Prospective evaluation of 110 patients following ultrasound-guided photodynamic therapy for deep seated pathologies.

INTRODUCTION: Photodynamic therapy, the fourth oncological interventional modality has proved its success in the management of variety of pathologies involving the human body. Our aim in this prospective clinical study was to continue evaluating the outcome following ultrasound-guided interstitial PDT of pathologies involving the human body. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome. MATERIALS AND METHODS: One hundred and ten patients were referred to the UCLH Head and Neck Centre, London for treatment of various deep-seated pathologies. These included tumours in the head and neck as well as vascular anomalies of the limbs. After multidisciplinary discussion, all patients underwent interstitial photodynamic therapy (iPDT) under general anaesthesia, using 0.15mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 26 months. RESULTS: Four out of five patients who presented with visual problems reported improvement after treatment. Also, 27/32 reported improvement of breathing. Improvement of swallowing was reported by 30/37 patients; while speech improvement was evident in 22/29 patients and 43/52 reported reduction in the disfigurement caused by their pathology. Seven out of nine patients with impeded limb function reported some degree of improvement. Clinical assessment showed that nearly half of the patients had "good response" to the treatment and 5 became disease free. Moderate clinical response was reported by 39 patients. Radiological assessment comparing radiological imaging 6-week post-PDT to the baseline showed moderate response in 45 patients and significant response in 32 patients. CONCLUSION: This study on 110 patients with deep-seated pathologies undergoing interstitial photodynamic therapy provided further evidence that PDT is a useful modality in the management of these pathologies that are otherwise resistant to conventional treatments, and with minimal side effects.

Photodynamic therapy outcome for T1/T2 N0 oral squamous cell carcinoma.

INTRODUCTION: This new prospective clinical study assessed the oncological outcomes following surface illumination mTHPC-photodynamic therapy of T1/T2 N0 oral squamous cell carcinoma (OSCC) patients. MATERIAL/METHODS: Thirty-eight patients participated in this study. Their mean age at the first diagnosis of OSCC was 58.0 years. Common clinical presentation was an ulcer mainly identified in the tongue, floor of mouth (FOM), or buccal mucosa. Current and ex-smokers represented 89.5% of the cohort; while current and ex-drinkers were 86.8%. Clinically nine patients had T1 disease while 29 had T2 disease. RESULTS: Pathological analysis revealed that 12 patients had well differentiated SCC, 16 moderately differentiated and 10 had poorly-differentiated cancer. All patients were discussed in a multidisciplinary meeting and, subsequently, underwent mTHPC-PDT. PDT was repeated in 6- to 7-month period following the first round when residual tumor was identified in the treated site. At last clinic review post-PDT, 26/38 patients showed complete normal clinical appearance of their oral mucosa in the primary tumor site. Recent surgical biopsies from the study cohort showed that 17 had normal mucosa, five with hyperkeratinization, 10 with dysplastic changes and six showed recurrent SCC. The overall recurrence was 15.8% and the 5-year survival was 84.2%. Death from loco-regional and distant disease spread was identified in three patients. The recurrence group comprised six patients. Most common presentation was an ulcer involving the buccal mucosa or retromolar area, identified in current or ex-smokers and current drinkers. The surgical margins in this group were also evaluated following laser or surgical excision and reconstruction. CONCLUSIONS: mTHPC-photodynamic therapy (up to three rounds) is a comparable modality to other traditional interventions in the management of low-risk tumors of the oral cavity. Although, sometimes, multiple rounds of the treatment is required, morbidity following PDT is far less when compared to the three conventional modalities: surgery, radiotherapy, and chemotherapy.