Louis-Armstrong

Sequential Follow Up In Treating Recurrent Nasopharyngeal Carcinoma With Photodynamic Therapy

OBJECTIVES

o Nasopharyngeal carcinoma (NPC) is endemic in certain parts of Asia, such as Southern China, but occurs sporadically in the Western world

o At Dr. Cipto Mangunkusumo Hospital, Jakarta, there are 90-120 new cases each year

o NPC is sensitive to both radiotherapy and chemotherapy (the first line treatment for NPC is irradiation)

o Several therapeutic modalities have been used in recurrent NPC including external irradiation, brachytherapy, chemotherapy, neck dissection, and combinations of those treatment. Serious side effects are seen following re-irradiation

METHODS

o Foscan (mTHPC, meta-tetrahydroxyphenilchlorin, temorphfin) is a second-generation photosensitizer which is activated by red light (652nm).

o It is a purified synthetic compound with a photophysical efficiency that allows short treatment times (typically 100 to 300 seconds), using small drug dosages

o The period of skin photosensitivity is approximately 2 weeks following injection of Foscan

BACKGROUND

o Photodynamic therapy is a therapeutical concept based on the ability of a number of photo-sensitizers to concentrate in tumor's tissue

o Light of a specific wave length illuminating the sensitized cells can then be used to cause selective necrosis of the tumor

o The tumor is readable by fiberoptic delivery of light energy that facilitating selective tumor destruction while sparing surrounding tissue

o Squamous cell carcinomas of the head and neck have been shown to respond favorably to PDT

o An induced period of generalized photosensitivity remains a side effect of Photodynamic therapy

CASE REPORT

o We reported a 59-year-old man with recurrent stage II NPC post-external radiation 50 Gy locoregional, 2 Gy / day, 5 day / week, with booster 20 Gy into tumor bed seven months earlier

o Foscan was injected with dosage 0.1 mg / kgBW, 48 hours before illumination with PDT

CONCLUSION

o Photodynamic therapy could be an effective local treatment modality for recurrent or persistent nasopharyngeal carcinoma

o PDT treatment of recurrent / persistent NPC has become feasible using a novel nasopharyngeal applicator

o Sequential follow up is necessary and useful for the patient to proof mucosal changes after illumination of photodynamic therapy

* Poster, presented at:

The 16th World Congress of the International Society for Laser Surgery and Medicine

The 1st Congress of the World Federation of Societies for Laser Medicine and Surgery

The 16th Congress of International YAG Laser Society

The 26th Annual Meeting of Japan Society for Laser Surgery and Medicine

Tokyo, Japan, September 7-10, 2005