Grant W E, Hopper C, Speight P M, Macrobert A J, Bown S G
National Medical Laser Centre, University College London Medical School.
J Laryngol Otol. 1993 Dec;107(12):1140-5. doi: 10.1017/s0022215100125496.
The management of patients with 'field cancerization' of the oral mucosa, with multicentric foci of invasion, presents a considerable problem for the head and neck surgeon. Surgical resection of synchronous or metachronous primary squamous cell carcinomas, along with adjacent premalignant lesions, is likely to be associated with considerable mutilation. Photodynamic therapy (PDT) has been shown to be of value in the treatment of superficial tumours in the upper aerodigestive tract, with excellent healing of treated areas. This study reports the use of PDT to treat 11 patients with 'field cancerization' occurring in the oral cavity. Six patients had multiple primary cancers and five had single primary tumours. All had associated areas of leukoplakia. Each received Photofrin 2 mg/kg 48 hours prior to photoirradiation with 50-100 J/cm2 red laser light by surface illumination. Six to eight weeks later treated areas in 10 of the 11 patients showed a complete response to PDT; one patient had areas of residual leukoplakia. Two patients developed further areas of leukoplakia or erythroplakia within 12 months but no patient has had evidence of recurrent invasive carcinoma in the treated areas. Longer term follow-up will be necessary to exclude further recurrence. It is concluded that PDT offers an effective repeatable treatment option, whether on its own or as an adjunct to local excision, for patients with 'field cancerization' of the oral cavity.
对于患有口腔黏膜“场癌化”且存在多中心浸润灶的患者，其管理对头颈外科医生而言是个相当棘手的问题。手术切除同步或异时性原发性鳞状细胞癌以及相邻的癌前病变，很可能会导致严重的毁容。光动力疗法（PDT）已被证明在治疗上呼吸道消化道浅表肿瘤方面具有价值，治疗区域愈合良好。本研究报告了使用PDT治疗11例口腔“场癌化”患者的情况。6例患者有多发性原发性癌症，5例有单一原发性肿瘤。所有患者均伴有白斑区域。每位患者在光照射前48小时接受2mg/kg的卟吩姆钠，通过表面照射用50 - 100J/cm²的红色激光进行光照射。6至8周后，11例患者中有10例的治疗区域对PDT显示出完全反应；1例患者有残余白斑区域。2例患者在12个月内出现了新的白斑或红斑区域，但没有患者在治疗区域有复发性浸润癌的证据。需要进行更长时间的随访以排除进一步复发。结论是，对于口腔“场癌化”患者，PDT无论是单独使用还是作为局部切除的辅助手段，都提供了一种有效的、可重复的治疗选择。
