In order to improve the PDT efficacy, different strategies are under development such as the use of targeted photosensitizers or nanoparticles to enhance the tumor selectivity, and also the design of light devices to better monitor the light dose. Due to the limited light tissue penetration depth, another way to improve the efficacy of PDT destruction of deep tumors is the use of upconversion nanoparticles or bi-photon absorption compounds. A relatively new approach, named PDTX, is the use of X-ray instead of UV-visible to overcome the poor penetration depth of visible light into tissue. Upon exposure to X-ray ionizing radiation nanoscintillators transfer their energy to the photosensitizers resulting in their activation and leading to the destruction of targeted cells. This novel PDTX approach could allow the deep-tissue PSs activation by X-ray radiation for deep-seated tumor PDT, using lower X-ray radiation dose than conventional radiotherapy. An overview of what has been tested in the past and what is currently done in this research field will be presented. On that occasion, we will also be describing some examples from our own expertise concerning terbium oxide NPs or gadolinium-based NPs coupled to porphyrin, chlorin or phthalocyanine-type photosensitizers.
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