Photodynamic therapy in management of head and neck cancers and precancerous lesions.

ABSTRACT

Photodynamic therapy (PDT) is a new form of cancer treatment with low morbidity. In this study, PDT was evaluated for its effectiveness in management of recurrent or widespread precancerous lesions, primary cancers in inoperable sites, recurrent or residual cancers which were refractory to radiotherapy and chemotherapy, and advanced tumors in the head and neck. Fifty-one patients were treated over a period of 5 years. A 91.67 per cent complete response rate was observed for T1 tumors (primary and recurrence) with a recurrent rate of 27.27 per cent. Nasopharyngeal carcinoma was highly responsive to PDT since all T1 and T2 tumors responded completely. This was in contrast to cancers in the soft palate which failed in most cases possibly due to inadequate light dose distribution. PDT was remarkably effective in curing premalignant diseases (100% complete response rate). Postoperative PDT was equally effective in treating the microscopic residual malignancy. For advanced tumors, PDT in adjunct to conventional modalities could induce complete response in 5 out of the 10 patients and resolve symptoms in 4 cases. The mean follow-up time for this series was 28.3 months (range 3-66 months). In conclusion, PDT is a useful modality for the treatment of head and neck tumors and precancerous lesions presenting in forms or under conditions that posed considerable difficulties in management by conventional approaches.