Leunig A, Betz C S, Heinrich P, Janda P, Baumgartner R
Klinik und Poliklinik für Hals-Nasen-Ohrenkranke, Germany.
Laryngorhinootologie. 2002 Nov;81(11):807-14. doi: 10.1055/s-2002-35769.
Cancer of the oral cavity, oropharynx and larynx are the most common malignancies in the head and neck region. The prognosis for the patients concerned is highly dependent on an early detection and fast surgical treatment. Fluorescence guided examinations may serve as a possible diagnostic tool for better demarcation and delimitation of head and neck cancer. Therefore, the presented study was aimed at the detection of a selective Protoporphyrin IX (PPIX) accumulation in malignant oral, oropharyngeal and laryngeal lesions following topical and systemic application of 5-aminolevulinic acid (5-ALA).
We investigated 193 patients with suspected lesions in the oral cavity and oropharynx (n = 126) as well as in the larynx (n = 67). The patients received a varying dose (rinsing 200 mg, inhalation 30 mg, 2,5 - 25 mg/kg BW by mouth) of 5-ALA in aqueous solution. Both fluorescence pictures and macroscopic findings under white light were recorded using a target integrating, color CCD camera. Fluorescence contrasts between tumor and normal tissue were registered by an optical multichannel analyser.
Our results have shown that after topical and systemic application of 5-ALA, PPIX fluorescence could be identified within the mucosa of the oral cavity, oropharynx and the larynx of all patients with a duration of up to 48 hours after systemic application. Malignant lesions usually showed higher intensities of PPIX-fluorescence than surrounding innocuous mucosa. A maximum fluorescence contrast between normal tissue and neoplastic lesions was observed at 1.5 hours after topical application and 3 hours after systemic application.
It will be the aim of further investigations to verify the optimal time of incubation and dosing of systemical 5-ALA application to enhance fluorescence contrasts and set the basis for fluorescence guided resections.
口腔癌、口咽癌和喉癌是头颈部最常见的恶性肿瘤。相关患者的预后高度依赖于早期检测和快速手术治疗。荧光引导检查可能是一种用于更好地界定和区分头颈部癌症的诊断工具。因此，本研究旨在检测在局部和全身应用5-氨基乙酰丙酸（5-ALA）后，恶性口腔、口咽和喉部病变中选择性原卟啉IX（PPIX）的蓄积情况。
我们调查了193例口腔和口咽（n = 126）以及喉部（n = 67）有可疑病变的患者。患者接受了不同剂量（漱口200 mg、吸入30 mg、口服2.5 - 25 mg/kg体重）的5-ALA水溶液。使用目标积分彩色CCD相机记录白光下的荧光图像和宏观表现。通过光学多通道分析仪记录肿瘤组织与正常组织之间的荧光对比度。
我们的结果表明，在局部和全身应用5-ALA后，所有患者口腔、口咽和喉部黏膜内均可检测到PPIX荧光，全身应用后可持续长达48小时。恶性病变通常比周围无害黏膜显示出更高强度的PPIX荧光。局部应用后1.5小时和全身应用后3小时观察到正常组织与肿瘤病变之间的最大荧光对比度。
进一步研究的目标将是验证全身应用5-ALA的最佳孵育时间和剂量，以增强荧光对比度，并为荧光引导切除奠定基础。
