Photodynamic therapy for recurrent nasopharyngeal cancer.

OBJECTIVE: A pilot study to determine if photodynamic therapy could be a safe and efficacious treatment for recurrent or persistent nasopharyngeal cancer. DESIGN: A consecutive sample intervention study with comparison with historic control subjects. SETTING: Tertiary referral hospital. PATIENTS: All patients with recurrent or persistent nasopharyngeal cancer following radiation therapy were considered for treatment. Patients with tumors with a depth of more than 10-mm invasion on computed tomographic scans were excluded, as were patients with recurrent metastasis to the neck. Five patients were thus acquired during a 3-year period. INTERVENTION: Four patients were injected intravenously with hematoporphyrin derivative (2.5 mg/kg) and one patient with porfimer sodium (2 mg/kg) (Photofrin, Quadra Logic Technologies, Vancouver, British Columbia) 48 hours before treatment. The drug was activated by a 630-nm laser light passed down a 1-mm core quartz fiber to a miniaturized convex mirror positioned in the nasopharynx via the contralateral nasal cavity. This procedure was carried out under topical anesthesia. MAIN OUTCOME MEASURE: Survival was determined after a minimum follow-up of 4 years. RESULTS: To date, three of five patients treated have no evidence of disease, with follow-up times of 51, 52, and 60 months, respectively. The patient with the longest survival time had been unsuccessfully treated with 136 Gy of ionizing radiation preceding photodynamic therapy. CONCLUSIONS: Long-term tumor control can be achieved by photodynamic therapy in cases where very high doses of ionizing radiation have failed. The entire treatment can be accomplished in 30 minutes under topical anesthesia. The technique carries no serious side effects.