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Ukwelashwa Nge-Photodynamic Komdlavuza
Kuyini ukwelashwa kwe-photodynamic?
I-Photodynamic therapy (PDT) yindlela yokwelapha esebenzisa umuthi, obizwa nge-photosensitizer noma i-photosensitizing agent, nohlobo oluthile lokukhanya. Lapho ama-photosensitizers evezwa kubude obuthile bokukhanya, akhiqiza uhlobo lomoya-mpilo obulala amaseli aseduze (1 ?? 3).
I-photosensitizer ngayinye yenziwe isebenze ngokukhanya kobude obuthile (3, 4). Le wavelength inquma ukuthi ukukhanya kungahamba kangakanani emzimbeni (3, 5). Ngakho-ke, odokotela basebenzisa ama-photosensitizers athile nama-wavelengths of light ukwelapha izindawo ezihlukene zomzimba nge-PDT.
I-PDT isetshenziswa kanjani ekwelapheni umdlavuza?
Esinyathelweni sokuqala se-PDT sokwelashwa komdlavuza, i-ejenti ye-photosensitizing ijojowe egazini. I-ejenti imuncwa amaseli emzimbeni wonke kepha ihlala kumaseli womdlavuza isikhathi eside kunalokho ehlala kumaseli ajwayelekile. Cishe amahora angama-24 kuye kwangama-72 ngemuva kokujova (1), lapho iningi le-ejenti selishiye amaseli ajwayelekile kepha lihlala kumaseli womdlavuza, isimila sivezwa ukukhanya. I-photosensitizer ku-tumor ithatha ukukhanya futhi ikhiqize uhlobo olusebenzayo lwe-oxygen olubhubhisa amangqamuzana omdlavuza aseduze (1 ?? 3).
Ngaphezu kokubulala ngqo amaseli omdlavuza, i-PDT ibonakala incipha noma ibhubhisa izicubu ngezinye izindlela ezimbili (1 ?? 4). I-photosensitizer ingalimaza imithambo yegazi esikhunjeni, ngaleyo ndlela ivimbele umdlavuza ekutholeni izakhamzimba ezidingekayo. I-PDT nayo ingenza ukuthi amasosha omzimba ahlasele amangqamuzana e-tumor.
Ukukhanya okusetshenziselwa i-PDT kungavela kwi-laser noma eminye imithombo (2, 5). Ukukhanya kwe-Laser kungaqondiswa ngezintambo ze-fiber optic (imicu emincane edlulisa ukukhanya) ukuletha ukukhanya ezindaweni ezingaphakathi komzimba (2). Isibonelo, ikhebula le-fiber optic lingafakwa nge-endoscope (ithubhu elincane, elikhanyisiwe elisetshenziselwa ukubheka izicubu ngaphakathi emzimbeni) emaphashini noma emphinjeni ukwelapha umdlavuza kulezi zitho. Eminye imithombo yokukhanya ifaka ama-diode akhipha ukukhanya (ama-LED), angasetshenziselwa izicubu zomhlaba, njengomdlavuza wesikhumba (5).
I-PDT ivame ukwenziwa njengenqubo yokuphulukiswa kweziguli (6). I-PDT nayo ingaphindwa futhi ingasetshenziswa nezinye izindlela zokwelapha, njengokuhlinzwa, ukwelashwa ngemisebe, noma i-chemotherapy (2).
I-Extracorporeal photopheresis (ECP) uhlobo lwe-PDT lapho umshini usetshenziselwa ukuqoqa amangqamuzana egazi esiguli, uwaphathe ngaphandle komzimba nge-photosensitizing agent, uwaveze ekukhanyeni, bese uwabuyisela esigulini. I-US Food and Drug Administration (i-FDA) ivume i-ECP ukusiza ukwehlisa ukuqina kwezimpawu zesikhumba ze-T-cell lymphoma enezinhlungu ezingaphendulanga kwezinye izindlela zokwelapha. Ucwaningo luyaqhubeka ukuthola ukuthi ngabe i-ECP ingaba yini nesicelo esithile somdlavuza wegazi, kanye nokusiza ukunciphisa ukwenqatshwa ngemuva kokufakelwa.
Yiziphi izinhlobo zomdlavuza njengamanje eziphathwa nge-PDT?
Kuze kube manje, i-FDA ivume i-ejenti ye-photosensitizing ebizwa nge-porfimer sodium, noma i-Photofrin®, ukuthi isetshenziswe ku-PDT ukwelapha noma ukuqeda izimpawu zomdlavuza wokucinana komdlavuza kanye nomdlavuza wamangqamuzana ongewona omncane. I-Porfimer sodium ivunyelwe ukukhulula izimpawu zomdlavuza wokucinana lapho umdlavuza uvimbela isopha noma lapho umdlavuza ungeke welashwe ngokwanelisayo nge-laser therapy iyodwa. I-Porfimer sodium isetshenziselwa ukwelapha umdlavuza wamangqamuzana ongewona omncane ezigulini lapho ukwelashwa okujwayelekile kungafaneleki kuzo, nokuqeda izimpawu ezigulini ezinomdlavuza ongewona omncane wamangqamuzana wamaphaphu ophazamisa imigwaqo yomoya. Ngo-2003, i-FDA yavuma i-porfimer sodium yokwelashwa kwezilonda ezingaphambi kwesikhathi ezigulini ezine-Barrett esophagus, isimo esingaholela kumdlavuza wokuqopha.
Yini imikhawulo ye-PDT?
Ukukhanya okudingekayo ukuze kusebenze iningi lama-photosensitizers alikwazi ukudlula ngaphezu kwengxenye eyodwa kwezintathu ye-intshi yethishu (isentimitha elilodwa). Ngalesi sizathu, i-PDT ivame ukusetshenziselwa ukwelapha izicubu ngaphakathi noma ngaphansi kwesikhumba noma kulayini wezitho zangaphakathi noma izimbotshana (3). I-PDT nayo ayisebenzi kangako ekwelapheni izicubu ezinkulu, ngoba ukukhanya akukwazi ukudlula kude kula mathumba (2, 3, 6). I-PDT iyindlela yokwelapha yendawo futhi ngokuvamile ayinakusetshenziswa ekwelapheni umdlavuza osabalele (owenziwe ngemetastasized) (6).
Ngabe i-PDT inezinkinga noma imiphumela emibi?
I-Porfimer sodium yenza isikhumba namehlo azwele ekukhanyeni cishe amasonto ayisithupha ngemuva kokwelashwa (1, 3, 6). Ngakho-ke, iziguli zelulekwa ukuthi zigweme ilanga eliqondile nokukhanya kwangaphakathi okukhanyayo okungenani amasonto ayisithupha.
Ama-photosensitizers athanda ukwakha amathumba futhi ukukhanya okusebenzayo kugxile ku-tumor. Ngenxa yalokhu, ukulimala kwezicubu ezinempilo kuncane. Kodwa-ke, i-PDT ingadala ukusha, ukuvuvukala, ubuhlungu, kanye nokusikeka ezicutshini eziseduze ezinempilo (3). Eminye imiphumela emibi ye-PDT ihlobene nendawo elashwa. Kungabandakanya ukukhwehlela, inkinga yokugwinya, ubuhlungu besisu, ukuphefumula okubuhlungu, noma ukuphefumula okuncane; le miphumela emibi ivame ukuba yesikhashana.
Likuphatheleni ikusasa le-PDT?
Abaphenyi bayaqhubeka nokutadisha izindlela zokwenza ngcono ukusebenza kwe-PDT futhi bayinwebele kwamanye amagciwane. Izilingo zomtholampilo (izifundo zocwaningo) ziyaqhubeka zokuhlola ukusetshenziswa kwe-PDT yomdlavuza wobuchopho, isikhumba, i-prostate, umlomo wesibeletho kanye nomgodi we-peritoneal (isikhala esiswini esiqukethe amathumbu, isisu nesibindi). Olunye ucwaningo lugxile ekwakhiweni kwama-photosensitizers anamandla amakhulu (1), aqonde ngqo amaseli womdlavuza (1, 3, 5), futhi acushwa ngokukhanya okungangena kwizicubu nokwelapha izicubu ezijulile noma ezinkulu (2). Abaphenyi baphinde baphenye izindlela zokwenza ngcono imishini (1) kanye nokulethwa kwelambu elisebenzayo (5).
Izinkomba ezikhethiwe
- AmaDolmans DE, uFukumura D, uJain RK. Ukwelashwa kwe-Photodynamic yomdlavuza. Umdlavuza Wokubuyekezwa Kwemvelo 2003; 3 (5): 380-387. [I-PubMed Abstract]
- UWilson BC. Ukwelashwa kwe-Photodynamic yomdlavuza: izimiso. Ijenali yaseCanada yeGastroenterology 2002; 16 (6): 393--396. [I-PubMed Abstract]
- IVrouenraets MB, Visser GW, Snow GB, van Dongen GA. Izimiso eziyisisekelo, ukusetshenziswa kwe-oncology nokukhethwa okuthuthukisiwe kokwelapha kwe-photodynamic. Ucwaningo lwe-Anticancer 2003; 23 (1B): 505-522. [I-PubMed Abstract]
- UDougherty TJ, uGomer CJ, uHenderson BW, et al. Ukwelashwa kwe-Photodynamic. Ijenali yeNational Cancer Institute 1998; 90 (12): 889–905. [I-PubMed Abstract]
- UGudgin Dickson EF, uGoyan RL, uPottier RH. Izinkomba ezintsha ekwelashweni kwe-photodynamic. Iselula ne-Molecular Biology 2002; 48 (8): 939-954. [I-PubMed Abstract]
- ICapella MA, iCapella LS. Ukukhanya kokumelana nemithi eminingi: ukwelashwa kwe-photodynamic kwezimila zemithi eminingi. Ijenali yeBiomedical Science 2003; 10 (4): 361-366. [I-PubMed Abstract]
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