We studied quantitative evaluation of skin erythema using dorsum of hand images of photodynamic therapy (PDT) patients before and after the exposure to sunlight. While PDT is used as a minimally invasive cancer treatment, there is a problem of photosensitivity caused by residual photosensitizer in the skin. To prevent this problem, a dark hospitalization of two weeks in a room with less than 500 lx is prescribed in the case of Npe6 in Japan. After 2 weeks of a dark hospitalization, dorsum of hand is exposed to sunlight for 5 minutes, and the photosensitivity is visually judged to determine the end of a dark hospitalization, but this method has the problem of being qualitative and invasive. The purpose of this study was to quantitatively evaluate cutaneous photosensitivity by analyzing dorsum of hand images of PDT patients before and after the exposure to sunlight using three colorimetric systems. Dorsum of hand images before and after sunlight exposure of nine PDT patients were taken along with color scales. Image processing software was used to extract the sRGB values of the sunlight-exposed area and color scale from the acquired images as histograms. The sRGB values of the color scale of the images were used to correct the imaging conditions and to compare the images before and after sunlight exposure in three color systems: sRGB, CIELAB, and HSV color system. We suggest that the G values of sRGB has the possibility of quantitative evaluation of erythema and photosensitivity.
As salvage surgery after failure of chemoradiotherapy (CRT) for esophageal cancer shows high morbidity and mortality, curative and less invasive salvage treatment has been needed. Photodynamic therapy (PDT) is a candidate for local failure after CRT. Taraporfin sodium (Leserphyrin) is the new generation photosensitizer which was made in Japan, and has an advantage of low skin toxicity because of rapid clearance.
We conducted multi-institutional trial to evaluate the safety and efficacy of PDT using taraporfin sodium for patients with histologically proven local failure limited within the muscularis propria after 50Gy or more CRT for esophageal cancer. The PDT procedure commenced with intravenous administration of a 40mg/m2 dose of talaporfin sodium followed by diode laser irradiation at a 664nm wavelength. We set the primary endpoint as local complete response (L-CR) per patients. In this study, 26 patients were enrolled and all were treated with PDT. Twenty three patients were assessed L-CR after PDT; the L-CR rate per patient was 88.5 % (95% CI: 69.8%-97.6%). No skin phototoxicity was observed only with two weeks’ sun shade, and no grade 3 or worse non-hematological toxicities related to PDT were observed. At the timing of all enrolled cases were followed 3 years or longer, the median local progression free and overall survival time were 3.1 and 4.2 years, respectively.
PDT using new generation photosensitizer and a diode laser is a safe and potentially curative salvage treatment for local failure after CRT for patients with esophageal cancer.
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