Photodynamic Therapy as an Alternative Therapeutic Tool in Functionally Inoperable Oral and Oropharyngeal Carcinoma: A Single Tertiary Center Retrospective Cohort Analysis

Abstract

Background: Head and neck cancer is typically treated with surgery, radiotherapy, chemoradiation, or a combination of these treatments. This study aims to retrospectively analyse oncological outcomes, adverse events and toxicity of treatment with temoporfin-mediated photodynamic therapy at a single tertiary referral center. More specifically, in a selected group of patients with otherwise (functionally) inoperable oral or oropharyngeal head and neck squamous cell carcinoma.Methods: Twenty-six consecutive patients who received photodynamic therapy for oral or oropharyngeal squamous cell carcinoma from January 2002 until July 2019 at the University Hospitals Leuven were included. These were (1) patients with an accessible recurrent or new primary tumor in an extensively treated area of the head and neck, not suitable for standard treatment, or (2) patients that were judged medically unfit to undergo standard treatment modalities.Results: Complete tumor response immediately after PDT was obtained in 76.9% of cases. During follow-up, a proportion of CR patients did recur, to reach recurrence-free rates at six months, one year and two years of 60.6%, 48.5% and 32.3%. Local control at the PDT treated area was 42.3% with a median recurrence free interval time of 9 months. Recurrence-free interval was statistically more favorable for oropharyngeal squamous cell carcinoma (with or without oral cavity extension) in comparison to oral cavity squamous cell carcinoma alone (p < 0.001). During a median follow-up period of 27 months, we report new tumor activity in 80.8% of patients. Median overall and disease-specific survival time was 31 and 34 months, respectively. Most reported adverse events were pain after treatment and facial edema. At the end of follow-up, swallowing and upper airway functionality were preserved in 76.9 and 95.7% of patients, respectively.Conclusion: Photodynamic therapy is a valuable treatment option in highly selected patients with oral and/or oropharyngeal (functionally) inoperable head and neck squamous cell carcinoma. Treatment with this alternative modality can induce durable local control in an important fraction of treated patients, with an acceptable toxicity profile.

Photo-Induced Drug Release from Polymeric Micelles and Liposomes: Phototriggering Mechanisms in Drug Delivery Systems

“…This formulation was used in many clinical trials to treat head, neck, and oral cavity tumors. Recently, Lambert et al [ 64 ] published a comprehensive report for clinical trials using temoporfin-PDT to treat oral or oropharyngeal head and neck squamous cell carcinoma. The study included twenty-six patients who received their temoporfin-PDT treatment between 2002 and 2019 at the University Hospitals in Leuven, Belgium.…”

Perspectives on interstitial photodynamic therapy for malignant tumors

“…For patients who have exhausted conventional treatment options, IPDT provides an alternative modality that may allow for an improved quality of life and prolonged survival. Interstitial treatment has been reported with both photofrin and temoporfin in a number of retrospective studies 82 and a large multi-institutional prospective study (temoporfin only), 62 but little randomized data are available. A new generation photosensitizer, redaporfin, with increased absorption and improved reactive oxygen species (ROS) generation, is also being evaluated in treatment of advanced HNC.…”

From Basic Mechanisms to Clinical Research: Photodynamic Therapy Applications in Head and Neck Malignancies and Vascular Anomalies

“…The author concluded "PDT is a valuable treatment option in selected patients with oral and/or oropharyngeal HNSCC that induces durable local control in an important fraction of treated patients. The technique has an acceptable toxicity profile" [9]. Karakullukcu et al analyzed the outcomes of 170 patients who were treated for OSCC and OPSCC using mTHPC-PDT.…”

“…Another study of 128 patients with advanced disease recorded a complete response in 38% of tumours, with 58% of tumours undergoing a >50% tumour mass reduction. The study also reported a clinical quality of life improvement (QoL) in 61% of patients, indicating the potential role of PDT in alleviating tumour-related symptoms [ 9 ].…”

“…Drug–light intervals vary from 48 h up to 120 h; other factors including spot-light and energy delivery of light remain largely preserved across reported studies. Post-treatment, limited exposure to light is recommended, with light sensitivity remaining for up to 4 weeks [ 9 , 31 , 32 ].…”