口腔发育异常的光动力治疗效果

Photodynamic therapy outcome for oral dysplasia.

作者信息

Jerjes Waseem, Upile Tahwinder, Hamdoon Zaid, Mosse Charles Alexander, Akram Sarah, Hopper Colin

机构信息

UCLH Head and Neck Centre, London, UK.

出版信息

Lasers Surg Med. 2011 Mar;43(3):192-9. doi: 10.1002/lsm.21036.

DOI:10.1002/lsm.21036

PMID:21412802

Abstract

INTRODUCTION

Photodynamic therapy (PDT) is a minimally invasive surgical intervention used in the management of tissue disorders. It can be applied before, or after, any of the conventional modalities, without compromising these treatments or being compromised itself.

MATERIALS AND METHODS

In this prospective study, a total of 147 consecutive patients with oral potentially malignant disorders were treated with surface illumination PDT, using 5-ALA or mTHPC as the photosensitizer. The average age was 53 ± 8.9 years. The patients' recovery was uneventful and no complications reported. Comparisons with the clinical and histopathological features and rate of recurrence as well as malignant transformation were made. The patients were followed-up for a mean of 7.3 years.

ANALYSIS AND RESULTS

Homogenous leukoplakias were identified in 55 patients, non-homogenous leukoplakias in 73 patients, whereas 19 patients had erythroplakias. Ex- and current lifelong smokers formed 84.4% of the recruited patients. While people who currently smoke and drink formed 38.1% (56 patients) of the cohort. Erythroplakias were mainly identified in heavy lifelong smokers. The most common identified primary anatomical locations were the lateral border of tongue, floor of mouth and retromolar area. Moderate dysplasia was identified in 33 patients while 63 patients had severe dysplasias; and 32 patients had a histopathological diagnosis of carcinoma in situ. The rate of recurrence in laser surgery was approximately 11.6%. Malignant transformation was observed in 11 patients (7.5%), in the tongue, floor of mouth and retromolar area. Recurrence and malignant transformation was mainly identified in erythroplakias and non-homogenous leukoplakias. The final outcome of the cohort showed that 11 (7.5%) suffered from progressive disease, 5 (3.4%) had stable disease, 12 (8.2%) were considered partially responsive to the therapy. Complete response was identified in 119/147 patients (81%).

CONCLUSION

5-ALA-PDT and/or mTHPC-PDT offer an effective alternative treatment for oral potentially malignant disorders.

摘要

引言

光动力疗法（PDT）是一种用于治疗组织疾病的微创手术干预手段。它可以在任何传统治疗方式之前或之后应用，不会影响这些治疗，自身也不会受到影响。

材料与方法

在这项前瞻性研究中，共有147例连续的口腔潜在恶性疾病患者接受了表面照射PDT治疗，使用5-氨基酮戊酸（5-ALA）或间四（羟基苯基）氯代卟啉（mTHPC）作为光敏剂。平均年龄为53±8.9岁。患者恢复顺利，未报告并发症。对患者的临床和组织病理学特征、复发率以及恶性转化情况进行了比较。对患者进行了平均7.3年的随访。

分析与结果

55例患者为均质型白斑，73例为非均质型白斑，19例为红斑。既往和目前的终身吸烟者占招募患者的84.4%。目前吸烟且饮酒的人占队列的38.1%（56例患者）。红斑主要在重度终身吸烟者中发现。最常见的原发解剖部位是舌侧缘、口底和磨牙后区。33例患者为中度发育异常，63例为重度发育异常；32例患者组织病理学诊断为原位癌。激光手术的复发率约为11.6%。11例患者（7.5%）发生了恶性转化，部位在舌、口底和磨牙后区。复发和恶性转化主要在红斑和非均质型白斑中发现。该队列的最终结果显示，11例（7.5%）患有进展性疾病，5例（3.4%）病情稳定，12例（8.2%）被认为对治疗部分有效。119/147例患者（81%）实现了完全缓解。