Intraoperative Photodynamic Surgery (iPDS) with Acridine Orange for Musculoskeletal Sarcomas
نویسندگان
چکیده
We recently established the new limb salvage modality of acridine orange (AO) therapy (AOT), in an attempt to develop minimally invasive limb salvage surgery with minimal damage of normal tissues and a low risk of local recurrence. The treatment modality consists of intraoperative photodynamic surgery (iPDS) and photodynamic therapy (iPDT), followed by postoperative radiodynamic therapy (RDT) using AO for patients with high-grade malignant musculoskeletal sarcomas. Clinical results have shown that the treatment is associated with a low risk of local recurrence, the risk being almost the same as that following conventional wide resection, and yields superior limb function as compared to that obtained after wide resection. In this review, we present the detailed mechanism of selective accumulation of AO in sarcomas, which is related to the acidic environment and lysosomal acidity of the tumor cells induced by cancer-specific glycolysis not involving the define tricarboxylic acid (TCA) cycle (Warburg's effect). We also describe the clinical uses of AOT and the procedure for intraoperative photodynamic surgery (iPDS) using local administration of AO. Categories: General Surgery, Oncology, Orthopedics
منابع مشابه
Photodynamic therapy with acridine orange in musculoskeletal sarcomas.
Limb salvage involving wide resection and reconstruction is now well established for managing musculoskeletal sarcomas. However, involvement of major nerves and vessels with a large volume of muscle and skin may result in a useless limb, contributing to depression and a low quality of life. We have been studying alternative treatments for musculoskeletal sarcoma since 1990, and have recently es...
متن کاملTumor Microenvironmental Factors and Acridine Orange Intensity Can Predict Clinical Outcome in Soft Tissue Sarcoma Patients
Introduction: The extracellular pH (pHe) in malignant tumors is lower than in benign tumors as a result of the high metabolism of tumor cells [1]. Furthermore, high metabolism causes a lack of nutrition and oxygen in solid tumors [2]. Tumor cells grown under acidic and hypoxic conditions exhibit a more proliferative phenotype than cells grown under typical neutral conditions. However, the use o...
متن کاملMethylene blue in place of acridine orange as a photosensitizer in photodynamic therapy of osteosarcoma.
We recently established a unique therapeutic modality for musculoskeletal sarcomas, combining acridine orange (AO) with photodynamic surgery (PDS), photodynamic therapy (PDT) and radiodynamic therapy (RDT); excellent results were obtained in the inhibition of local tumor recurrence after intralesional excision. However, AO is not yet approved for clinical use and intravenous injection. Therefor...
متن کاملSafety of Systemic Acridine Orange Administration with Low-dose Radiation in Mice
Acridine orange (AO) is a known radiation sensitizer, and concomitant local administration of AO and irradiation (5 Gy) after cytoreductive surgery results in good local control of musculoskeletal sarcomas in humans. Local administration of AO solution into the surgical field can act directly on residual tumor cells, and it is thought that systemic administration of AO may affect tumor cells in...
متن کاملAcridine orange used for photodynamic therapy accumulates in malignant musculoskeletal tumors depending on pH gradient.
BACKGROUND Intra-operative photodynamic therapy has been applied with acridine orange (AO-PDT) to human musculoskeletal sarcomas for the past 4 years, resulting in a low local recurrence rate, within 10%, after intra-marginal tumor resection and excellent limb function. However, it is still unclear why acridine orange (AO) specifically accumulates in tumor cells, especially in malignant tumor c...
متن کامل