Before reading this information  please read  "What is SPDT/SDT?"

Frequently asked questions 

Note to patients. Any list of FAQ ‘s is a work in progress. If this doesn’t answer all your questions as well as we are capable of answering them, please let us know.

General questions

What do the therapy names mean?

Systemic Photodynamic Therapy

SPDT is systemic photodynamic therapy. Photodynamic means activated by photons (light). The substance that gets activated is called a sensitizer.
In our clinic, we use SPDT both systemically and semi-locally. Systemically means it is used to treat the whole body, and semi-locally means it is used to treat a fairly large local area of the body. This is in contrast to surgery and radiation therapies, which are both by necessity, local therapies. The surgeon removes a single tumour or “lump”, and the radiation therapist treats a small area of the body. These therapies are too damaging for extensive use.

Sonodynamic Therapy

SDT is sonodynamic therapy. It is similar to SPDT except that the sensitizer is activated by sound rather than by light.  SDT is a semi-local therapy.

Back to top

Why two therapies?

Because the two together work better than either alone. Our general strategy is to intensively treat the areas where cancer is present or is likely to be present with the semi-local SPDT and SDT, and the whole body with less intense systemic SPDT. “If the cancer can be anywhere, we have to treat everywhere”.
SDT should do best with deeper tumours, because the body transmits sound better than light.  Further, there is research evidence that both therapies used together are more effective than light alone.

Back to top

Why haven’t my doctor and I heard of them?

 There are several reasons:

1.       Your doctor should have heard of photodynamic therapy (PDT). It has been used therapeutically for about 100 years, there are 8,600 + research articles about it, and it is widely used to treat skin cancers.  He or she is less likely to have heard of Systemic PDT. The necessary technology (needing a highly selective, rapidly clearing sensitizer and a whole body light delivery system) is only a few years old.  SDT is very, very new. There are only about 40 research articles on the subject.

2.       The medical industry is notoriously slow to take up new technology.  A good example is the discovery by the Australian winners of the 2005 Nobel Prize for medicine.  In 1982 they did simple, unambiguous, easily understood experiments to prove that bacteria caused stomach ulcers.  It took about 12 years for this discovery to become generally available to the public, so the public could be treated with antibiotics instead of stomach surgery.

The net result of this slow uptake is that improved therapies developed in, say, the last 15 years are not available, or if they are available, they are not covered by insurance.  Needless to say, 15 years is a long time, and the latest therapies will very often be better than the currently used therapies.

3.       It is legally safer for a doctor to wait for a new therapy to be generally accepted by the industry, rather than to be a pioneer.

4.       In cancer therapy, there is a massive focus on surgery, chemotherapy, radiotherapy and hormone therapies. There are other therapy options, but these are generally not on the radar screen.

Back to top

Who is interested in getting SPDT/SDT? 

People who choose SPDT/SDT mainly fall into these groups:

a.       Those who have studied all the therapy options they can find, and cannot find a conventional treatment with reasonable prospects of solving their problem with acceptable side effects. Our patients are often very knowledgeable.

b.       Personal recommendation by our patients

c.       Those who have tried conventional therapies, and they have failed.

d.       Those who do not accept the side effects associated with other therapies.

Back to top

What does SPDT/SDT do? 

These therapies kill cancer. 

Back to top

How do you know that SPDT/SDT kills cancer? 

There is a range of evidence :

1.       Independent evidence, such as improved scans, improved or normalized tumour marker values, disappearance of detectable cancer, such as hard nodules (cancer) on the prostate.  Photodynamic diagnosis, where relevant (see below) can provide particularly impressive evidence.  It may show tumours before treatment, and then their progressive disappearance as treatment progresses.

2.       Subjective evidence, such as improved health, less pain, better breathing, better sleep, longer than expected freedom from evidence of cancer.

Back to top

Is “killing cancer “ enough to remove all the cancer?

It may or may not be. SPDT/SDT is more likely to remove all cancer with early stage patients, but we may not know for years.
Late stage patients are more difficult. They may have already incurred so much damage from the cancer and previous treatment that the situation is irretrievable. Also, SPDT/SDT (and other therapies except surgery) can only kill cancer at a limited rate.  If the cancer is growing faster than it can be killed, then we are not going to win the race.
Best strategy is to repeat the SPDT/SDT until there is no evidence of cancer (if this can be achieved).

Back to top

How good are conventional cancer treatments?

We need to address this question before looking at the effectiveness of SPDT/SDT. Unfortunately, there are big problems measuring the effectiveness of cancer treatments.
People with early stage cancer typically have no evidence of cancer, which means that it is impossible to know if any treatment has benefited.  What is usually done is to wait until the cancer has grown sufficiently to be detectable, and then treat the patient. By then, the cancer is much harder to remove. This strategy is forced on to doctors because mainstream therapies are usually too dangerous to use with patients who “might” have cancer.
With late stage cancer, the evidence is much clearer, but then the problem is much harder to solve.

This is typically what we know during the first 6 months or so after initial diagnosis:

1.       Surgery to remove primary tumours. It is often possible to prove that the surgery has been completely effective in removing the tumour, but it is not known if any undetectable secondary tumours (metastases) remain.

2.       Chemotherapy.  If used “preventively” eg after surgery for breast cancer, an individual patient will not know if it had any benefits (there may be evidence of “statistical benefit” i.e patients on average may benefit).  What will be known are some or all of the side effects of the therapy.  If chemotherapy is used to treat metastatic cancer, it may well shrink tumours, but this does not necessarily result in improved quality and quantity of life.  Its effectiveness may not be known for many months.

3.       Radiation therapy used “ preventively”.  Its effectiveness with any individual patient will be unknown.  Once again, there may be a statistical benefit to patients on average.  If radiation is used to treat known tumours, its benefits on those tumours may be obvious e.g. if it results in less pain.  There are likely to be other tumours present, and the effect on survival is not likely to be known.

We will eventually know how effective a program of cancer therapy is, but by then it may be too late to try other therapies with better prospects.

Back to top

How good is SPDT/SDT therapy?

The first thing to note is that there is no evidence whatsoever of any long term damage from the therapy.  This is a huge advantage, because it means that:

a.       the risks of over treatment are money and  time, and not health and longevity.

b.       the therapy is repeatable.  If a patient needs more SPDT/SDT, then the barriers to getting this are access to treatment and money.  If a patient needs more chemotherapy or radiation, the barriers may be too much toxicity, or too much damage.

With early stage cancer, SPDT/SDT has the same problem with evidence as other therapies. We won’t know for a long time.
With late stage cancer, the evidence is much clearer.  Many Opal Clinic patients are late stage and most do not have good alternative treatment options.  Some have been given up as “ terminal” or “palliative” by other practitioners.

Back to top

Benefits of improved equipment introduced in August, 2006

SPDT/SDT as practiced in Opal Clinic uses new technology, and new technology often rapidly improves.  From time to time we have made modest improvements in the therapy; in August 2006, however, we began using specially designed light sources, and as of this writing (November, 2006) this has so far resulted in a significant  improvement in outcomes.  Please read “Photodynamic and Sonodynamic therapy outcomes”, obtainable by contacting the clinic, for the latest information.

Back to top

What can you expect to notice during SPDT/SDT therapy?

Responses to the therapy are variable. The following are typical:

1. Patients with no evidence of cancer before treatment.

These patients are typically people who have had cancer before, or have a high risk of getting cancer because of family history, etc.  They are doing the therapy for preventive purposes.

They have no evidence of cancer, and they may or may not have it. There is nothing to observe or measure, so therapy efficacy is un-provable for a long time (though one patient was found to have a walnut sized tumour about a year after his preventive SPDT/SDT.  The tumour contained dead cancer cells). 

The argument for doing SPDT/SDT for prevention is that since the therapy is known to remove many tumours that we can detect, it should do even better on those (smaller) tumours we can’t detect. This is logical, but un-provable over the short term.

2. Patients with evidence of cancer before treatment, no evidence of benefit or change during SPDT/SDT

Possibilities are:

• The treatment completely failed, or perhaps resulted in undetectable benefits.
• The therapy provided benefits that cannot be detected until well after therapy is completed. This happens.  For example, one patient’s PSA didn’t decline until 9 months after SPDT/SDT.

3. Patients with evidence of cancer before treatment, with significant tiredness during treatment as the only observed change

We believe that significant tiredness during treatment is a reasonable indicator of cancer kill off.

4. Evidence of much cancer before treatment, usually extreme tiredness during treatment, necessitating gentle treatment over 3 or more weeks.

The tiredness is an excellent sign, but over the short term, diagnostic tests to measure progress may be misleading. 

Scans ( CT, MRI, etc) immediately after SPDT/SDT may show a tumour to be bigger. This could be due to tumour growth and treatment failure, but the growth is more likely to be only short term  and due to inflammation.  The treatment kills cancer cells, the immune system attacks the dead material and it inflames and swells. After at least a week, the inflammation subsides and tumour shrinks to below its original size.

Similarly cancer markers (blood tests) often increase markedly immediately after SPDT/SDT. This also could be to tumour progression, but once again it is more likely due to successful treatment - cancer cell death. The SPDT/SDT kills cancer cells, which then release their contents  into the blood stream. Cancer cell contents include the tumour marker proteins , and once in the blood stream, they can be detected by blood tests, resulting in higher values.  After some time, possibly months, the cancer markers trend towards normal. 

This short term worsening of these cancer indicators is difficult to accept psychologically, but it is usually a good sign.  We have observed this many times, as have colleagues in the U.K and China .

Back to top

Special note for later stage patients

Cancer growth typically accelerates as the disease progresses, resulting in a “race” between how fast we can kill the cancer and how fast it is growing and doing damage.  You will certainly need multiple rounds of therapy, as closely spaced as possible.  It is a good idea to avoid other therapies with little prospects of improving your cancer status, particularly if they make you sick.
We consider improved quality and duration of life to be a successful outcome.

Back to top

How much treatment do I need?

Assuming it can be done, best strategy is to continue treatment until there is no evidence of cancer.
These are our best estimates at what is needed:

• Our anti-cancer lifestyle program is likely to slow down the disease process, but not “cure” the cancer. It is a good idea to follow this program, no matter what stage the cancer, and no matter what therapies are chosen.
• One round of therapy may be adequate for patients with a small amount of cancer. 
• Patients with significant amounts of cancer should plan on two or more rounds of therapy.

Back to top

Does “no evidence of cancer “ mean no cancer ?

No.  Anyone can have undetected cancer, and many people do. A cancer may take, say, 15 years from onset to death, and it will only be detected in years 12 to 15. No evidence of cancer after treatment means that cancer has not been detected. This is the best that can be said.  The terms “cured” ,“all clear“ and “in remission”  mean that there is currently no evidence that cancer is present.  They certainly do not mean that there is no cancer, or that the patient will be free from cancer for a long time.  The conservative approach is to assume that ( undetected) cancer remains and take action to slow down growth and/or kill remaining cancer. We strongly recommend that you follow an anti-cancer lifestyle, and consider getting “preventive” SPDT/SDT from time to time.

Back to top

Why is SPDT/SDT a new ball game?

Because it kills cancer without longer term damage. This makes it highly acceptable to patients,  and it can be repeated as necessary.

Conventional cancer therapies may well be effective, but treatment may be limited by long term damage, and the therapy may ultimately fail.
Surgery – is often very effective, but cannot be repeated very often. Each time the patient loses healthy tissue.
Radiation therapy - is damaging, and patients have a maximum lifetime dose.
Chemotherapy - the body usually builds up resistance to chemotherapy.  Different drugs can be used, usually with increasing toxicity and decreasing tolerance by both the body and the patient. Even if initially effective, chemotherapy may (after a while) cease to be effective.

Another factor is that patients may get fed up with damaging therapies, even if they are effective, and they give up.

With SPDT/SDT however, there is no evidence of  long term damage, and no evidence that it loses effectiveness.  As far as we know, it can repeated as necessary to treat existing cancer, and to treat any recurrences. The downsides with additional SPDT/SDT treatment are money and boredom.
Back to top

When does SPDT/SDT fail?

Factors relating to  the patient

• Waiting too long before getting SPDT/SDT therapy, often reaching the stage where complete recovery is impossible.  It is important to avoid wasting time with treatments which are not likely to be effective.
• Not getting enough SPDT/SDT therapy, after it has shown evidence of benefit.
• Being in too poor general health
• Having no great interest in surviving the disease.
• Having medical problems that preclude the use of SPDT/SDT.  For example, cancer invading a large blood vessel.
• Too demoralized from the side effects of previous treatment, and from gloomy prognoses, causing the patient to give up hope.

Back to top

Factors relating to the treatment

It is likely that the equipment and protocol changes introduced in August 2006 will significantly reduce failure rates. The following is what we expect to happen:

• The treatment will fail some of the time, for no known reason. 
• It will do worst with large, deep tumours. Best is to surgically remove them, or at least de-bulk them, before starting SPDT/SDT.
• It will do worst with tumours such as mesothelioma, known to be refractory to all types of treatment.
• Some patients will require more therapy than they choose to get, or can afford.
• Some patients will experience only temporary benefit from the therapy.  It may be possible to make further progress with further treatment, but patients may be unwilling or unable to do this.

Back to top

Where does SPDT/SDT fit into your cancer treatment program?

Let us begin with the obvious statement that if you have access to proven therapies with acceptable side effects, you should take these therapies.  In cancer treatment most surgery for early stage disease meets these criteria.  However, once the cancer has metastasized, it is often hard to find therapies which have been proven to increase the quality and quantity of life.

There are many studies of conventional therapies for metastatic cancer showing little if any net benefit.  They may be effective in killing cancer, but they do not kill enough, and their side effects prevent the treatment being used enough to solve the problem.  Some therapies have only been evaluated in terms of their ability to shrink tumours, but this does not necessarily translate into more and better life.

A good place to start is with your GP.  The question to ask is not “What is the usual therapy?”, but “Assuming you had my problem, what would you do ? “. Bear in mind that your GP is not likely to know much about SPDT/SDT and is unlikely to be in a position to recommend it (or to not recommend it).  Further, he or she is under some legal pressure to direct patients to standard therapies.

A good information source is the U.S. National Cancer Institute (http://www.cancer.gov/), but always go to the web pages for professionals because material written for patients is usually loaded with optimistic statements to promote the placebo effect, and lacking in detail on effectiveness. You want to know what the professionals are saying to each other.  If you have access to someone who can read the original research, then this is even better. This will take some work, but the stakes are high. Choice of therapy is a huge decision.

We believe that the best approach to cancer is diagnosis, some SPDT/SDT to attack any small metastases, then surgery where effective and safe, and then further SPDT/SDT after surgery. As a practical matter, most of our patients choose  surgery, then usually radiation and chemotherapy, and then  SPDT/SDT.

Note that getting SPDT/SDT therapy does not close the door to other therapies.  If it fails, it is easy to then try other therapy options.  The reverse is not necessarily true.  Any therapy that causes significant damage to general health and/ or to the immune system will make it harder for SPDT/SDT (or any other therapy) to succeed.

Back to top

What about follow up after getting SPDT/SDT?

No one can guarantee that any treatment has “cured “cancer, so patients need regular monitoring.  Risk averse patients may choose to get occasional additional rounds of SPDT/SDT therapy, no matter what monitoring shows. There is no downside other than a possible waste of money and time.

Back to top

What about immune stimulation?

Most of our patients have previously had chemotherapy and/or radiation therapy. These damage the immune system which will make other therapies less effective. We include immune stimulants with our treatment.

Back to top

About the therapies

What are the elements of SPDT/SDT?

SPDT/SDT needs three things before it can work:

• A sensitizer that is selectively absorbed by cancer cells, and is rapidly cleared from healthy cells.
• A source of energy (light or sound) that can activate the sensitizer.
• Oxygen, to react with the activated sensitizer to form free radicals in the cancer cells.

Our main sensitizer is a tin complex of chlorophyllin, with “side chains” to make it responsive to sound.  It is activated by both light and sound.

The energy sources we use are:

• A light treatment bed fitted with light emitting diodes, which illuminates the whole body with red and infra red light.
• Intense red lights
• An ultra sound instrument that generates low intensity ultra sound radiation.

Back to top

Who developed these therapies?

Photodynamic therapy (PDT) has been known for about a century.  Systemic PDT (SPDT) required the development of a new class of photosensitizer, typically derivatives of chlorin e6. These have only been available for about 10 years.  Our main sensitizer was developed by Dr Don Burke and colleagues in Boston , USA .

Back to top

Are SPDT/SDT mainstream or alternative therapies?

“Mainstream” and “alternative” are vague terms.
If mainstream means “widely used”, then SPDT is a mainstream therapy in other countries, but not in Australia .  SPDT is important enough to have its own research journal “Photodiagnosis and photodynamic therapy”.
If mainstream means a therapy that directly attacks cancer cells, then SPDT/SDT is mainstream. (Alternative or complementary therapies seek to improve general health, thereby building up the body’s ability to resist the cancer. They do not directly attack cancer).
SPDT/SDT is a very safe and pain free therapy, a property that relates more to alternative than to mainstream therapies.

Back to top

How important is diagnosis of the type of cancer?

SPDT/SDT is not very dependant on knowledge of the type of cancer.  What our doctors do need to know is the size and approximate location of the primary tumour (if still present), and to have a general indication of where metastases may be.  This information is usually available from scans, from photodynamic diagnosis, and from our doctor’s knowledge of typical cancer migration pathways.

Conventional therapies need to know the above and a lot more.  Chemotherapy and hormone therapy are dependant on accurate diagnosis of the type of cancer.  Radiation therapy and surgery are both dependant on an accurate knowledge of where the tumours are.

Back to top

Receiving the therapy

When is it best to get these therapies?

The earlier the better.  To maximize the probability of success, it is best to do SPDT/SDT shortly after diagnosis and (usually) surgery, no matter whether the surgery was “successful” or not.

What should I do before starting SPDT/SDT?

Everything you can to improve your general health and to build up a positive attitude and determination to overcome the disease.

Will there be side effects?

Except for late stage patients, the only likely side effect during treatment is tiredness.  Make sure that you get enough rest.  Late stage patients might experience excessive tiredness and possibly other symptoms, making it necessary to slow down the treatment.

Will there be side benefits?

Patients can experience improved energy, improved appetite, weight gain, easier breathing and less pain.
Patients sometimes report benefits that are not likely to be related to reduction in the tumour load.  We have had reports of increased energy in patients with little cancer, reduced arthritis pain, disappearance of hives and skin blemishes, better eyesight, and better sexual function for patients with prostate cancer.

Back to top

The theory behind SPDT/SDT

What makes a good sensitizer?

The sensitizers we use for SPDT/SDT have the following properties:

• Rapid clearance from healthy cells, but remain for many days in cancer cells.
• High concentrations in cancer cells, but negligible concentrations in healthy cells.
• Non-toxicity, with a wide safety margin between the therapeutic dose and the dose causing any toxic effects.
• Efficient production of free radical oxygen, the chemical species that attacks the (cancer) cells they are in.
• Activation in the red and infra-red regions, where the body is reasonably transparent to light (for SPDT)
• Absorbs and is activated by ultra sound energy (for SDT)
• Water soluble, so that it dissolves in the blood, but sufficiently lipophilic (fat loving) so that it can bind to cell membranes and pass into the cell.

Back to top

How safe is the sensitizer?

Our main sensitizer is a tin complex of chlorophyllin, and it has impeccable safety qualifications.   Over the last 30 years, tin complexes of chlorophyllin have been used in quantities up to about 2 grams to treat new born babies with elevated bilirubin levels.  Our therapeutic dose is up to about 100 milligrams, and adults are much less sensitive to toxicity than new borns.

How does the sensitizer selectively bind to cancer cells?

There are several theories, and different sensitizers may have different mechanisms of action.  Cancer cells have an anaerobic (no oxygen) metabolism and produce lactate.  Healthy cells have an aerobic (oxygen) mechanism.  In one theory, the sensitizer molecule with its positive charge binds to the negatively charged lactate in the cancer cell.  It is less tightly held by healthy cells.

Back to top

What is the mechanism of action in killing the cancer?

It is the same for both SPDT and SDT.  Light or sound activation raises the energy level of the sensitizer, producing an “activated “molecule.  This is turn reacts with nearby oxygen to form “free radical “oxygen.  This is a super powerful oxidant, so powerful that it is quite unstable and it reacts with the nearest oxidizable material – the organic matter in the cancer cell.  This breaks down the organic matter, destroying the cells structure, and killing or damaging the cell.  The free radical oxygen has a very small radius of action, so it only damages the cells that it is in - the cancer cells.
There are other mechanisms of action.

Back to top

Other applications of SPDT/SDT

There are other applications.  One sensitizer we use is designed to attach to the membranes of microbes such as bacteria, viruses, fungi and parasites.  It is also designed to attach to atherosclerotic plaque and the arteries of newly forming tissue (this is why SPDT/SDT cannot be given for at least 3 weeks after surgery). These potential applications have yet to be adequately researched, but they may account for some of the side benefits patients have seen.

Back to top

Are there new developments in progress?

Absolutely.  The Opal Clinic uses new SPDT/SDT technology, and new technologies have plenty of scope for improvement.  We are currently getting further sensitizers, and developing improved light and sound equipment.  We have a history of continually improving the therapy.  The new light sources, introduced in August, 2006 are probably the most important development.

IMPORTANT DISCLAIMER

This article is intended for informational purposes only. Nothing in this article is intended to be a substitute for professional medical advice.
This document may not be modified, and derivative works of it may not be created.

Back to top