. Herzen MCRI is described. The efficacy of the method was proved by results of diagnostics in 198 patients with superficial bladder cancer. In the study group 67 patients had primary tumor, 131 patients had recurrence of superficial bladder cancer after previous treatment. In 3.5% patients the lesion was determined as carcinoma in situ, in 29.5% – non-invasive papillary carcinoma, bladder cancer with invasion into submucosal layer of bladder wall occurred in 67% of cases. Diagnostics was performed 1.5–2 h after instillation of 50 ml 3% solution of alasens into bladder. The data analysis was made with calculation of the diagnostic parameter and value of tumor/normal mucosa fluorescence contrast. The total number of fluorescence spectra accounted for 528. All determined areas of fluorescence were studied morphologically. During fluorescence spectroscopy 53 areas of fluorescence were determined on visually intact mucosa under white light, showed high values of diagnostic parameter. Morphological study proved severe dysplasia (3%), carcinoma in situ (95%) and bladder cancer (2%). Correlation between data of local fluorescence spectroscopy and morphological study of biopsy specimen was assessed, values of diagnostic parameter, характеризующих intact urothelium, areas of inflammation and moderate dysplasia, severe dysplasia and bladder cancer were estimated. Local fluorescence spectroscopy combined with visual assessment of fluorescence image allowed to increase specificity of cystoscopy from 70% to 85%, total accuracy – from 80% to 86%, with improvement of predictive value for positive result from 0,67 to 0,94.

The review of available theories explaining mechanisms of photosensitizer selective accumulation in tumor tissue is represented in the article. Variants associated with both targeted delivery of compounds with different chemical structure to tumor and low elimination rate of photosensitizers in the tumor are described. Details of tumor cell up-take of photosensitizer bounded with lipoproteins due to increased expression of low solidity lipoproteins receptors comparing with normal cells; mechanisms of photosensitizer accumulation in tumor tissue due to phagocytosis by macrophages localized in this area; mechanisms of binding of porphyrin-based photosensitizer by collagen fibers, production of which is increased in tumor cells, and other mechanisms are reviewed. Perspectives of practical application of knowledge about mechanisms of selective accumulation for induced increase in selectiveness of photosensitizer accumulation in tumor through targeted delivery of agent to pathological tissues are shown. Analysis of world trends in the search of transport systems for photosensitizers is performed.

The case of diagnosis of recurrent skin cancer using fluorescence methods is reported. The patient who underwent multiple courses of treatment (surgical resection, cryotherapy and laser ablation) for multifocal basal cell carcinoma of head. trunk and extremities. The patient represented with multiple whitish scars in the region of surgery, cryotherapy and laser ablation (one of them was in the region of external ear) and with multiple foci of hyperemia and skin peeling. The patient underwent fluorescence diagnosis according to developed regimen: alasens was given per os at a dose of 30 mg/kg body weight 4 h before study. In the white light there were no features of recurrent tumor in scar areas. During fluorescence examination there was bright red fluorescence in the area of ear scar, which was intact visually, with no additional fluorescence foci in regions of surgical resection, cryotherapy and laser ablation and other regions. According to cytological study of shave biopsy from fluorescecnse area of ear scar the recurrence of basal cell skin carcinoma was diagnosed.