Possibilities of Photodynamic Therapy in the Complex Treatment of Malignant Gliomas

Abstract INTRODUCTION The median life expectancy of patients with malignant glial tumors is in the range of 18 to 23 mo for Grade III and 12 to 15 mo for Grade IV. The use of the method of PDT in the surgery of glial tumors of various degrees of malignancy, as well as a comparative analysis of the effectiveness of the method in patients, is discussed in this study. METHODS This study includes an analysis of 190 patients with glial brain tumors of supratentorial localization, of various degrees of malignancy, operated on in the Department of Neurooncology, Polenov Russian Research Institute of Neurosurgery, from 2004 to 2016; 95 patients (study group) who underwent removal of a tumor with intraoperative photodynamic therapy with a drug of the chlorin e6 group of the second generation; and 95 patients (control group) who underwent tumor removal without PDT. RESULTS The median survival for patients with Grade III gliomas using PDT was 38.5 ± 5.9 mo; in the control group (without PDT), it was 20.3 ± 2.8 mo (P = .0003). The median survival for patients with Grade IV gliomas using PDT was 19.4 ± 3.1 mo; in the control group (without PDT), it was 14.8 ± 2.6 mo (P = .0002). The median duration of the disease-free period for patients in the Grade III subgroup was as follows: in the study group, 20.4 ± 2.79 mo; and in the control group, 13.1 ± 4.1 mo (P = .0002). The median duration of the disease-free period for patients in the Grade IV subgroup was 10.1 ± 3.3 mo in the study group; in the control group, it was 8.7 ± 1.11 mo (P = .0001). CONCLUSION PDT is a promising and safe technique that allows intraoperative action on the residual volume of tumor cells located in the perifocal zone. The use of PDT in the complex treatment of glial brain tumors allows us to increase the median of survival and the recurrence-free period.