Photodynamic Therapy for Head and Neck Dysplasia and Cancer

Abstract

Objective To determine the response of dysplasia, carcinoma in situ (CIS), and T1 carcinoma of the oral cavity and larynx to photodynamic therapy with porfimer sodium. Design Prospective trial. Setting A National Cancer Institute–designated cancer institute. Patients Patients with primary or recurrent moderate to severe oral or laryngeal dysplasia, CIS, or T1N0 carcinoma. Intervention Porfimer sodium, 2 mg/kg of body weight, was injected intravenously 48 hours before treatment. Light at 630 nm for photosensitizer activation was delivered from an argon laser or diode laser using lens or cylindrical diffuser fibers. The light dose was 50 J/cm2 for dysplasia and CIS and 75 J/cm2 for carcinoma. Main Outcome Measures Response was evaluated at 1 week and at 1 month and then at 3-month intervals thereafter. Response options were complete (CR), partial (PR), and no (NR) response. Posttreatment biopsies were performed in all patients with persistent and recurrent visible lesions. Results Thirty patients were enrolled, and 26 were evaluable. Mean follow-up was 15 months (range, 7–52 months). Twenty-four patients had a CR, 1 had a PR, and 1 had NR. Three patients with oral dysplasia with an initial CR experienced recurrence in the treatment field. All the patients with NR, a PR, or recurrence after an initial CR underwent salvage treatment. Temporary morbidities included edema, pain, hoarseness, and skin phototoxicity. Conclusion Photodynamic therapy with porfimer sodium is an effective treatment alternative, with no permanent sequelae, for oral and laryngeal dysplasia and early carcinoma.

Photodynamic therapy in dentistry: a literature review

“…In a prospective case series by Rigual et al [38], PDT use was assessed for the treatment of laryngeal and oral cavity premalignant and malignant disease of the head and neck. Two cohorts of patients were included in this trial, one of which included patients having tumor grade T1 squamous cell carcinoma and the other containing dysplasia and carcinoma in situ.…”

Aktuelle Therapieoptionen bei Larynx- und Hypopharynxkarzinomen

“…Durch entsprechende operative Variationen (Wahl des geeigneten Laryngoskops, Gegendruck von außen, Zuhilfenahme starrer Optiken) gelingt es fast immer, Eine besondere Form der Laserchirurgie stellt die Anwendung der photodynamischen Therapie (Bestrahlung von Gewebe mit Laserlicht nach vorheriger Anreicherung einer photosensitierenden Substanz im Gewebe) dar. Ihre prinzipiellen Möglichkeiten zur Behandlung von dysplastischen Schleimhautverände-rungen und insbesondere von oberfläch-lichen Karzinomen des oberen Aerodigestivtrakts sind in der Literatur gut dokumentiert [57]. Dennoch hat dieses Therapieverfahren kaum Eingang in die klinische Routine gefunden, wahrscheinlich wegen des damit verbundenen hohen Aufwands, der hohen Kosten und der Beeinträchtigungen für die Patienten.…”

Photofrin-mediated photodynamic therapy for treatment of early stage laryngeal malignancies

“…Numerous clinical investigations have demonstrated the effectiveness of photodynamic therapy (PDT) with dihematoporphyrin ether (PHOTOFRIN), 5-aminolevulinic acid (ALA), and meta-tetrahydroxyphenylchlorin (mTHPC) (FOSCAN) in the treatment of minimally invasive early squamous cell carcinoma (SqCCa) of the head and neck due to the ability of the activating 630-664 nm laser light to penetrate 0.5-1 cm into tissues resulting in destruction of microscopic tumor with preservation of protected normal tissues [3][4][5][6][7][8].…”