Betz Christian S, Jäger H Rolf, Brookes Jocelyn A S, Richards Robin, Leunig Andreas, Hopper Colin
Department of Oral and Maxillofacial Surgery, University College London Hospital NHS Foundation Trust, Mortimer Market, London, USA.
Lasers Surg Med. 2007 Aug;39(7):571-82. doi: 10.1002/lsm.20535.
Photodynamic therapy is based on an interaction of a drug and light in oxygenated tissue. The photosensitizing drug Foscan is licensed in the EU for the treatment of advanced head and neck cancer. The light can be applied by surface illumination or directly into tumour tissue by optical fibres. One interesting feature of PDT is that it does not cause major damage to nerves and major blood vessels. This raises the possibility of using this therapy in the treatment of benign neoplasms in the head and neck.
STUDY DESIGN/MATERIALS AND METHODS: A total of 11 patients with lymphatic [8] or venous malformation [3] were treated on 25 occasions. The treatments were carried out using Temoporphin (Foscan) 0.15 mg/kg; the drug-light-interval was 4 days. Illumination was performed at 652 nm delivered interstitially through bare tip fibres at a total light dose of 20 J per fibre. Multiple fibres were positioned either image guided [13] or clinically [12] to ensure accurate targeting of tissue while avoiding damage of the surrounding and overlying tissue.
In all cases there was a significant reduction in the volume of abnormal tissue without damage to the overlying skin; the results were objectified using MRI-imaging, CT-volumetry and surface optical scanning. The best results were obtained with lymphatic malformations, especially for those that had not undergone previous surgery. Post-treatment pain and swelling were successfully controlled with steroids and a variety of analgesics (opioids and non-steroidal anti-inflammatories). No vascular or neurological signs were encountered.
This minimally invasive approach to treat complex benign neoplasias seems promising. The treatment is safe, effective and repeatable and merits further evaluation.
光动力疗法基于药物与光在含氧组织中的相互作用。光敏药物福斯卡林（Foscan）在欧盟被批准用于治疗晚期头颈癌。光可通过表面照射或通过光纤直接照射到肿瘤组织中。光动力疗法的一个有趣特性是它不会对神经和主要血管造成重大损伤。这增加了将该疗法用于治疗头颈部良性肿瘤的可能性。
研究设计/材料与方法：共有11例患有淋巴管畸形[8例]或静脉畸形[3例]的患者接受了25次治疗。治疗采用0.15 mg/kg的替莫泊芬（Foscan）；药物与光照间隔为4天。通过裸端光纤以间质方式在652 nm波长下进行照射，每根光纤的总光剂量为20 J。多根光纤通过影像引导[13次]或临床引导[12次]进行定位，以确保准确靶向组织，同时避免损伤周围和上方的组织。
在所有病例中，异常组织体积均显著减小，且未损伤上方皮肤；结果通过磁共振成像、CT体积测量和表面光学扫描得以客观化。淋巴管畸形取得了最佳效果，尤其是那些未曾接受过手术的病例。治疗后疼痛和肿胀通过类固醇和多种镇痛药（阿片类药物和非甾体抗炎药）成功得到控制。未出现血管或神经方面的体征。
这种治疗复杂良性肿瘤的微创方法似乎很有前景。该治疗安全、有效且可重复，值得进一步评估。
