Intraoperative photodynamic therapy in the structure of complex treatment of patients suffering from recurrence and continued growth of intracranial meningioma

Abstract

The effectiveness and safety of intraoperative photodynamic therapy in patients with recurrent intracranial meningiomas were examined. Intraoperative photodynamic therapy was performed in three patients suffering from relapse and continued growth of histologically confirmed intracranial meningiomas of supratentorial localization. Intraoperative photodynamic therapy was conducted with consent from patients and was confirmed by a medical commission. We used a photosensitizer of the chlorin e6 group — photoditazine (Veta-Grand, Russia). The drug was administered intravenously at a dose of 1 mg/kg during induction of anesthesia. For irradiation, laser installation Latus (ATKUS, St. Petersburg, Russia) with a power of 2.5 W and wavelength of 662 nm was used. Irradiation was conducted in a continuous mode; the duration of therapy depended on the area of the irradiated surface based on a therapeutic light dose of 180 J/cm2. In the early postoperative period, the patients’ eyes were protected for 24 h from exposure to direct sunlight, and clinical, laboratory, and intrascopic controls were carried out. No complications associated with intraoperative photodynamic therapy were observed in the early postoperative period. On control intrascopy (magnetic resonance imaging in DWI, Flair, T2, T1 + contrast modes), data showing the therapeutic effect of intraoperative photodynamic therapy were obtained. In two cases, changes in tumor tissue and its matrix were confirmed pathomorphologically, indicating the therapeutic effect of intraoperative photodynamic therapy in relation to local control of meningiomas. Thus, the use of intraoperative photodynamic therapy in the complex treatment of patients suffering from a recurrent course of the neoplastic process (“aggressive” meningiomas) reveals its effectiveness for increasing the degree of radicality of the operation and safety. Further development of the technology of intraoperative photodynamic therapy is crucial in treating patients with “aggressive” meningiomas.

Keywords

photodynamic therapy / photoditazine / photosensitizer / laser machine / meningioma / fluorescent diagnostics / neoplastic process / intrascopic control

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