Aggravation of Eyelid and Conjunctival Malignancies Following Photodynamic Therapy in DeSanctis-Cacchione Syndrome

Abstract

A 5-year-old girl with DeSanctis-Cacchione syndrome (a severe variant of xeroderma pigmentosum) was referred for evaluation of multiple eyelid and bulbar conjunctival squamous cell carcinomas. Examination evidenced multiple vegetating lesions on the eyelid, bulbar conjunctiva, and cornea of both eyes. As the lesions were considered not to be manageable by surgical excision and would have required exenteration, photodynamic therapy was performed on the patient's left eye. Three months after photodynamic therapy, the patient presented with a dramatic increase in the extension of the tumors. Since xeroderma pigmentosum is a DNA repair disorder, the radiation involved in photodynamic therapy probably played an iatrogenic role in the evolution of the case. We believe that photodynamic therapy may be harmful to patients with DNA repair disorders.

Ruthenium oligonucleotides, targeting HPV16 E6 oncogene, inhibit the growth of cervical cancer cells under illumination by a mechanism involving p53

“…Several studies demonstrate high efficiency of topical PDT in non-melanoma skin cancers such as for actinic keratosis (precancerous lesions), [39][40][41][42] Bowen's disease [43][44][45] and superficial basal cell carcinomas, [46][47][48] but current evidence does not support the use of topical PDT for invasive squamous cell carcinomas. [49][50][51] PDT can also reduce the number of new lesions in patients at high risk of skin cancers and therefore may have a role as a preventive therapy. 52 PDT was shown as being as effective as conventional therapies, but with shorter healing times and the absence of scarring in treatment of vulval intraepithelial neoplasia.…”

Clinical use of photodynamic therapy in ocular tumors

“…Procianoy et al, 144 on the other hand, reported a dramatic increase in tumor size in the third month of De Sanctis-Cacchione syndrome, a variant of xeroderma pigmentosum disease in which thereare multiple vegetating squamous cell carcinomas on the eyelid and bulbar conjunctiva. In a patient with a DNA repair disorder, the light involved in PDT may exacerbate the underlying pathology.…”

Guidelines for topical photodynamic therapy: update

“…Topical ALA‐PDT cleared an SCC in a hospitalized patient with xeroderma pigmentosum, but produced an enhanced phototoxic reaction lasting over 2 weeks despite the absence of UV radiation 68 . Caution is advised in this indication following the report of a 5‐year‐old patient with DeSanctis–Cacchione syndrome, a variant of xeroderma pigmentosum, where PDT using a systemic photosensitizer to multiple eyelid SCCs was followed by a rapid extension of tumours within the treatment field 69 …”

“…68 Caution is advised in this indication following the report of a 5-year-old patient with DeSanctis-Cacchione syndrome, a variant of xeroderma pigmentosum, where PDT using a systemic photosensitizer to multiple eyelid SCCs was followed by a rapid extension of tumours within the treatment field. 69 The high efficacy of topical PDT for in situ SCC, and the efficacy figures reported particularly for superficial invasive lesions limited to papillary dermis, suggest that depth of therapeutic effect is the limiting factor for PDT in invasive SCC, with further study required. Current evidence supports the potential of topical PDT for superficial, microinvasive SCC, but in view of its metastatic potential, topical PDT cannot currently be recommended for the treatment of invasive SCC (Strength of recommendation D, Quality of evidence II-iii).…”