Objective lt;brgt;To evaluated the effect of transpupillary thermotherapy (TTT) on age-related macular degeneration (AMD). lt;brgt; lt;brgt;Methods lt;brgt;Sixty-two cases (62 eyes) of exudative AMD were managed with TTT. Before treatment, 58 cases underwent fundus fluorescein angiography(FFA),42 cases underwent simultaneous indocyanine green angiography (ICGA), and 56 cases underwent optic coherence tomography (OCT).TTT was delivered using a 810 nm diode laser with variable spot sizes 0.5-3.0 mm and power range 60-40 mW,60 seconds duration. Sixty-two cases were followed up for 1-10 months with 4.8 months average. lt;brgt; lt;brgt;Results lt;brgt;The visual acuities of last visit were compared with those before the treatment. The visual acuity was unchanged in 43 cases (69.3%), improved in 15 cases (24.2%), and declined in 4 cases (6.5%). OCT was re-done in 51 cases and compared with OCT images before TTT treatment. The height of macular edema was unchanged in 29 cases (56.9%), decreased in 18 cases (35.3%), and increased in 4 cases (7.8%). The amelioration of visual acuity was compatible with that of macular configuration in the majority of cases (74.5%). Only in 13 cases (25.5%) the amelioration of visual acuity lagged behind that of macular configuration. The re-treatment was performed in 18 cases (29.1%), probably due to insufficiency of laser power. No side-effect was found. lt;brgt; lt;brgt;Conclusion lt;brgt;TTT makes most of the cases of exudative AMD retaining or improving their visual acuity. The employment is secured. Further exploration is needed in order to obtain the parameters of the laser treatment. (Chin J Ocul Fundus Dis, 2002, 18: 180-183)
Objective To assess the effectiveness and safety of hyperthermia combined with chemotherapy for advanced colorectal cancer. Methods Databases such as CNKI, VIP, WanFang Data, CBM, EMbase, PubMed and The Cochrane Library (Issue 3, 2012) were electronically searched from the date of their establishment to June, 2012, and the relevant literature and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on comparison of chemotherapy with hyperthermia plus chemotherapy for advanced colorectal cancer. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Results A total of 11 RCTs involving 708 patients with advanced colorectal cancer were included. The results of meta-analysis showed that: a) as for effectiveness, the chemotherapy combined with hyperthermia group was superior to the chemotherapy group in the partial improve rate (OR=1.65, 95%CI 1.39 to 1.97, Plt;0.000 01) and the total effective rate (OR=3.59, 95%CI 2.51 to 5.12, Plt;0.000 01), with significant differences; b) as for safety, the chemotherapy combined with hyperthermia group was lower than the chemotherapy group in the incidence of neurotoxicity (OR=0.50, 95%CI 0.33 to 0.75, P=0.000 8). Conclusion Compared with chemotherapy, chemotherapy combined with hyperthermia can increase partial improve rate and total effective rate and reduce the incidence of neurotoxicity. Due to the limitation of the included studies, large sample size, multicenter, high quality studies are needed to verify the above conclusion. We recommend that chemotherapy combined with hyperthermia therapy could be applied to clinic combining individual conditions of patients.
Objective To systematically review the effectiveness and safety of hyperthermia (HT) plus intraperitoneal hyperthermic perfusion chemotherapy (IHPC) versus IHPC alone for malignant ascites. Methods Such databases as PubMed, The Cochrane Library, EMbase, VIP, WanFang, CNKI and CBM were electronically and comprehensively searched for randomized controlled trials (RCTs) on HT plus IHPC vs. IHPC alone for malignant ascites from inception to March 2013. Two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data and assessed quality of the included studies. References of the included studies were also retrieved. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 16 RCTs involving 984 patients were included. The results of meta-analysis showed that, compared with the IHPC alone group, the HT plus IHPC group had a higher effective rate of controlling ascites (OR=3.40, 95%CI 2.58 to 4.48, Plt;0.000 01), better improvement in quality of life (OR=2.77, 95%CI 1.90 to 4.05, Plt;0.000 01), with significant differences. The two groups were alike in 1-year survival with no significant difference (OR=1.80, 95%CI 0.61 to 5.31, P=0.28). As for safety, there was no significant difference between the two groups in the incidences of nausea and vomiting, abdominal distension and pain, myelosuppression, diarrhea, and constipation. Conclusion The results of this systematic review show that, compared with IHPC alone, HT plus IHPC improves the effective rate as well as the quality of life of patients with malignant ascites, and it does not increase the incidences of adverse reactions. Due to the limited quality and quantity of the included studies, more high quality RCTs with larger sample size are needed to verify the above conclusion.
To observe the pathologic changes of normal tissue in nude mice after peritoneal perfusion with hyperthermia, hyper-osmolar solution and mitomycin C (MMC). Fifty BALB/c nunu mices (7-10 weeks old) bearing HT-2 lines were chosen for the study, and were randomly divided into five groups: isotonic solution (control group), hyperosmolar solution (HOS group), HOS plus MMC group, hyperthermia (HT group) and HOS plus HT plus MMC group. After continuous hyperthermic peritoneal perfusion (42℃/30min) with 7.5% NaCl and 5μg/ml MMC, the liver, spleen, small intestine and kidney were examined by light microscopy. Results: ①In HOS and HOS plus MMC groups, no changes of liver, spleen and kidney were found. ②In HT and HOS plus HT plus MMC groups, slight degeneration of liver, hyperemia of spleen, swelling of kidney tubule cells and small intestine were found. ③In HOS plus HT plus MMC group, partial loss of small intestinal villi were also observed. Conclusioin: After continuous hyperthermic perfusion conbined with hyper-osmolar solutions and mitomycin C, a slight injury was showed in normal tissue of nude mice.
The antitumor activity of hyperthermia combined with mitomycin(MMC),5-fluorouracil(5-Fu)was observed in human gastric carinoma cell line MGC-803.The study was aimed at understanding the percentage of living carcinoma cell,plating efficiency and survival fraction.The results showed that hyperthermia combinedwith MMC had a synergistic antitumor activity which was enhanced with temperature increasing,but it was not the same as hyperthermia combined with 5-Fu.In comparison with simple hyperthermia,the antitumor activity of hyperthermia combined with 5-Fu was enhanced at lower temperture.This results raises a basis of clinical practice.
Objective To observe the therapeutic efficacy and complications of plaque radiotherapy (PRT) combined with transpupillary thermotherapy (TTT) on choroidal melanoma (CM). Methods Thirty unilateral CM patients (30 eyes, including 15 males and 15 females) were treated by PRT and TTT. The visual acuity ranged from 0.1 to 0.8 with an average of 0.3plusmn;0.2. The largest base diameter of tumor ranged from 6.8 mm to 17.9 mm with an average of (11.3plusmn;2.8) mm；The tumor height ranged from 3.9 mm to 10.6 mm with an average of (7.2plusmn;2.4) mm. The criteria of controlled local tumor: based on B-scan ultrasound measurement, the tumor was considered as ldquo;growingrdquo; if tumor height increased 2 mm or tumor largest base diameter increased 250 mu;m, otherwise the tumor was considered ldquo;controlledrdquo;. The followup ranged from 15 to 57 months with an average (33.01plusmn;9.81) months. The local tumor control rate, enucleation rate and visual acuity, complications after treatment were observed.Results The tumor largest base diameter after treatment ranged from 4.6 mm to 17.0 mm with an average (9.79plusmn;3.35) mm, which had statistically significant difference（t=2.195，F=0.49；P=0.032) with that before treatment. The tumor height after treatment ranged from 2.7 mm to 11.9 mm with an average (5.19plusmn;2.57) mm, which had statistically significant difference（t=2.069，F=0.018；P=0.0435) with that before treatment. At the end of follow up, the tumor largest diameter and height increased in two eyes respectively compared with those before treatment. Local tumor control rate was 86.7%. Three eyeballs were enucleated after treatment，the enucleation rate was 10.0%. The visual acuity remained unchanged in 12 eyes，improved in one eye and decreased in 17 eyes. Treatment complications included radiation retinopathy in 12 eyes (40.0%), secondary retinal detachment in three eyes (10.0%), secondary glaucoma in one eye (3.3%), cataract in four eyes (13.3%) and dry eye syndrome in five eyes (16.7%). Conclusion PRT combined with TTT is an effective therapy for choroidal melanoma with less complications.
Objective To observe the therapeutic effect of photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) on circumscribed choroid hemangioma (CCH).Methods Clinical data of 32 patients (33 eyes) with CCH diagnosed by ocular fundus examination, fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA),optical coherence tomography (OCT) and Bultrasound examination were retrospectively analyzed.Before the therapy the selected cases had best corrected visual acuity (BCVA) of fingercounting/15 cm-0.2,the sizes of 2-10 disc diameter (DD) and serous retinal detachment.Twentyone patients (22 eyes) whose tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent TTT.The parameters of TTT included: Iris 810 nm infra red diode laser，7001200 mW,60 s,and 1-3 spots. Eleven patients (11 eyes) with tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent. After 15 minutes of intravenous injection with Visudyne, laser irradiation with the wavelength of 689 nm was performed with the time of 83-123 s. The followup period was 12-48 months with the mean of 25.6 months.BCVA and results of indirect ophthalmoscopy,fundus photogrphy,FFA,ICGA,OCT and B ultrasound examination were exanmined and anlyzed.Results In the 22 eyes in TTT group, the BCVA improved in 15 and kept unchanged in 7;the results of fundus examinations showed healed retina and atrophy tumor with greywhite organized scar;the results of FFA revealed no fluorescence leakage and scar fluorescence dyeing of the lesion in later period；the results of OCT indicated disappeared retinal detachment, completely absorbed subretinal liquid and increased reflection of choroid tumor with scar；the results of Bultrasound examination showed no retinal detachment and atrophy tumor.In 11 eyes in PDT group,the BCVA improved in 9, unchanged in 2;the results of fundus examinations showed atrophy tumor with pigmentation；the results of FFA revealed disappeared fluorescence leakage；the results of OCT indicated completely absorbed subretinal liquid；the results of B-ultrasound examination showed atrophy tumor.Conclusions Both TTT and PDT can make the tumor atrophy,improve BCVA or keep it still;but apply to different area.
Objective To observe the therapeutic effects of transpupillary thermal therapy (TTT) on exudative agerelated macular degeneration (AMD) accompanied with subfoveal choroidal neovascularization (CNV).Methods The clinical data of 44 eyes of 41 patients with exudative AMD diagnosed by fundus fluorescein angiography (FFA) who had undergone 810 nmdiode laser were retrospectively analyzed. In the 44 eyes of 41 patients, there were 26 eyes of 24 patients had occult CNV,12 eyes of 12 patients had classic CNV,and 5 eyes of 5 patients had small classic CNV. According to the focus sizes, the diameters of beam spot was 1.2-3.0 mm,the power of laser was 160-400 mW,and the duration was 60 s.The frequency of photocoagulation was once to thrice with the mean of 1.48.The followup duration was 3-24 months with the mean of 10.8 months.Visual acuity, haemorrhage in ocular fundus,absorption of exudation, and the closure of CNV were examined in the followup examination.Results A total of 42 eyes of 40 patients were examined at the last time in the followup duration,in which the visual acuity kept still or improved in 35 eyes of 33 patients (83.34%) and reduced in 7 eyes of 7 patients (16.67%). The results of OCT revealed that 1 and 3 months after the treatment and at the last time of followup duration, the decrease rate of exudative liquid at the macular area was 79.5%,86.4%,and 88.1%, respectively. Three months after the treatment,the macular volume decreased significantly than that before the treatment (P=0.01).The results of FFA demonstrated that at the last time in the folowup duration,the closure rate of occult CNV,classic CNV,and small classic CNV was 79.16%,46.15%,and 60%,respectively.The exudates increased in 6 eyes of 5 paitnets,including 5 eyes of 4 patients with classic CNV and 1 eye of 1 patient with small classic CNV.Conclusion TTT is effective for AMD accompanied with occult CNV,classic CNV, and small classic CNV.
Objective To observe the vascular endthelial cellular apoptosis induced by transpupillary thermotherapy (TTT). Methods Vascular endothelial cells (VEC) cultured in vitro were treated with TTT, hyperthermia and TTT combined with indocyanine green (ICG) pretreatment. The cellular apoptosis was detected by doublelabelled flow cytometer (annexin Vfluroescein isothiocyanate and propidium iodide) analysis, fluorescent microscopy, nucleolus stainned with DNA dye hoechst 33258, DNA ladder detection and electron microscopy. Results Without significant rising of the temperature, TTT couldnprime;t increase the apoptosis of VEC. Pure hyperthermia and TTT combined with ICG pretreatment could increase apoptosis of VEC significantly, and the effect of the latter method was more obvious. The higher power of TTT was used and the longer duration the cells were cultured, the higher apoptosis rate of VEC was. Conclusion The induction of apoptosis of VEC might play an important role in the mechanism of the occlusion of CNV by TTT, and combining with ICG may obviously enhance the apoptosis rate at the same temperature, which may supply a theoretical basis for promoting the clinical effect of TTT.
Objective To compare the clinical results of photodynamic therapy(PDT) and transpupillary thermotherapy (TTT) for patients with choroidal neovascu larization caused by exudative age-related macular degeneration. Methods Seventy cases (82 eyes) with exudative AMD were divided into PDT and TTT groups. Thirty-five cases (42 eyes) were treated with PDT. Nineteen eyes had occult or predominantly occult CNV. Twenty-three eyes had classic or predominantly classic CNV. Thirty-five cases (40 eyes) were treated with TTT. Twenty-five eyes had occult or predominantly occult CNV. Fifteen eyes had classic or predominantly classic CNV . Visual acuity, FFA, ICGA and OCT were evaluated before and after treatment. All cases were subfoveal or juxtafoveal CNV. The follow-up was 3-6 months. Results Visual acuity in 3 eyes (15.8％) of PDT group and 1 eye (4.0％) in TTT group increased at least 2 lines. The difference was no significant(P=0.1778), FFA showed cessation or reduction of fluorescein leakage from CNV in 15 eyes(78.9％) in PDT group and 13 eyes(52.0％) in TTT group. The difference was not significant (P=0 .0657). Three months after treatment, The visual acuity of 2 eyes(10.5％) in PDT group and 2 eyes (8.0％) in TTT group increased at least 2 lines. The difference was not significant (P=0.7728). FFA showed cessation or reduction of fluorescein leakage from CNV in 8 eyes(42.1％) in PDT group and 21 eyes(84.0％) in TTT group. The difference was significant (P=0.0037). Conclusion For classic CNV, the short-term effect of PDT is better than TTT concerning visual acuity. The effect of PDT is apparently better than TTT in cessation or reduction of fluorescein leakage one month after treatment. But there was no significant difference between PDT and TTT in cessation or reduction of fluorescein leakage three month after treatment. For occult CNV, there is no significant short-term difference between PDT and TTT concerning visual acuity. There was no significant difference between PDT and TTT in cessatin or reduction of fluorescein leakage one month after treatment. But three month after treatment TTT is apparently better than PDT in cessation or reduction of fluorescein leakage. We need more cases and longer follow-up to evaluate these two kinds of treatments in treating exudative age-related macular degeneration.(Chin J Ocul Fundus Dis，2004，20：285-288)