Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0613—Apparatus adapted for a specific treatment
  • A61N5/0616—Skin treatment other than tanning
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/203—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser applying laser energy to the outside of the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
  • A61B2018/00452—Skin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/067—Radiation therapy using light using laser light

Definitions

• the present invention relates to the field of oncology and relates to an apparatus and a method for treating cancer or a precancerous state by means of a therapeutic light beam, and in particular of a laser beam which is not necessarily thermal.
• cancer is a cellular process which results in the appearance, from a normal cell, cells of generally abnormal morphology and behavior, called cancer cells. These cancer cells grow at the expense of normal cells and work together to form cancerous tumors. Cancerous tissue is thus formed: - of cancer cells proper arranged in more or less architectural formations and corresponding to the cancerous tumor, and - of the stroma, that is to say of a connective tissue providing support and nutrition of the cancerous tumor.
• precancerous conditions which are clinical conditions associated with a significantly high risk of cancer
• - precancerous lesions namely histopathological abnormalities, which if they persist long enough can lead to cancer.
• These lesions precancerous are also called dysplasias.
• PDT photodynamic therapy
• This method consists firstly in marking the area to be treated (cancerous tissue or precancerous lesion) with a photosensitizing product, then in a second step to illuminate the area to be treated with a laser beam which has an appropriate wavelength preferably absorbed by the photosensitizing product, and which makes it possible to activate the photosensitizing product and to produce cytotoxic compounds ensuring the destruction in situ of cancer cells.
• the photosensitizing product can be injected intravenously, be administered orally or applied directly to the surface of the area to be treated: for example treatment of skin cancer, treatment of actinic keratosis which are precancerous lesions of the skin induced by photoaging, ...
• Photodynamic therapy lies in the possibility of using low power lasers ("non-thermal" lasers) which induce very little or no thermal effect in the treated area, and therefore not destructive.
• Photodynamic therapy has several drawbacks, however.
• the first drawback is linked to the photosensitization of the patient, which makes it necessary to avoid any sun exposure for a relatively long period, generally of the order of 48 hours.
• a second drawback is linked to the use of a drug (photosensitizing product) which is expensive, which makes this treatment expensive, all the more so since generally the treatment must be repeated several times to be effective.
• a third disadvantage lies in the appearance in certain patients of undesirable side effects linked to the injection. or the application of the photosensitizer.
• the present invention aims to propose a new solution to the treatment of cancer or a precancerous condition, which has the advantages of PDT, in that it uses a “non-thermal” therapeutic light beam , but which does not require the use of a photosensitizing product.
• the subject of the invention is therefore an apparatus for the treatment of cancer or of a precancerous state, which in a manner known per se, comprises a source of therapeutic light.
• the light source is designed to emit a therapeutic light beam with a wavelength between 1.2 ⁇ m and 1.3 ⁇ m.
• the subject of the invention is also a method of treating cancer or a precancerous condition according to which the site to be treated is illuminated with a therapeutic light beam of wavelength between 1.2 ⁇ m and 1.3 ⁇ m, preferably without prior administration of a photosensitizing drug as in the case of PDT.
• the processing device is more particularly characterized by one and / or the other of the following additional characteristics, taken individually or in combination with each other: - the source is designed to emit a light beam impulse therapy; - the duration of each pulse is adjustable; - The duration of each pulse is adjustable to a value less than 0.5s, and preferably at least between 0.1s and 0.3s; - the time interval between two pulses is adjustable; - the time interval between two pulses is adjustable to a value greater than 0.5 s, and preferably to a greater value or equal to 0.9s; - the duration of emission of the therapeutic light beam is adjustable; - the number of pulses on each transmission is adjustable; - the number of pulses on each transmission is adjustable at least between 50 and 300; - the power of the therapeutic light beam is adjustable; - the power of the therapeutic light beam is adjustable at least between 1W and 5W; - the power density of the pulses is adjustable at least between 30W / cm 2 and 300W / cm 2 ; - the source is
• the treatment method of the invention has one and / or the other of the following additional characteristics, taken individually or in combination with one another: - the therapeutic light beam is advantageously pulsed; -
• the power density (d) of the laser beam at the site to be treated is preferably between 30W / cm 2 and 300W / cm 2 , and is more preferably still of the order of 100W / cm 2 ; .
• the fluence per pulse is preferably between 1 J / cm 2 and 30J / cm 2 ; - The total fluence for each emission is between 6000J / cm 2 and 90,000 J / cm 2 , and is even more preferably of the order of 30000J / cm 2 ; - the duration (T) between two successive pulses is greater than 0.5s, and more particularly still greater than or equal to 0.9s; - the number of pulses (N) on each transmission is preferably between 50 and 300 pulses; - The duration (t) of each pulse is preferably less than 0.5s, and more preferably still between 0.1s and 0.3s; - The lighting operation of the site to be treated is repeated several times, preferably with at least one day of rest between each lighting operation.
• FIG. 1 representing a general block diagram of a processing apparatus of the invention.
• the apparatus 1 for treating cancer or a cancerous state essentially comprises a light source 2 with fibered output 200, and an adaptation interface
• the adaptation interface 3 generally makes it possible to direct the therapeutic light beam (L) delivered at output 200 by the source to the site to be treated.
• the adaptation interface 3 is known in itself by those skilled in the art and will therefore not be detailed in the present description. It is chosen by a person skilled in the art according to the type of cancer or precancerous condition to be treated, in a manner comparable to what is practiced in the context of PDT.
• the adaptation interface 3 is a handpiece which allows the practitioner to bring the beam of the cancerous tumor as close as possible or the precancerous lesion to be treated;
• the adaptation interface 3 can be a handpiece, a biomicroscope, or a slit lamp with aiming laser, - in gastroenterology, pneumology, urology, gynecology, the interface of adaptation 3 is an endoscope.
• the light source 2 is designed to emit at output 200 a beam of therapeutic light having an emission wavelength comprised in 1, 2 ⁇ m and 1, 3 ⁇ m.
• this therapeutic light beam is a coherent light beam (laser).
• the therapeutic light beam could be an incoherent light beam, generated from a light source of sufficient power followed by optical filtering to keep only the frequency components in the 1.2 ⁇ m range at 1.3 ⁇ m.
• the light source 2 of the device 1 further comprises means (208, 209,210, S1, S2, S3, S4, S5) allowing adjustment by the practitioner of the main beam emission parameters (L) (in particular power, number of pulses, duration of each pulse, time interval between two pulses); these adjustment means will be described in more detail below.
• the apparatus 1 further comprises control means 4 which allow the practitioner to control the triggering of the therapeutic light beam in accordance with the emission parameters which have been set.
• control means 4 comprise for example an action pedal or any other equivalent manual tripping means.
• the therapeutic light beam is a laser beam
• the invention is not limited to a particular type of laser source 2, any laser source allowing the emission of a laser beam fulfilling the condition wavelength above, and known to those skilled in the art, which can be used.
• the following types of laser source can be used:
• - Cr laser Forsterite (Cr 4 +: Mg 2 SIO 4 ) pulsed or continuous, pumped by a solid laser or with neodymium doped fiber (Nd), by a solid laser or with Ytterbium doped fiber, or pumped by diode;
• a fiber Raman laser is preferably used for the following main reasons:
• the fiber output of the laser facilitates the transport of the beam to the output 200; - the laser beam generated has good spectral and spatial quality, the laser source 2 is advantageously compact,
• the laser source 2 is reliable and requires no maintenance
• the source 2 is a fiber Raman laser and includes a pump laser diode 201 to a wavelength of 910-930 nm or 970 980 nm, a Ytterbium Yb 202 doped fiber laser, and a Raman converter 204 which has the function of transposing the wavelength of the beam at the output of the fiber laser 202, so as to obtain a laser beam at the wavelength 1260nm-1270nm.
• the Ytterbium (Yb) 202 doped fiber laser consists of a double-clad fiber 205 whose core is doped with Ytterbium and two Bragg networks 207a at the input and output which are photo-inscribed in the fiber.
• the output 203 of the laser fiber 202 is welded directly to the input of the Raman converter 204.
• the Raman converter 204 comprises a fiber 206 whose core is doped with phosphorus and two Bragg gratings 207b at input and output which are regulated at a wavelength in the range 1260 - 1270 nm. This converter 204 makes it possible to transpose the emission wavelength of the laser 202 in a single step.
• the number of conversion steps of the Raman converter 204 should be adapted according to the nature of the fiber, and in particular the type of dopant used. It is also possible to replace the Bragg gratings by single-mode couplers.
• the fiber Raman laser which has just been described with reference to FIG. 1, and which allows the emission of a therapeutic laser beam at a wavelength between 1, 2 ⁇ m and 1.3 ⁇ m is new in itself, and can therefore advantageously also be used in other applications (medical or not), outside the particular field of cancer treatment or conditions precancerous.
• the power adjustment of the laser beam is carried out via a coupler 208 having a low coupling rate, and a photodiode 209 connected to electronic control means 210.
• the electronic control means 210 also receive as input a first continuous setpoint signal (S1) whose value is manually adjusted by the practitioner (for example by means of a potentiometer or equivalent) and which characterizes the setpoint power in continuous mode of the laser beam. From this setpoint (signal S1), the electronic control means 210 automatically regulate the power of the laser beam emitted by acting as an output directly on the current of the pump diode 201.
• the electronic control means 210 thus allow the practitioner to manually adjust the power of the therapeutic laser beam to a predefined value (setpoint signal S1).
• the electronic control means 210 receive as input four other continuous setpoint signals S2, S3, S4 and S5 whose values are adjusted manually by the practitioner: - the setpoint signal S2 characterizes for example the operating regime (continuous or pulse), - the setpoint signal S3 characterizes for example, in the case of a pulse regime, the duration of each pulse of the therapeutic laser beam, - the setpoint signal S4 characterizes for example, in the case of a pulse regime, the time interval between two successive pulses, - the setpoint signal S5 characterizes the duration of transmission (or in other words the number of pulses in the case of a regime pulse) of the therapeutic laser beam, on each actuation of the control means 4.
• the setpoint signal S2 characterizes for example the operating regime (continuous or pulse)
• the setpoint signal S3 characterizes for example, in the case of a pulse regime, the duration of each pulse of the therapeutic laser beam
• the setpoint signal S4 characterizes for example, in the case of a pulse regime, the time interval between
• the electronic control means 210 thus control the current of the pump diode 201 from the setpoint signals S1 to S5 and the signal taken by the coupler 208 and photodiode 209, so as to automatically adjust the physical characteristics of the emitted laser beam [power, speed (pulse or continuous), duration of emission, and in the case of pulse mode: duration of each pulse and time interval between each pulse ).
• Processing method The implementation of the apparatus of the invention is as follows. Step 1: The practitioner manually sets the parameters for the emission of the therapeutic laser beam [power, speed (continuous or pulsed), duration of emission (or number of pulses in the case of pulsed regime), and in the case of pulsed regime: duration of each pulse, interval between two pulses].
• Step 2 By means of the adaptation interface 3, the practitioner very precisely and known per se adjusts the spatial position of the laser beam relative to the cancerous or precancerous site to be treated.
• Step 3 When the alignment is perfect, the practitioner actuates the control pedal 4, which triggers the emission of the therapeutic beam (lighting of the site to be treated) with the predefined emission parameters.
• the controller pedal 4 When the target site is treated, the practitioner repeats the operations of steps 2 and 3 on a new site to be treated, as many times as necessary to scan the entire surface of a tumor or cancerous or precancerous lesions. The above operations are repeated with a frequency which will depend on a treatment protocol determined on a case-by-case basis by the practitioner.
• the treatment method of the invention can be used for the treatment of malignant or benign tumors, the treatment of precancerous conditions, the treatment of tumors postoperatively or in postradiology and / or post-chemotherapy. Treatment can be performed in addition to surgery, chemotherapy or radiology.
• the treatment device can be used to treat all precancerous lesions (dysplasias, carcinomas in situ)) or cancers which are accessible by a light beam; you just have to choose the appropriate adaptation interface depending on the location of the site.
• the treatment apparatus can be used to treat all precancerous lesions (dysplasias, carcinomas in situ)) or cancers which are currently treated by means of PDT.
• the various cancers which can be treated are in particular: - In ENT: cancer of the oral cavity, cancer of the thyroid, cancer of the hypopharynx, cancer of the larynx, cancer of the nasopharynx.
• - Digestive system cancer of the esophagus, Barnett's mucosa, cancer of the stomach, cancer of the colon and rectum, cancer of the pancreas, cancer of the gallbladder.
• Respiratory system all known types of cancer of the respiratory tract or lung.
• - In urology kidney cancer, testicular cancer, bladder cancer, prostate cancer, penis cancer.
• the power density (d) of the laser beam at the site to be treated is preferably between 30W / cm 2 and 300W / cm 2 , and is more preferably still of the order of 100W / cm 2.
• the fluence per pulse is preferably between 1 J / cm 2 and 30J / cm 2
• the surface (S) of the spot depends on the diameter of the laser beam leaving the fiber, the "waist" of the beam and the distance between the fiber output of the laser and the site to be treated. For a given waist and diameter of the laser beam, the further the fiber output from the laser is moved away, the larger the spot surface, and the lower the power density and the fluence per pulse.
• the time (T) between two successive pulses must be long enough to avoid overheating of the tissues.
• the duration (T) between two successive pulses is greater than 0.5 s, and more particularly still greater than or equal to 0.9 s.
• the processing apparatus is preferably characterized by a beam whose power per pulse is between 1W and 5W and is more preferably still of the order of 3W, and whose power density per pulse at the output of l 'device is between 30W / cm 2 and 300W / cm 2 , and is more preferably still of the order of lOOW / cm 2 .
• the treatment protocol is defined by the practitioner according in particular to the size of the cancerous or precancerous tumor or lesion and also to the duration of immobilization desired for the patient.
• Example of Treatment Protocol daily for several days in a row or every three days for several days in a row. In all cases, it is preferable to repeat the lighting operation of the site to be treated several times with at least one day of rest between each lighting operation. Nevertheless, it should be emphasized that advantageously the treatment of the invention may cause no harmful side effects, and in particular not cause excessive tissue overheating. It is therefore also possible to shorten the total duration of the treatment protocol by combining several successive lighting operations on the site to be treated on the same day, without it being necessary to plan a day of rest between each operation as in the examples of the aforementioned protocol.
• the invention is however not limited to the parameters and conditions of use mentioned above, which are given for information only.

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• 2004
  • 2004-01-14 FR FR0400283A patent/FR2864903B1/fr not_active Expired - Fee Related
• 2005
  • 2005-01-10 CN CNA2005800024077A patent/CN1909945A/zh active Pending
  • 2005-01-10 EP EP05715180A patent/EP1703948A1/fr not_active Withdrawn
  • 2005-01-10 JP JP2006548237A patent/JP2007517559A/ja active Pending
  • 2005-01-10 CA CA002552618A patent/CA2552618A1/fr not_active Abandoned
  • 2005-01-10 WO PCT/EP2005/000128 patent/WO2005077460A1/fr not_active Ceased
  • 2005-01-10 US US10/586,082 patent/US20080287932A1/en not_active Abandoned

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