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Dosimétrie basée sur l'imagerie pour l'optimisation de la thérapie photodynamique pour le mésothéliome pleural malin

Abstract : Malignant pleural mesothelioma (MPM) is a cancer with a poor prognosis due to deceiving treatments. When surgery is part of a multimodal treatment for MPM, it is crucial to combine it with a local adjuvant treatment to kill residual tumour cells. Recently, intrapleural photodynamic therapy (PDT) after surgical resection has appeared to be a promising treatment for MPM. Its success relies essentially on the most complete and homogeneous illumination of the pleural cavity, monitored by light dosimetry. The dosimetry method used today in the United States, with intrathoracic probes collecting the light at 7 strategic locations, does not give information about the light delivered on the whole pleural surface. This research project has a clinical and experimental axis: 1) to set up a phase II clinical trial in Lille University Hospital, combining intrapleural PDT to surgery within a multimodal treatment, 2) to develop an innovative peroperative light dosimetry method by the characterization of a light device and use of imaging.Clinical trial has started in February 2016, with the seven probes dosimetry method of reference, following the American protocol. An innovative light wand was conceived within the laboratory, as well as the dosimetry sytem. Four patients have undergone pleurectomy/decortications, intrapleural PDT (with photosensitizer Photofrin®) and adjuvant chemotherapy, without major toxicity. Regarding the experimental project, an illumination profile of the light wand was defined using two complementary methods: power measurements (Watt) and pixel intensity from digital photography. An effective attenuation coefficient was calculated: µeff = 0.705 cm-1. With an electromagnetic spatial tracking system (TrackStar®), we localized in real time the position of the light wand within the pleural cavity and projected its spatial coordinates to the 3D CT scan images. After having inserted the illumination profile of the light wand to the tracking system, a dedicated software allowed the spatial representation on CT images of the cumulated light dose. This work has been completed on an intraoperative thoracic cavity phantom. Our dosimetry method was validated on this phantom and compared to the one of reference.The perspectives are to test the feasibility of this new dosimetry method in humans, and to develop alternative light devices for a better standardization of the intrapleural PDT technique for MPM.
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Camille Munck. Dosimétrie basée sur l'imagerie pour l'optimisation de la thérapie photodynamique pour le mésothéliome pleural malin. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2017. Français. ⟨NNT : 2017LIL2S050⟩. ⟨tel-01967622⟩

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