Increasing the efficiency of hyperthermic intraperitoneal chemotherapy
(HIPEC) by a combination with a photosensitive drug in pediatric
rhabdomyosarcoma
Abstract
Background: Cytoreductive surgery (CRS) in combination with hyperthermic
intraperitoneal chemotherapy (HIPEC) is an option in advanced peritoneal
sarcomatosis. Nevertheless, CRS and HIPEC are not successful in all
patients. An enhancement of HIPEC using photodynamic therapy might be
beneficial. Therefore, a combination of the photosensitizer Hypericin
(HYP) with HIPEC was evaluated in an animal model. Procedure: An
established HIPEC animal model for rhabdomyosarcoma (NOD/LtSz-scid
IL2Rγnullmice, n=80) was used. All groups received HYP (100 µg/200 µl)
intraperitoneally with and without cisplatin-based (30 or 60 mg/m2)
HIPEC (37 or 42 °C, for 60 min) (five groups, each n=16). Tumor
dissemination was documented visually and by using HYP-based
fluorescence guidance. HYP-based photodynamic therapy (PDT) of the tumor
was performed. Finally, tissue samples were evaluated regarding
proliferation (Ki-67) and apoptosis (TUNEL). Results: HYP uptake even in
smallest tumor nodes (< 1 mm) was found. HYP-based
fluorescence guidance allowed a better tumor detection in comparison to
visual inspection. Immunohistochemistry revealed HYP penetration across
the tumor surface. HYP-based PDT without HIPEC induced marginal
apoptotic effects at the tumor surface. Combining HYP with HIPEC
revealed cisplatin concentration dependent decrease in proliferation
capacity and induction of apoptosis across determined cell layers of the
tumor surfaces. Conclusion: HYP as fluorescent photosensitizer offers an
intraoperative diagnostic advantage detecting intraperitoneal tumor
dissemination. The combination of HYP and cisplatin-based HIPEC was
feasible in vivo showing enhanced effects on tumor proliferation and
apoptosis induction across the tumor surface. Further studies combining
HYP and HIPEC will follow to establish a clinical application.