Sebastian Kwiatek

Comparison of cryotherapy and photodynamic therapy in treatment of oral leukoplakia

Oral leukoplakia is a pre-malignant lesion of the oral mucosa. The aim of this study is to compare the curative effects of photodynamic therapy and cryotherapy in the treatment of oral leukoplakia. The first group, treated by photodynamic therapy (δ-aminolevulinic acid (ALA), 630-635 nm wavelength), consisted of 48 patients suffering from leukoplakia. The second group consisted of 37 patients treated using cryotherapy. Analyses and comparisons of the complete responses, recurrences, numbers of procedures and adverse effects after both PDT and cryotherapy were obtained. In the first group, a complete response was obtained in 35 patients (72.9%), with thirteen recurrences observed (27.1%) over a six-month period. In the second group, a complete response was obtained in 33 patients (89.2%), and recurrence was observed in nine patients (24.3%). Photodynamic therapy and cryotherapy appear to be comparative methods of treatment that may both serve as alternatives for the traditional surgical treatment of oral leukoplakia. The advantages of PDT are connected with minimally invasive and localized character of the treatment and with not damage of collagenous tissue structures, therefore normal cells will repopulate these arrangements. PDT is more convenient for patients, less painful, and more esthetic.

Twenty years of experience with PDD and PDT in Poland—-Review

This article is a review of laboratory and clinical research undertaken in Poland in PDD and PDT over the past 20 years. These are divided into two parallel research areas. The first is based on clinical trials where new modalities of photosensitizer synthesis, molecular mechanisms of PDT and other aspects are investigated. The second is concerned with clinical aspects of PDD and PDT in both pre-neoplastic and malignant disease. In Poland there were 2 National Congresses in 2006 and 2008 with 100 and 400 participants respectively. One of the oldest centers of Photodynamic Diagnostics and Therapy is located in Bytom. For about 10 years it has led clinical research in Poland with PDD and PDT in such medical disciplines as dermatology, gastroenterology, laryngology, pulmonology, gynecology, and orthopedics.

Does the temperature gradient correlate with the photodynamic diagnosis parameter numerical colour value (NCV)

BACKGROUND Photodynamic diagnosis (PDD) as well as thermovision belong to the category of non-invasive optical diagnosis techniques. Among many different skin cancer diseases, basal cell carcinoma (BCC) is the most frequently occurring one (almost 95% of all skin tumours). In contrast, seborrhoeic keratosis represents almost 70% of benign skin tumours. In this paper we present infrared thermography as an additional method, combined with PDD, to show the differentiation between these two skin mutations. METHODS The photodynamic diagnosis studies were performed by using the autofluorescence diagnosis system Xillix Onco. As an additional non-invasive diagnosis technique, thermovision studies were performed. Thermal imaging was done by using a Thermovision Camera A40M with a sensitivity of 0.07K. The thermograms of the chosen areas were performed in a special room with a temperature of 22.5±1°C. All patients were treated in the Chair and Clinic of Internal Diseases, Angiology and Physical Medicine in Bytom. Thirteen skin lesions were studied: 9 diagnosed as basal cell carcinoma and 4 as seborrhoeic keratosis. All skin lesions were confirmed in histopathological examinations. RESULTS AND CONCLUSIONS The results of the studies revealed significant differences in skin thermal mapping between patients suffering from basal cell carcinoma and seborrhoeic keratosis. It appears that benign skin lesions are characterised by a lower mean temperature than the surrounding healthy skin. To the contrary, cancerous skin mutations appeared on the thermal map at a higher mean temperature. Thermal images for the chosen skin lesions and temperature parameters derived from the thermograms are contiguous with the photodynamic diagnosis results and may give some additional diagnostic information.

Autofluorescence endoscopy with “real-time” digital image processing in differential diagnostics of selected benign and malignant lesions in the oesophagus

BACKGROUND Oesophageal papilloma and Barretts oesophagus are benign lesions known as risk factors of carcinoma in the oesophagus. Therefore, it is important to diagnose these early changes before neoplastic transformation. METHOD Autofluorescence endoscopy is a fast and non-invasive method of imaging of tissues based on the natural fluorescence of endogenous fluorophores. The aim of this study was to prove the diagnostic utility of autofluorescence endoscopy with digital image processing in histological diagnosis of endoscopic findings in the upper digestive tract, primarily in the imaging of oesophageal papilloma. RESULTS During the retrospective analysis of about 200 endoscopic procedures in the upper digestive tract, 67 cases of benign, precancerous or cancerous changes were found. White light endoscopy (WLE) image, single-channel (red or green) autofluorescence images, as well as green and red fluorescence intensities in two modal fluorescence image and red-to-green (R/G) ratio (Numerical Colour Value, NCV) were correlated with histopathologic results. The NCV analysis in autofluorescence imaging (AFI) showed increased R/G ratio in cancerous changes in 96% vs. 85% in WLE. Simultaneous analysis with digital image processing allowed us to diagnose suspicious tissue as cancerous in all of cases. Barretts metaplasia was confirmed in 90% vs. 79% (AFI vs. WLE), and 98% in imaging with digital image processing. In benign lesions, WLE allowed us to exclude tissue as malignant in 85%. Using autofluorescence endoscopy R/G ratio was increased in only 10% of benign changes causing the picture to be interpreted as suspicious, but when both methods were used together, 97.5% were cases excluded as malignancies. Mean R/G ratios were estimated to be 2.5 in cancers, 1.25 in Barretts metaplasia and 0.75 in benign changes and were statistically significant (p=0.04). CONCLUSION Autofluorescence imaging is a sensitive method to diagnose precancerous and cancerous early stages of the diseases located in oesophagus. Especially in two-modal imaging including white light endoscopy, autofluorescence imaging with digital image processing seems to be a useful modality of early diagnostics. Also in observation of papilloma changes, it facilitates differentiation between neoplastic and benign lesions and more accurate estimation of the risk of potential malignancy.

The role of fluorescence diagnosis in clinical practice

Fluorescence diagnosis is a fast, easy, noninvasive, selective, and sensitive diagnostic tool for estimation of treatment results in oncology. In clinical practice the use of photodynamic diagnosis is focused on five targets: detection for prevention of malignant transformation precancerous changes, detection of neoplasmatic tissue in the early stages for fast removal, prevention of expansion and detection of recurrence of the cancer, monitoring therapy, and the possibility of excluding neoplasmatic disease. In this article, selected applications of fluorescence diagnosis at the Center for Laser Diagnostics and Therapy in Bytom, Poland, for each of these targets are presented.

The role of autofluorescence diagnostics in the oral mucosa diseases

BACKGROUND Laser-induced fluorescence diagnostics (LIFE) can be used as an imaging system of precancerous and neoplasmatic lesions of oral mucosa. LIFE system utilizes healthy and neoplasmatically changed tissue in autofluorescence, without using any fluorescence substances. Neoplasmatic lesions are visible in pseudo colors, healthy tissue as a shade of green color and abnormal tissue as a shade of red color. All visible colors have different intensity. Color intensity is relevant to the grade of dysplasia, carcinoma progress and is called numerical color value (NCV). AIM The aim of our study was to find correlation between autofluorescence diagnostics with NCV assessment and type of histopathological diagnostics of specimen biopsy. PATIENTS AND METHODS Fourteen patients participated in our study. Lesions were located in different intraoral areas. The most common location was: buccal, gingival and mandibular mucosa. Patients were examined using laser induced fluorescence diagnostics (400-750 nm wavelength) with NCV using OncoLIFE system. Then the specimen biopsy from the lesion was taken and histopathological examination was performed. RESULTS We have noted different NCV and dependence of NCV on histopathological grade. CONCLUSION Diagnostics using white-light imaging with LIFE imaging is not only a significant faster method and a better diagnostics of preneoplasmatic and neoplasmatic lesions, but also there is a correlation between NCV and histopathological grade. The farther investigations are necessary to prove these preliminary findings.

The effect of ALA-PDT under normoxia and cobalt chloride (CoCl2)-induced hypoxia on adhesion molecules (ICAM-1, VCAM-1) secretion by colorectal cancer cells

BACKGROUND The most fundamental problem in cancer biology research is to understand the mechanisms of cancer cell resistance to oncological therapies. Literature reports emphasize the important role of adhesion molecules: intercellular adhesion molecule 1 and vascular cell adhesion molecule 1 (ICAM-1 and VCAM-1) in cancer progression and resistance to treatment. Photodynamic therapy (PDT) could become the component of a personalized approach to colorectal cancer, therefore we examined the effects of ALA (δ-aminolevulinic) acid PDT in normoxia and under cobalt chloride (CoCl2)-induced hypoxia on ICAM-1 and VCAM-1 secretion by colorectal cancer cells. METHODS Human colorectal cancer cells of different malignant potential SW480 and SW620 were used in the experiment. Cell lines were treated ALA, in order to achieve conditions comparable to in vivo hypoxia, CoCl2 was added, then cells were irradiated both in normoxia and in hypoxia-like conditions. Cell viability was assessed using the LDH and MTT assays and apoptosis. ICAM-1 and VCAM-1 concentrations were determined with the Bio - Plex ProTM Assay and System. RESULTS The experiment revealed that ALA PDT under normoxia and CoCl2-induced hypoxia had no significant effect on ICAM-1 and VCAM-1-dependent adhesion of colorectal cancer cells. The secretion of ICAM-1 by SW480 ell line was more pronounced compared to ICAM-1 secretion by SW620 cells. CONCLUSION Determination of tumor marker levels and especially adhesion molecules involved in metastatic spread is necessary. Our experiment reveals, that ALA PDT in normoxia and CoCl2-induced hypoxia has no effect on adhesion molecules secretion by colon cancer cells in vitro.

Clinical evaluation of twenty cases of heterotopic gastric mucosa of upper esophagus during five-year observation, using gastroscopy in combination with histopathological and microbiological analysis of biopsies

Aim of the study Heterotopic gastric mucosa of the upper esophagus (HGMUE) may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. Furthermore, HGMUE may be the origin of malignant progression to cervical esophageal carcinoma. Material and methods In this work, 20 patients with diagnosed heterotopic gastric mucosa of the upper esophagus (HGMUE) were subjected to 5-year follow-up to determine the extent and structure of histopathological changes within HGMUEs, as well as HGMUE dysplasia and metaplasia, and risk of their malignant transformation. As a diagnostic tool to describe localization, form, size and surface feature of HGMUEs, endoscopy was used. At the same time, the biopsies were collected for histopathological and microbiological analysis. Results In examined patients, HGMUEs were associated with inflammation, chronic gastritis, hiatus hernia, duodenal bulb erosion and ulcer and infection of H. pylori. Intestinal metaplasia and low grade dysplasia were also indicated. During 5 years of observation, both the clinical and histopathological image of diagnosed HGMUEs was stable. The patients with detected presence of H. pylori were treated with triple or quadruple therapy. These results show that HGMUEs may be associated with severe complications in the gastrointestinal tract, such as infection by H. pylori, hiatus hernia or duodenal ulcer. Although dysplasias and metaplasias found in diagnosed HGMUEs were not very numerous and relatively stable both clinically and histopathologically, at the present stage of the study we cannot exclude the possibility of HGMUE malignant transformation.

Proposal of thermal imaging application in photodynamic therapy—Preliminary report

There are many different skin lesions that manifest a skin temperature gradient. Basal cell carcinoma (BCC) is the most frequently occurring type of malignant skin lesion (almost 95% of all skin tumors). BCC is sometimes treated by using photodynamic therapy which is very well tolerated by patients and provides good results, especially in superficial skin layer lesions. The results of our studies showed significant changes in the area of temperature gradient due to photodynamic therapy. It seems that the ability to acquire knowledge of such area changes may provide additional useful information to physicians. The increase of observed isotherm area in comparison to lesion size on the skin was a few times higher. It may suggest the range of areas where the metabolism processes take place. Due to the accumulation of photosensitivity only in tumor cells, we theorize that such a large region of increased metabolism observed during therapy may be connected with a larger range of tumor cells than was previously predicted through diagnosis. However, it should be noted that the region can be much bigger due to the existing heat transfer. The results obtained have a potential meaning in describing the range of chemical and physiological processes occurring during photodynamic therapy.

Whole-Body Cryostimulation as an Effective Method of Reducing Oxidative Stress in Healthy Men

BACKGROUND Whole-body cryostimulation (WBC) is the therapeutic exposure of the total human body (without underwear) to a very low temperature (below -100°C) for 120-180 s. Currently, WBC is used more frequently not only in the treatment of patients suffering from various diseases, but also by healthy people as a wellness method. OBJECTIVES The aim of this research is to evaluate the impact of WBC procedures on oxidative stress parameters in healthy men. MATERIAL AND METHODS The study involved 32 healthy male subjects who were randomly divided into 2 groups: 16 men exposed to WBC procedures with subsequent kinesiotherapy (WBC group) and 16 men exposed only to kinesiotherapy procedures (KT group). Depending on the group, the subjects were exposed to 10 daily WBC procedures lasting 3 min, with a subsequent 60-min of kinesiotherapy, or exclusively to kinesiotherapy. In subjects from both groups, a day before the beginning of a cycle of treatment and a day after its completion, the level of selected indicators of oxidative stress and non-enzymatic antioxidants, as well as the activity of antioxidant enzymes in serum, plasma and erythrocyte lysates were determined. RESULTS In the WBC group subjects, we recorded a statistically significant decrease in the concentrations of most of the parameters of oxidative stress with an accompanying increase in plasma concentrations of non-enzymatic antioxidants (total antioxidant status and uric acid). We recorded no significant changes in the activities of antioxidant enzymes (plasma total superoxide dismutase (SOD) and its isoenzymes SOD-Mn and SOD-ZnCu, erythrocyte catalase, glutathione peroxidase and glutathione reductase). CONCLUSIONS The results we obtained confirmed that WBC decreases oxidative stress in healthy men.