Читать книгу Intracranial Gliomas Part III - Innovative Treatment Modalities - Группа авторов - Страница 13

Current management strategy of malignant gliomas is basically similar to cases of other cancers, generally relying on the multimodal approach combining maximum surgical resection and postoperative chemoradiotherapy. However, in difference with somatic neoplasms, attainment of radical elimination of the brain tumor is nearly impossible. Even radiologically total removal is frequently very difficult owing to its effect on nearby eloquent neuronal structures, infiltrative growth without a clearly identified border, and inability to perform extensive resection of the adjacent cerebral tissue except in rare cases [1]. Neoplasms located within or in close vicinity to functionally important brain structures usually cannot be aggressively resected without compromise of the quality of life (QOL). Moreover, it has been demonstrated that approximately 20% of malignant glioma cells are located within 2–4 cm beyond the border of the lesion on post-contrast MRI, whereas 2% are presented even in distant areas of the brain, including the opposite cerebral hemisphere. Such infiltrating growth is difficult to assess during routine evaluation of the extent of resection (EOR) of the tumor. Thus, there is a strong need for novel diagnostic and therapeutic modalities that can be effectively used in such cases.

Clinical applications of photodynamic diagnosis (PDD) and therapy (PDT) have attracted significant attention due to their safety and efficacy in management of various cancers, including intracranial malignant gliomas [2–8]. Both techniques are based on administration of a photosensitizer selectively incorporating into neoplastic cells. Subsequent illumination with appropriate excitation wavelength may permit identification of the tumor employing fluorescence emitted from the given agent or its metabolic products (PDD). On the other hand, photo-irradiation of the neoplasm accumulating photosensitizer may initiate a cascade of photochemical reactions resulting in cell damage and leading to eradication of the lesion (PDT). This chapter provides a review of the current status of such treatment in the management of malignant gliomas and summarizes the personal experience of the authors [9–15] with its clinical application.