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Photodynamic therapy (PDT) is a remarkable alternative or complementary technique to chemotherapy, radiotherapy or immunotherapy to treat certain forms of cancer. The synergistic effect of light, photosensitizer (PS) and oxygen allows for the treatment of tumours with an extremely high spatio-tumoral control, therefore minimizing the severe side effects usually observed in chemotherapy. The currently employed PDT PSs based on porphyrins have, in some cases, some limitations, which include a low absorbance in the therapeutic window, a low body clearance, photobleaching, among others. In this context, Ru(ii) polypyridyl complexes are interesting alternatives. They have low lying excited energy states and the presence of a heavy metal increases the possibility of spin-orbit coupling. Moreover, their photophysical properties are relatively easy to tune and they have very low photobleaching rates. All of these make them attractive candidates for further development as therapeutically suitable PDT PSs. In this review, after having presented this field of research, we discuss the developments made by our group in this field of research since 2017. We notably describe how we tuned the photophysical properties of our complexes from the visible region to the therapeutically suitable red region. This was accompanied by the preparation of PSs with enhanced phototoxicity and high phototoxicity index. We also discuss the use of two-photon excitation to eradicate tumours in nude mice. Furthermore, we describe our approach for the selective delivery of our complexes using targeting agents. Lastly, we report on our very recent synergistic approach to treat cancer using bimetallic Ru(ii)-Pt(iv) prodrug candidates.

Background: To enhance the efficacy of photodynamic therapy (PDT) for actinic keratosis (AKs), physical and chemical pre-treatments, such as calcipotriol (CAL) have been suggested. Objectives: To compare the long-term 12-month efficacy and safety between methylaminolevulinate (MAL)-PDT and prior application of topical CAL versus conventional MAL-PDT for AKs of the scalp. Materials & Methods: Twenty patients with multiple AKs on the scalp were randomized to receive conventional PDT on one side of the scalp and CAL-assisted PDT, in which CAL was applied daily for 15 days beforehand, on the other side. Patients were evaluated for AK clearance at three, six and 12 months thereafter. Results: All 20 patients completed the study. At three months, overall AK clearance was 92.07% and 82.04% for CAL-PDT and conventional PDT, respectively (p < 0.001). Similar results were found at six and 12 months: 92.07% and 81.69% (p < 0.001), and 90.69% and 77.46% (p < 0.001) for CAL-PDT and conventional PDT, respectively. Grade I AKs showed a similar response rate for both sides (p  =  0.055) at three months and significant differences were obtained at six (p  =  0.001) and 12 months (p < 0.001) for CAL-PDT and conventional PDT. Grade II AKs showed greater improvement on the CAL-PDT side (89.55% vs 62.90%) (p < 0.001) at three months. No difference was found at six and 12 months. Conclusion: CAL-PDT proved to be safe and more effective than conventional PDT for the treatment of AKs on the scalp after 12 months. CAL pre-treatment may have enhanced the efficacy of PDT for AK treatment, however, larger trials are needed to corroborate our findings. [ABSTRACT FROM AUTHOR]

Background: Common warts (verrucae vulgares) are human papilloma virus (HPV) infections with a high incidence and prevalence, most often affecting hands and feet, being able to impair quality of life. About 30 different therapeutic regimens described in literature reveal a lack of a single striking strategy. Recent publications showed positive results of photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) in the treatment of HPV-induced skin diseases, especially warts, using visible light (VIS) to stimulate an absorption band of endogenously formed protoporphyrin IX. Additional experiences adding waterfiltered infrared A (wIRA) during 5-ALA-PDT revealed positive effects. Aim of the study: First prospective randomised controlled blind study including PDT and wIRA in the treatment of recalcitrant common hand and foot warts. Comparison of "5-ALA cream (ALA) vs. placebo cream (PLC)" and "irradiation with visible light and wIRA (VIS+wIRA) vs. irradiation with visible light alone (VIS)". Methods: Pre-treatment with keratolysis (salicylic acid) and curettage. PDT treatment: topical application of 5-ALA (Medac) in "unguentum emulsificans aquosum" vs. placebo; irradiation: combination of VIS and a large amount of wIRA (Hydrosun® radiator type 501, 4 mm water cuvette, waterfiltered spectrum 590-1400 nm, contact-free, typically painless) vs. VIS alone. Post-treatment with retinoic acid ointment. One to three therapy cycles every 3 weeks. Main variable of interest: "Percent change of total wart area of each patient over the time" (18 weeks). Global judgement by patient and by physician and subjective rating of feeling/pain (visual analogue scales). 80 patients with therapy-resistant common hand and foot warts were assigned randomly into one of the four therapy groups with comparable numbers of warts at comparable sites in all groups. Results: The individual total wart area decreased during 18 weeks in group 1 (ALA+VIS+wIRA) and in group 2 (PLC+VIS+wIRA) significantly more than in both groups without wIRA (group 3 (ALA+VIS) and 4 (PLC+VIS)): medians and interquartile ranges:-94% (-100%/-84%) vs. -99% (-100%/-71%) vs. -47% (-75%/0%) vs. -73% (-92%/-27%). After 18 weeks the two groups with wIRA differed remarkably from the two groups without wIRA: 42% vs. 7% completely cured patients; 72% vs. 34% vanished warts. Global judgement by patient and by physician and subjective rating of feeling was much better in the two groups with wIRA than in the two groups without wIRA. Conclusions: The above described complete treatment scheme of hand and foot warts (keratolysis, curettage, PDT treatment, irradiation with VIS+wIRA, retinoic acid ointment; three therapy cycles every 3 weeks) proved to be effective. Within this treatment scheme wIRA as non-invasive and painless treatment modality revealed to be an important, effective factor, while photodynamic therapy with 5-ALA in the described form did not contribute recognisably - neither alone (without wIRA) nor in combination with wIRA - to a clinical improvement. For future treatment of warts an even improved scheme is proposed: one treatment cycle (keratolysis, curettage, wIRA, without PDT) once a week for six to nine weeks.

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Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Die Optische Kohärenztomographie (OCT) stellt ein nicht invasives, quantitatives bildgebendes Verfahren dar, bei dem ähnlich der Ultraschall-untersuchung zweidimensionale Querschnitte durch die retinalen Strukturen ermöglicht werden. Ziel unserer Studie war es, die Bedeutung des OCT bei der Verlaufskontrolle von Patienten, die mit Photodynamischer Therapie (PDT) behandelt wurden, zu untersuchen. Die OCT-Scans aller Augen (n = 53), die wegen einer rein klassischen subfovealen chorioidalen Neovascularisation (sCNV) mit PDT behandelt wurden, wurden vermessen, und die Ergebnisse mit den Bildern aus der Fluoreszenzangiographie (FLA) verglichen. 43 Augen konnten eingeschlossen werden, davon 18 Augen mit hoher Myopie, 23 Augen mit altersbedingter Makuladegeneration (AMD) und 2 Augen mit multifokaler Choroiditis. Bei 10 behandelten Augen war zwar die FLA, nicht aber das OCT verwertbar, diese wurden ausgeschlossen. Die mittlere retinale Dicke über der Membran gemessen betrug bei den AMD-Patienten 314 μm bei der Erstuntersuchung und 236,7 um nach 12 Monaten. Bei hoher Myopie wurden vor der PDT im Mittel 256 um gemessen und 204,1 um nach 1 Jahr. Bei 30 Augen (72%) war es möglich den Durchmesser der Membran zu messen, die Werte stimmten mit den mit Hilfe der Fluoreszenzangiographie gemessenen Werten überein. Die Indikation zur Wiederbehandlung konnte ohne FLA nur in wenigen Fällen gestellt werden. Das OCT bringt zusätzliche Informationen über das Ausmaß und die Veränderungen des retinalen Ödems im Verlaufe der Behandlung. Mit Hilfe des OCT können der Behandlungserfolg und die strukturellen Veränderungen sowie Größe und Lokalisation der neovaskulären Membran dokumentiert werden. Derzeit kann das OCT aber die FLA nicht ersetzen. The Optical Coherence Tomography (OCT) is a non-invasive, noncontact, high resolution scan of the retina. The purpose of our study was to evaluate the changes of the retina after Photodynamic Therapy (PDT) with OCT. 53 eyes with classic subfoveal choroidal neovascularisation treated with PDT were examined and the result were compared with the results of the fluorescein angiography (FA). In 10 eyes it was not possible to get scans of sufficient quality. Finally 43 eyes could be included: 23 eyes with age related macular degeneration, 18 eyes with pathologic myopia and 2 eyes with multifocal choroiditis. The mean values of the retinal thickness measured in front of the membrane decreased in AMD patients from 314 μm at baseline to 236.7 μm after 12 months. The mean values in eyes with pathologic myopia decreased from 256 μm to 204.1 urn after one year. In 30 eyes it was possible to measure the greatest horizontal diameter of the membrane with the OCT. These values were similar to the results of the measurement with the FA. There was a good correlation between the results of the measurements with the OCT and the FA. In 72% it was possible to measure the greatest diameter of the lesion with the OCT. In few cases it was possible to decide for retreatment with the OCT alone. Measurements of the retinal thickness are useful in evaluating the effect of PDT and structural changes can be evaluated with high precision. However today the FA cannot be replaced by the OCT. [ABSTRACT FROM AUTHOR]