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

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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.

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About the authors

Konstantin K. Kukanov

Russian Research Neurosurgical Institute named after prof. A.L. Polenova

Email: pashsukhoparov@gmail.com
ORCID iD: 0000-0002-1123-8271
SPIN-code: 8938-0675

MD, Сand. Sci. (Med.), senior research associate

Russian Federation, Saint Petersburg

Anastasiia S. Nechaeva

Russian Research Neurosurgical Institute named after prof. A.L. Polenova; World-class scientific center "Center for Personalized Medicine"

Email: nastja-nechaeva00@mail.ru
ORCID iD: 0000-0001-9898-5925
SPIN-code: 2935-0745

junior research associate

Russian Federation, Saint Petersburg; Saint Petersburg

Darya A. Sitovskaya

Russian Research Neurosurgical Institute named after prof. A.L. Polenova

Email: pashsukhoparov@gmail.com
ORCID iD: 0000-0001-9721-3827
SPIN-code: 3090-4740

researcher

Russian Federation, Saint Petersburg

Mikhail V. Dikonenko

Russian Research Neurosurgical Institute named after prof. A.L. Polenova; V.A. Almazov National Medical Research Center

Email: pashsukhoparov@gmail.com
ORCID iD: 0000-0002-8701-1292
SPIN-code: 6920-5656

neurosurgeon

Russian Federation, Saint Petersburg; Saint Petersburg

Pavel D. Sukhoparov

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: pashsukhoparov@gmail.com
ORCID iD: 0009-0007-3185-7348
SPIN-code: 4066-7810

student

Russian Federation, Saint Petersburg

Ilya O. Ishchenko

Saint Petersburg State Pediatric Medical University

Email: pashsukhoparov@gmail.com
ORCID iD: 0009-0006-9122-5935
SPIN-code: 6451-5600

student

Russian Federation, Saint Petersburg

Yulia M. Zabrodskaya

Russian Research Neurosurgical Institute named after prof. A.L. Polenova

Email: pashsukhoparov@gmail.com
ORCID iD: 0000-0001-6206-2133
SPIN-code: 8571-3190

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Nikita K. Samochernykh

V.A. Almazov National Medical Research Center

Email: pashsukhoparov@gmail.com
ORCID iD: 0000-0002-6138-3055
SPIN-code: 6131-4468

a neurosurgeon

Russian Federation, Saint Petersburg

Garry V. Papayan

V.A. Almazov National Medical Research Center

Email: pashsukhoparov@gmail.com
ORCID iD: 0000-0002-6462-9022
SPIN-code: 7327-7837

Сand. Sci. (Tech.), senior research associate

Russian Federation, Saint Petersburg

Victor E. Olushin

Russian Research Neurosurgical Institute named after prof. A.L. Polenova

Email: pashsukhoparov@gmail.com
ORCID iD: 0000-0002-9960-081X

MD, Dr. Sci. (Med.), professor

Russian Federation, Saint Petersburg

Konstantin A. Samochernykh

V.A. Almazov National Medical Research Center

Email: pashsukhoparov@gmail.com
ORCID iD: 0000-0003-0350-0249
SPIN-code: 4188-9657

MD, Dr. Sci. (Med.), professor

Russian Federation, Saint Petersburg

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Supplementary files

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1. JATS XML
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2. Fig. 1. Patient M., 52 years old. Magnetic resonance imaging of the brain in T1 mode + contrast in axial (а), coronal (b) and sagittal projections (с)

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3. Fig. 2. Spectroscopic examination before photodynamic therapy: a — skin fluorescence index — 3; fluorescence index of the intact dura mater — 4; tumor matrix fluorescence index — 7.5; fluorescence index of meningioma — 8; b — intraoperative fluorescence visualization, fluorescence index — 3

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4. Fig. 3. Spectroscopic examination during photodynamic therapy: a — fluorescence index of the tumor matrix before the start of photodynamic therapy — 12; after session 1 of photodynamic therapy, the fluorescence index decreased to 4.5. After session 2 of photodynamic therapy, the fluorescence index in the irradiated area decreased to 4 (to the level of the fluorescence index in the intact dura mater). b — Intraoperative fluorescence visualization, fluorescence index — 0

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5. Fig. 4. Patient M., 52 years old. Magnetic resonance imaging of the brain in T1 + contrast mode in axial (а), coronal (b), and sagittal (c) projections (postoperative control)

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6. Fig. 5. Patient M., 52 years old. Magnetic resonance imaging of the brain in DWI mode in axial projection (arrow: zone of reduction/ limitation of diffusion)

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7. Fig. 6. Expression of progesterone receptors in atypical meningioma, increase × 400: a — before photodynamic therapy; b — after photodynamic therapy

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8. Fig. 7. Expression of caspase-3 of the perifocal zone of tumors, increase × 400: a — before photodynamic therapy; b, c — after photodynamic therapy (black arrow: gliocytes; green arrow: neurons)

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9. Fig. 8. Patient P., 49 years old. Magnetic resonance imaging of the brain in T1 + contrast mode in axial (a), coronal (b), and sagittal (c) projections

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10. Fig. 9. Spectroscopic examination before photodynamic therapy: а — skin fluorescence index — 2; fluorescence index of intact dura mater at 1 cm from the tumor matrix — 4.6; tumor matrix fluorescence index — 5.6; meningioma fluorescence index — 7. However, only the fluorescence curve of meningioma has the form of true chlorine fluorescence; b — intraoperative fluorescence visualization, fluorescence index — 3

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11. Fig. 10. Spectroscopic examination during photodynamic therapy: а — fluorescence index of the bed of the removed tumor before photodynamic therapy, 8; after session 1 of photodynamic therapy, fluorescence index decreased to 3.2. After the second half of photodynamic therapy, fluorescence index decreased to 1.2; b — intraoperative fluorescence imaging, fluorescence index — 0

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12. Fig. 11. Patient P., 49 years old. Magnetic resonance imaging of the brain (postoperative control) in the DWI mode (a) and T1 + contrast in axial (b) and coronal (c) projections

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13. Fig. 12. Patient P., 48 years old. Magnetic resonance imaging of the brain in T1 + contrast mode in axial (a), coronal (b), and sagittal (c) projections

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14. Fig. 13. Spectroscopic examination before photodynamic therapy: а — skin fluorescence index — 4.8; intact dura mater fluorescence index — 7; tumor matrix fluorescence index — 12; meningioma fluorescence index — 22; b — intraoperative fluorescence imaging, fluorescence index — 1

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15. Fig. 14. Spectroscopic examination during of photodynamic therapy: а — fluorescence index of the residual part of the tumor before photodynamic therapy — 13; after session 1 of photodynamic therapy, fluorescence index decreased to 7. After session 2 of photodynamic therapy, fluorescence index decreased to 6 (to the level of fluorescence index in the intact dura mater); b — intraoperative fluorescence imaging, fluorescence index — 0

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16. Fig. 15. Patient P., 48 years old. Magnetic resonance imaging of the brain (postoperative control) in the DWI mode (a) and T1 + contrast in axial (b) and coronal (c) projections

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