Photodynamic therapy. A viable alternative to conventional therapy for early lesion of the upper aerodigestive tract?

Photodynamic therapy (PDT) is a treatment modality that results in selective destruction of malignant cells by combining a photosensitizing agent (hematoporphyrin derivative), which is taken up by the cells, and a laser light. This therapeutic modality has been effectively used in managing cancers of the skin, bronchi, and bladder. In the head and neck area, however, its use has been confined to the palliation of advanced lesions that have proved refractory to conventional therapy. While this is unquestionably a valid role, its true therapeutic value may be in the management of early cancers arising in the upper aerodigestive tract. At the University of Cincinnati, PDT has been used on a variety of such early cancers where, for multiple reasons, conventional therapy was not possible. While no attempt will be made to comment on long-term survival or to compare PDT with more conventional therapeutic regimens, a preliminary experience with this modality in managing lesions of the larynx, oral cavity, and oropharynx will be presented. Apparent advantages, disadvantages, and pitfalls will be presented.