Dr. Cyril Maire Profile

Dr. Cyril Maire

at Onco-ThAI

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Publications (2)

Proceedings Article | 7 August 2019 Presentation + Paper

Light emitting fabrics for photodynamic treatment of vulvar primary extramammary Paget's disease

E. Thecua, F. Lecomte, L. Ziane, A-S. Vignion, C. Maire, C. Vicentini, H. Abirached, D. Staumont, L. Mortier, S. Mordon

Proceedings Volume 11070, 110703J (2019) https://doi.org/10.1117/12.2525609

KEYWORDS: Photodynamic therapy, Biomedical optics, Light, Optical fibers, Dermatology, Skin, Light sources, Laser sources, Cancer, Laser ablation

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Primary Extramammary Paget’s disease (EMPD) is a rare cancer that mainly affects the genital region including vulvar and perianal areas. Without treatment, vulvar EMPD progresses and presents always more erythematous and pruritic plaques, which may become ulcerated and erosive. To control disease progression and symptoms usually experienced by patients, surgical excision is the mainstay of treatment. Unfortunately, even after large surgical excision with intra-operative margin control, recurrences are common [1]. For recurrent patients which undergo multiple resections, severe functional and sexual alterations are described. Only few data are available on the efficacy of alternative conservative treatments, such as laser ablation, radiotherapy, topical chemotherapy and photodynamic therapy (PDT) [2]. To date, none of them can be considered as a solid alternative to surgical excision yet [3]. Nonetheless, multiple clinical cases suggest that PDT could provide the opportunity to treat subclinical lesions, and give some relief on patient’s symptoms of the disease [4-6]. Unfortunately, the benefits of using photodynamic therapy for vulvar EMPD remains a challenge to demonstrate, because of the inhomogeneous illumination of vulvar and perianal areas, and the extreme pain that patients usually experienced during the illumination procedure that may lead to premature end of treatment [7, 8]. Resulting from the knowledge of previous works on actinic keratosis of the scalp treatment with PDT, light emitting fabrics (LEF) technology could address both of the hereinbefore described issues [9-12]. A new medical device based on LEF named PAGETEX dedicated to illumination of vulvar and perianal areas has been developed. The device delivers a homogeneous red light (635 nm) with a low irradiance during 2h30, for a total fluence of 12 J/cm². The PAGETEX device is being assessed in a clinical study (NCT03713203) which aims to establish PAGETEX- PDT efficacy and tolerability.

Proceedings Article | 7 August 2019 Presentation + Paper

Light emitting fabrics for PDT: technology and results of clinical studies

Serge Mordon, Elise Thecua, Fabienne Lecomte, Anne-Sophie Vignion-Dewalle, Pascal Deleporte, Cyril Maire, Henry Abi-Rached, Claire Vicentini, Theresa Hommel, R. Markus Szeimies, Laurent Mortier

Proceedings Volume 11070, 110705L (2019) https://doi.org/10.1117/12.2524874

KEYWORDS: Photodynamic therapy, Light, Dermatology, Light sources, Skin, Optical fibers, Manufacturing

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A homogeneous and reproducible fluence rate delivery during clinical PDT plays a determinant role in preventing underor overtreatment. In Dermatology, topical PDT has been carried out with a wide variety of light sources delivering a broad range of light doses. However, these light sources do not deliver a uniform light distribution on the skin due to their structure and morphology and the complexities of the human anatomy. The development of a flexible light source able to generate uniform light on all its surface would considerably improve the homogeneity of light delivery. The integration of plastic optical fibers (POF) into textile structures offers an interesting alternative. The homogeneous light side-emission from the fabric is obtained by controlling the bending angles of POF inside the LEF due to specific architecture generated by knitting of textile structure. LEF of different surfaces can be easily manufactured (up to 500cm² The LEF thickness is less than 1 mm. The mean irradiance is typically 2.5 mW.cm^-2. W-1 with heterogeneity of 12.5% at any point of the LEF. The temperature elevation remains below 1°C. These LEF were evaluated in Dermatology for the treatment of Actinic Keratosis. Two clinical evaluation were performed. The first one was a monocentric, randomized, controlled, phase II clinical study (ClinicalTrials.gov Identifier: NCT03076918). Twenty five (25) patients with grade I-II actinic keratosis (AK) of the forehead and scalp were treated with methyl aminolevulinate photodynamic therapy in two symmetrical areas. One area was treated with the conventional LED panel (154 AK), whereas the other area was treated with the LEF device (156 AK). The second clinical was performed in 2 centers. This new LEF device was a more ergonomic and compact version of the original system developed for FLEXIPDT. In this clinical study (ClinicalTrials.gov Identifier: NCT03076892), the irradiance has been reduced from 12.3 mW/cm² to 1.3 mW/cm² and the light dose from 37 J/cm² to 12 J/cm² . Compared to Conventional PDT, the 2 protocols clearly shown that LEF are equivalent and even superior in terms of efficacy for treating AK of the forehead and scalp. However, the use of LEF resulted in much lower pain scores and fewer adverse effects. In conclusion, thanks to LEF, PDT of AK can be conducted in all weather conditions, in any geographic location, year-round and benefits from the optimal adaptability of the flexible, light-emitting, fabrics to the treatment area. At last, LEF can be easily can be easily manufactured in large series.

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