Influence of Fractionation and Fluence Rate in Photodynamic Therapy with Photofrin or mTHPC

Various schedules of fractionated photodynamic therapy (PDT), delivered at two different light fluence rates, were investigated in the RIF1 tumor model in an attempt to minimize the development of hypoxia during PDT and thereby improve tumor response relative to single treatments. The photosensitizers Photofrin and meta-tetrahydroxyphenylchlorin (mTHPC) were used in combination with either interstitial or superficial illumination. For both methods of illumination, equal volumetric light doses gave similar tumor responses, as measured by tumor regrowth times and number of cures. Fractionation of superficial illumination did not generally improve tumor response compared with a single illumination with the same total light dose. The only fractionated schedules which demonstrated a trend for increased cure were six fractions of superficial illumination given with short (1 h) dark periods between illuminations. Using both photosensitizers, an increase in tumor regrowth time occurred when tumors were illuminated interstitially with continuous light at a linear diffuser output of 50 mW compared with 100 mW per cm diffuser length. Discontinuous illumination with alternating light and dark periods of 30 s improved the tumor response further for mTHPC-mediated PDT at a fluence rate of <tex-math>$100\ {\rm mW\ cm}^{-1}$</tex-math>. No improvement in response was seen by discontinuous interstitial illumination after Photofrin-mediated PDT. These results demonstrate that lower fluence rates and/or fractionating the light dose delivered can improve the response of the RIF1 tumor to PDT but that the choice of dark intervals between fractions is critical.