PHOTODYNAMIC THERAPY IN HEAD AND NECK-SURGERY

A clinical study was conducted on the application of photodynamic therapy on tumours in the head and neck region to assess the value of this new modality for superficial cancer (T(is)-T2). Patients with recurrent laryngeal papillomatosis were included in a photodynamic treatment pilot study. 2 mg/kg body weight of haematoporphyrin-derivative (Photosan-3(R)) was administered 48 hours prior to laser irradiation intravenously. The patients rooms were advised to avoid daylight for two to three weeks. Tumours of the facial skin were irradiated homogeneously by means of an optical bench. Directly after laser application we observed an extensive extravasation of the tumour tissue, whereas the surrounding normal tissue showed mild erythema. A dry crust formed subsequently, which disappeared within two weeks associated with re-epithelisation. Mucous membrane tumours showed fibrin layers in the tumour area 24 hours after laser application with selective tumour necrosis. These lesions also epithelised completely within three weeks. Scarring never occurred. Laryngeal tumours as well as laryngeal papillomas were treated by a cylindrical light applicator system and the patients admitted to intensive care unit for 24 hours after laryngoscopy because of risk of laryngeal oedema. 94 patients with tumours of the head and neck with different histological origins were treated photodynamically, as well as 21 patients with laryngeal papillomatosis. Two months after photodynamic laser treatment, controlled biopsies of the former tumour area were performed. 5 patients had a relapse during a maximum follow-up of 4.5 years. This signified a histologically confirmed full response rate of 95 %, accompanied by good plastic and functional results. Photodynamic treatment of small eyelid tumours is particularly important, since 48 % of patients with identical therapy patterns demonstrate recurrence of the disease within 17 months. 10 patients with recurrent laryngeal papillomatosis (14 adults and 7 children) had recurrence within a maximum follow-up of three years. In all other patients there was no recurrence after photodynamic treatment. Photodynamic therapy appears to offer a new chance in treating small superficial growing tumours in important functional aesthetic areas, with significant prolonged disease free intervals compared with conventional surgical procedures.