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Photodynamic therapy of malignant and premalignant lesions in patients with ’field cancerization‘ of the oral cavity

Published online by Cambridge University Press:  29 June 2007

W. E. Grant ,
C. Hopper ,
P. M. Speight ,
A. J. Macrobert  and
S. G. Bown
W. E. Grant*
Affiliation:
National Medical Laser Centre, University College London Medical School, London
C. Hopper
Affiliation:
Department of Surgery and the Department of Oral and Maxillo-Facial Surgery, University College London Medical School, London
P. M. Speight
Affiliation:
Department of Oral Pathology, Institute of Dental Surgery, Eastman Dental Hospital, London
A. J. Macrobert
Affiliation:
National Medical Laser Centre, University College London Medical School, London
S. G. Bown
Affiliation:
National Medical Laser Centre, University College London Medical School, London
*
William E. Grant, F.R.C.S.I., Department of Otolaryngology, Royal Free Hospital, Pond Street, London NW3 2QG
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Abstract

The management of patients with ’field cancerization‘ of the oral mucosa, with multicentric foci of invasion, presents a considerable problem for the head and neck surgeon. Surgical resection of synchronous or metachronous primary squamous cell carcinomas, along with adjacent premalignant lesions, is likely to be associated with considerable mutilation. Photodynamic therapy (PDT) has been shown to be of value in the treatment of superficial tumours in the upper aerodigestive tract, with excellent healing of treated areas. This study reports the use of PDT to treat 11 patients with ’field cancerization‘ occurring in the oral cavity. Six patients had multiple primary cancers and five had single primary tumours. All had associated areas of leukoplakia. Each received Photofrin 2 mg/kg 48 hours prior to photoirradiation with 50–100 J/cm² red laser light by surface illumination. Six to eight weeks later treated areas in 10 of the 11 patients showed a complete response to PDT; one patient had areas of residual leukoplakia. Two patients developed further areas of leukoplakia or erythroplakia within 12 months but no patient has had evidence of recurrent invasive carcinoma in the treated areas. Longer term follow-up will be necessary to exclude further recurrence. It is concluded that PDT offers an effective repeatable treatment option, whether on its own or as an adjunct to local excision, for patients with ’field cancerization‘ of the oral cavity.

Keywords

Photodynamic therapyHead and neck neoplasms
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 107 , Issue 12 , December 1993 , pp. 1140 - 1145
Copyright
Copyright © JLO (1984) Limited 1993

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