Clinical study of photodynamic therapy for laryngeal cancer

Abstract

Photodynamic therapy (PDT) is an innovative treatment involving the use of a photosensitizer and low powered laser to selectively destroy tumor cells. In the head and neck, its application to laryngeal papilloma. metastatic tumor and oral cancer have been reported but our report on PDT for laryngeal cancer is the only clinical report in Japan. At present, we treat laryngeal cancer by PDT using argon and excimer dye lasers such as the HpD. In the present study, we assessed the utility and safety of PDT and investigated long-term prognosis after this therapy. The subjects were 12 patients with laryngeal cancer who underwent PDT between February 1988 and October 1993. Among them, ten with cancer of the vocal cords underwent PDT as the primary treatment and two underwent PDT because of recurrence after radiotherapy. Under local anesthesia, PDT was performed using a video endoscope (Pentax EB2000). The optimal dose from an argon dye laser was set at 200-500mW/cm2 of continuous waves for 20 minutes and that from the excimer dye laser was set at 200J/cm2 of pulse waves (3-4 mJ/pulse, 30-40Hz). The argon dye laser used was the Fujinon PDT developed by Fuji Photo Optical Co., Ltd. The excimer dye laser used was a product of Hamamatsu Photonics Co., Ltd. 1) Effect of PDT The effect of PDT as a primary treatment for ten patients was classified as CR in eight and PR in two cases, the CR rate being 80.0%. When evaluated only for T1 patients, the results were classified as CR in eight and PR in one. The patient whose response was classified as PR had refused repeated PDT. CR was maintained for five and 13 months in the two patients who underwent PDT as a secondary treatment after radiotherapy. CR was obtained in 83.3% of all patients studied. 2) Duration of the effect of PDT and long-term prognosis The patients were followed up for 14 to 71 months. The longest duration of CR achieved by PDT monotherapy was 65 months. Among the patients who underwent PDT as a sprimary treatment, one developed local recurrence and underwent radiotherapy. However, the prognosis was uneventful in all other patients. CR after PDT monotherapy was maintained for 42 months in one T3 patient. Two patients with a history of previous treatment thereafter relapsed and underwent total laryngectomy. The larynx could be conserved in 83.3% of all patients. However, it could be conserved in 100% of patients who underwent PDT as a primary treatment. When the prognosis of laryngeal cancer was investigated in all patients, two deaths from other causes, that is, leukemia and esophageal cancer, were confirmed, but there were no patients who died from the primary disease. Based on the results presented, PDT may be as effective as conventional therapies for early laryngeal cancer. 3) Adverse reactions and complications of PDT Photosensitivity occurred in all patients, but required no therapy or other intervention. Laboratory tests for liver, renal and bone marrow function revealed no abnormal values attributable to PDT. There were no adverse reactions of clinical relevance and patients with severe complications and elderly patients were also treated safely with this therapy. © 1995, The Oto-Rhino-Laryngological Society of Japan, Inc. All rights reserved.