胸腔外科专科护理师纪慧莹.ppt

Photodynamic therapy ( PDT ) in Chest surgery 胸腔外科專科護理師紀慧瑩 2007/12/03 What is photodynamic therapy? It uses a drug, called a photosensitiser, which is activated by light, usually from a laser. The activated drug can kill the cells around the light fiber. PDT uses laser, or other light sources, combined with a light-sensitive drug (called a photosensitising agent) to destroy cancer cells. History of PDT History of PDT 1990 Acridine and light on infusoria History of PDT History of PDT 1913 Meyer–Betz injecting 200mg Hematoporphyrin into himself. The first study with photodynamic therapy in humans. History of PDT The first applications in the UK were in 1981 by John Carruth, who treated patients with advanced ENT and skin cancers. Thomas Dougherty initiated clinical trials and formed the International Photodynamic Association, in 1986. History of PDT FDA first approved Photofrin? (Photosensitizer) in 1998 Taiwan approved in 2002 NTUH chest surgery first used in 2005 Mechanism of PDT Three key components Photosensitizer Light Tissue oxygen The activated drug can kill the cells around the light fiber, by producing reactive oxygen species. These are powerful forms of oxygen which can either kill cells directly, or attack the blood vessels which supply the cells. Mechanism of PDT Why do photosensitizers localize selectively in tumors ? Tumor have a larger interstitial volume than normal Tumor often contain a larger fraction of macrophages than normal tissues Why do photosensitizerslocalize selectively in tumors ? Tumor have a leaky microvasculature Tumor have poor lymphatic drainage The extracellular pH is low in tumor Tumor contain a relatively large amount of newly synthesized collagen Tumor tissue contains many receptors for lipoproteins Photosensitiser Porfimer sodium (Photofrin?) Light Light Light Dosimetry Cylinder Length 1.0 cm 400mW/cm ? 1.0cm = 400mW 2.5 cm 400mW/cm ? 2.5cm = 1000mW 5.0 cm 400mW/