PHOTODYNAMIC

THERAPY
By
Dr.Shakil Ashraf
Postgraduate Trainee
 CONTENTS
• HISTORY
• PHOTODYNAMIC THERAPY
• PRINCIPLES OF PDT
• TYPES OF PDT
• MECHANISM OF ACTION
• INDICATIONS
• LIMITATIONS & ADVERSE EFFECTS
HISTORY
PHOTOSYNTHESIS --PDT
chlorophyll absorbs the sunlight.
PHOTODYNAMIC
THERAPY???
PDT PARAMETERS
 Photodynamic Therapy
(PDT)???
Photosensitiser (retained in tumour)
+
Visible light - wavelength to activate
phosensitiser

Singlet oxygen

Tumour cell death
(necrosis+apoptosis)
 SYSTEMIC PDT

S0

light
T1
1O PDT
2
drug O2

GROUND GROUND
STATE STATE O2
PRINCIPLES OF PDT

Our major
light source:
the Sun
 PRINCIPLES OF PDT CONTD…..
The Electromagnetic Spectrum
 Wavelength
Color Name
(Nanometers)
Infrared 880
Ultra Red 660
Super Red 633
Super Orange 612
Orange 605
Yellow 585
Incandescent
4500K (CT)
White
Pale White 6500K (CT)
Cool White 8000K (CT)
Pure Green 555
Super Blue 470

Blue Violet 430

Ultraviolet 395
 PRINCIPLES OF PDT CONTD…..
COHERENT LIGHT VS INCOHERENT LIGHT
ICL:Lamps, flashlights, etc… all produce light-- released in
many directions--is very weak and diffuse.
CL: Lasers and holograms.. the wavelength and frequency of
the photons emitted are the same

Incoherent

Coherent
 PRINCIPLES OF PDT CONTD ….
LIGHT SOURCES

• Incandescent lamps-light (bulbs )

• High pressure arc lamps—(Hg or Xn)
• Low pressure arc lamps(fluorescent
material ---ordinary room lighting)
• Light diodes
• LDs – Laser Diodes
• Tunable Lasers
• Optical fiber technology
 PRINCIPLES OF PDT COND…..
LIGHT SOURCES & WAVE LENGTH
1. Therapeutic window for PDT (600nm---
1200nm)
2. Light bulbs ( 400---infra red)
3. Argon pumped dye lasers (630nm)---PP1X
4. Nd –YAG laser (690-1100nm)---NON-PP
5. Lamps with red light—large surface ( metal
halogen lamp---600---800nm
6. Short arc Xenon lamp ( 400—1200nm )
7. Diode laser ( 632----670nm )
8. Light diodes (20---50nm )
ILLUMINATION ??
 LED?

LED..Semiconductor..emit radiation by electroluminescence

in the UV, visible or infrared regions of the
electromagnetic spectrum.
LED: How It Works ?
• When current flows
across a diode

• Negative electrons move one way

and positive holes move the other
way
LED: How It Works
• The holes exist at a
lower energy level
than the free
electrons

• Therefore when a free electrons

falls it losses energy
LED: How It Works ?
• This energy is
emitted in a form of
a photon, which
causes light

• The color of the light is

determined by the fall of the
electron and hence energy level of
the photon
 Laser Diodes
• Use semiconductor
materials (tiny chips of
silicon) as the lasing
media
• When current flows
through the silicon chip it
emits an intense beam of
coherent light.
• Used to read the
information embedded in
the pits in CD’s and
DVD’s, and also to read
In a variety of different UPC’s in bar code
colors scanners and in laser
pointers!
 SINGLET VS TRIPLET
STATES
• Ordinary oxygen, O2, is
actually a pair of free
radicals because each O
has an unpaired
electron. However, the
electron spins of these
electrons are parallel
which make the O2
molecule in the triplet
state.
 SINGLET VS TRIPLET
STATES
• A singlet state is a
molecular electronic
state such that all
electron spins are
paired. That is, the spin
of the excited electron
is still paired with the
ground state electron

1 
O 2
 SINGLET VS TRIPLET
STATES
• In a triplet state
the excited electron
is no longer paired
with the ground
state electron; that
is, they are parallel
(same spin).
3
O2
PHOTOSENSITIZERS
ALA CONVERSION TO PP1X
MECHANISM(PDT) ? ?
• Light source
• Target tissue
• Photosensitizer (PS)
• Molecular oxygen

Tumour
 TYPE-1 & TYPE-11
REACTION
• Type 1:
– Direct reaction with substrate (cell
membrane or molecule)
– Transfer of H atom to form radicals
– Radicals react with O2 to form oxygenated
products
• Type 2:
– Transfer of energy to O2 to form 1O2
Type 1 and 2 Reactions
MECHANISM ???
MECHAMISM ? ? ?
PROCEDURE ? ? ?
USES OF PDT IN DERMA
 Advantages of Topical PDT
• Relatively selective treatment
 Non-invasive
 Multiple lesions may be treated
simultaneously
 Safe
 Supervised outpatient procedure
 Repeated treatments possible
 Minimal or no scarring, good/excellent
cosmesis
 Side-effects and their
management
• Pain/discomfort, often described as “burning”,
“stinging” or “prickling” restricted to treatment
area is common
• Onset in the early part of light exposure, peaking
within minutes, then leveling out
• Most patients tolerate topical PDT without pain
relief
• Face and scalp and large and/or ulcerated lesions
may be more likely to be painful
• Option to reduce pain: topical/injected local
anaesthetic, pre-med., cooling fans or spraying
water
 Side-effects and their
management
– Immediately following illumination,
erythema and oedema are common, with
crust formation and healing over 2-6
weeks
– No generalised photosensitivity
– Hyper- or hypo- pigmentation
occasionally seen
– Hair loss observed for thicker tumours in
scalp/pubis, but much less than
radiotherapy
 Side-effects and their
management
• Systemic photosensitisers can cause long-
lasting generalized cutaneous photosensitivity
(burning,stinging,erythema,edema and bullae
formation)
• Sunlight ,bright spotlights, photocopy
machines, photographic flashlights, medical
examination lights and operation lamps---
AVOID
• Ordinary indoor light --SAFE
 PDT Trials on Tumor Cells:
Skin Cancer
• Traditional Treatments:
– Surgery, electrodesiccation, cryosurgery,
topical application of podophyllin or 5-
fluorouracil, radiation

• Problems:
– High cost, scarring, pigmentation changes,
pain, inflammation, irritation
PDT FOR CANCER OF ESOPHAGUS
 Treatment of Lung Cancer Using
PDT

Cancer cells before PDT Bronchus during PDT Bronchus 24 months after
 CONCLUSION
• Tumor cells show some selectivity for
photosensitizing agent uptake
• Limited damage to surrounding tissues
• Less invasive approach
• Outpatient procedure
• Various application types
• Well accepted cosmetic results
Thank you for your
attention!