Photodiagnosis and Photodynamic Therapy (2005) 2, 167—168
EDITORIAL COMMENT
Mobile photodynamic therapy unit for service to district general hospitals PDT becomes upwardly mobile PDT has been in use for over 30 years. Its application to the treatment of lung cancer has been shown to be beneficial in reducing obstructions and improving quality of life in advanced stage, with additional survival benefit in early stage [1,2]. Nonetheless, very few units offer PDT as a therapeutic option to their patients. Similar statements could be made regarding its use, or rather its lack of use, in treatment of Barrett’s oesophagus [3,4] and bile duct cancer [5]. For patients suffering from these conditions, there are very compelling arguments for including PDT as a treatment option. For other conditions PDT has also been used with some success. Another situation which could be cited is the treatment of non-melanoma skin cancer [6,7] where the current mantra of ‘evidencebased medicine’ reveals the success of this form of treatment. Yet even here, many departments will resort to disfiguring surgery before considering PDT. Why does PDT continue to be practiced by the few? One contributing factor is to do with the fact that it is quite a different sort of therapy from conventional surgery, radiotherapy or chemotherapy, where expertise has been developed and skills have been honed over many years. The specialist has acquired considerable knowledge and experience in his/her speciality and has some understanding of the likely outcome of a particular type of treatment. PDT does not fit into this. There is also the need for expensive lasers which cannot be used for anything else. Moreover, there is the other problem of photosensitivity. How is
this managed? Are we condemning our patients to live out their final days in a dismal twilight zone? For many years, PDT has been given by ‘the few’ in palaces of PDT-excellence while ‘the many’ in less well-endowed establishments have continued to largely ignore its existence. But does it have to be this way? The current issue of PDPDT contains a paper describing the operation of a mobile PDT facility set up and operated by the Yorkshire Laser Centre [8]. This is a bold initiative that facilitates the use of PDT in hospitals that do not possess the equipment or expertise to perform the treatment. The concept of the mobile unit is that the patient is treated in the hospital where he was investigated by the hospital’s own medical team, assisted by a dedicated PDT team. This has been operational since 2002 and scores of patients have received PDT who may not have had the opportunity. Another model for extending the availability of PDT is that which has been adopted by the Scottish PDT Centre [7], which is a virtual centre with a core administrative, nursing and photophysics function. These core skills and the technology are provided to clinicians with a special interest in a range of internal cancers, and trained personnel support PDT in other hospitals as required. The key element is the provision of equipment and expertise to support PDT in hospitals and departments where hitherto this has not been available. It requires a willingness on the part of the Centre to use some of its own resource to help spread the availability of PDT. It is not uncontrolled, which would be harmful, but it involves
1572-1000/$ — see front matter © 2005 Elsevier B.V. All rights reserved. doi:10.1016/S1572-1000(05)00103-1
168 the Centre moving out into the areas where PDT has not yet reached. This can only be to the benefit of the patient and the long-term future of PDT. The Yorkshire Laser Centre is to be applauded for this bold initiative. As well as improving patient care, it also raises awareness of the benefits of PDT—–a truly upwardly mobile unit!
References [1] Moghissi K, Dixon K, Thorpe JAC, Oxtoby C, Stringer MR. Photodynamic therapy (PDT) for lung cancer: The Yorkshire Laser Centre experience. Photodiagn Photodyn Ther 2004;1:253—62. [2] Erickson L. Assessment of photodynamic therapy using porfimer sodium for esophageal, bladder and lung cancers. Agence d’´ evaluation des technologies et des modes d’intervention en sant´ e. AETMIS-04-01; 2004. [3] Barr H. Photodynamic therapy for dysplastic Barrett’s oesophagus and early cancer. Photodiagn Photodyn Ther 2004;1:195—201.
Editorial Comment [4] Claydon PE, Ackroyd R. Barrett’s oesophagus and photodynamic therapy (PDT). Photodiagn Photodyn Ther 2004;1:203—9. [5] Ortner M, Caca K, Berr F, et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomised prospective study. Gastroenterology 2003;125: 1355—63. [6] Morton CA, Brown SB, Collins S, et al. Guidelines for topical photodynamic therapy: report of a workshop of the British Photodermatology Group. Br J Dermatol 2002;146: 552—67. [7] Ibbotson SH, Moseley H, Brancaleon L, et al. Photodynamic therapy in dermatology: Dundee clinical and research experience. Photodiagn Photodyn Ther 2004;1:211—23. [8] Moghissi K, Dixon K. Yorkshire Laser Centre mobile Photodynamic Therapy unit: for service to district general hospitals. Photodiagn Photodyn Ther 2005;2:169—74.
Harry Moseley PhD, FInstP ∗ Scottish PDT Centre and Photobiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK ∗ Tel.:
+44 1382 632240. E-mail address: [email protected]
EDITORIAL COMMENT
Mobile photodynamic therapy unit for service to district general hospitals PDT becomes upwardly mobile PDT has been in use for over 30 years. Its application to the treatment of lung cancer has been shown to be beneficial in reducing obstructions and improving quality of life in advanced stage, with additional survival benefit in early stage [1,2]. Nonetheless, very few units offer PDT as a therapeutic option to their patients. Similar statements could be made regarding its use, or rather its lack of use, in treatment of Barrett’s oesophagus [3,4] and bile duct cancer [5]. For patients suffering from these conditions, there are very compelling arguments for including PDT as a treatment option. For other conditions PDT has also been used with some success. Another situation which could be cited is the treatment of non-melanoma skin cancer [6,7] where the current mantra of ‘evidencebased medicine’ reveals the success of this form of treatment. Yet even here, many departments will resort to disfiguring surgery before considering PDT. Why does PDT continue to be practiced by the few? One contributing factor is to do with the fact that it is quite a different sort of therapy from conventional surgery, radiotherapy or chemotherapy, where expertise has been developed and skills have been honed over many years. The specialist has acquired considerable knowledge and experience in his/her speciality and has some understanding of the likely outcome of a particular type of treatment. PDT does not fit into this. There is also the need for expensive lasers which cannot be used for anything else. Moreover, there is the other problem of photosensitivity. How is
this managed? Are we condemning our patients to live out their final days in a dismal twilight zone? For many years, PDT has been given by ‘the few’ in palaces of PDT-excellence while ‘the many’ in less well-endowed establishments have continued to largely ignore its existence. But does it have to be this way? The current issue of PDPDT contains a paper describing the operation of a mobile PDT facility set up and operated by the Yorkshire Laser Centre [8]. This is a bold initiative that facilitates the use of PDT in hospitals that do not possess the equipment or expertise to perform the treatment. The concept of the mobile unit is that the patient is treated in the hospital where he was investigated by the hospital’s own medical team, assisted by a dedicated PDT team. This has been operational since 2002 and scores of patients have received PDT who may not have had the opportunity. Another model for extending the availability of PDT is that which has been adopted by the Scottish PDT Centre [7], which is a virtual centre with a core administrative, nursing and photophysics function. These core skills and the technology are provided to clinicians with a special interest in a range of internal cancers, and trained personnel support PDT in other hospitals as required. The key element is the provision of equipment and expertise to support PDT in hospitals and departments where hitherto this has not been available. It requires a willingness on the part of the Centre to use some of its own resource to help spread the availability of PDT. It is not uncontrolled, which would be harmful, but it involves
1572-1000/$ — see front matter © 2005 Elsevier B.V. All rights reserved. doi:10.1016/S1572-1000(05)00103-1
168 the Centre moving out into the areas where PDT has not yet reached. This can only be to the benefit of the patient and the long-term future of PDT. The Yorkshire Laser Centre is to be applauded for this bold initiative. As well as improving patient care, it also raises awareness of the benefits of PDT—–a truly upwardly mobile unit!
References [1] Moghissi K, Dixon K, Thorpe JAC, Oxtoby C, Stringer MR. Photodynamic therapy (PDT) for lung cancer: The Yorkshire Laser Centre experience. Photodiagn Photodyn Ther 2004;1:253—62. [2] Erickson L. Assessment of photodynamic therapy using porfimer sodium for esophageal, bladder and lung cancers. Agence d’´ evaluation des technologies et des modes d’intervention en sant´ e. AETMIS-04-01; 2004. [3] Barr H. Photodynamic therapy for dysplastic Barrett’s oesophagus and early cancer. Photodiagn Photodyn Ther 2004;1:195—201.
Editorial Comment [4] Claydon PE, Ackroyd R. Barrett’s oesophagus and photodynamic therapy (PDT). Photodiagn Photodyn Ther 2004;1:203—9. [5] Ortner M, Caca K, Berr F, et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomised prospective study. Gastroenterology 2003;125: 1355—63. [6] Morton CA, Brown SB, Collins S, et al. Guidelines for topical photodynamic therapy: report of a workshop of the British Photodermatology Group. Br J Dermatol 2002;146: 552—67. [7] Ibbotson SH, Moseley H, Brancaleon L, et al. Photodynamic therapy in dermatology: Dundee clinical and research experience. Photodiagn Photodyn Ther 2004;1:211—23. [8] Moghissi K, Dixon K. Yorkshire Laser Centre mobile Photodynamic Therapy unit: for service to district general hospitals. Photodiagn Photodyn Ther 2005;2:169—74.
Harry Moseley PhD, FInstP ∗ Scottish PDT Centre and Photobiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK ∗ Tel.:
+44 1382 632240. E-mail address: [email protected]
