Optical coherence angiography monitoring of tumor early response to PDT in experimental and clinical studies

Photodynamic therapy (PDT) is emerging as a common and efficacious method for basal cell carcinoma (BCC) treatment, and new non-invasive imaging technologies can further enhance it. Optical coherence angiography (OCA) was employed in this study. OCA is a non-invasive, label-free, real-time bioimaging method that has proven to be a helpful tool for visualizing normal and pathological vasculature, including vascular damage evaluation after using a vasculature-targeted therapy for predicting its success. In experimental study, it was shown that both the tumor and peritumorous vessels stasis (disappearance in OCA images) in 24 hours post treatment play significant roles in PDT success. On controllable mouse ear tumor model the following practical and robust OCA-based criterion of PDT success was formulated: there should be no visibly perfused vessels on OCA images inside the tumor borders, whereas in the 2 mm near-tumor proximity regions the vascular density should not exceed 1% from OCA image area in 24 hours post PDT. The criterion obtained on the experimental model was translated to clinical study. OCA monitoring of basal cell carcinoma reaction to PDT has shown that dramatic decrease in the vascular density in the tumor in 24 hours post PDT can predict tumor non-recurrence with high diagnostic accuracy for 12 months follow-up. The strong reaction of peritumorous vessels in 24 hours post PDT is associated with hypertrophic scar formation in 3-6 months, but the weak reaction of peri-tumorous vascular reaction leads to normotrophic scar formation.