The use of topical ALA-photodynamic therapy combined with induction chemotherapy for locally advanced oral squamous cell carcinoma

Abstract

Backgrounds: Platinum-based induction chemotherapy (ICT) confers benefits in suitable patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Additionally, the application of a proper local approach can not only promote the survival quality and alleviate the suffering, but also improve the resectability in patients with advanced malignant tumor. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a promising minimally invasive therapy and has shown good efficacy in the treatment of patients bearing precancerous lesions and oral squamous cell carcinoma (OSCC). The aim of the study was to evaluate the application of topical ALA-PDT synchronized with ICT in locally advanced OSCC.

Patients and methods: This study described the application of topical ALA-PDT combined with TPF (docetaxel, cisplatin, and 5-fluorouracil) ICT in eleven patients treated due to locally advanced in the oral cavity. Patients qualified for this type of local treatment had cancerous lesions located on the surface of the gum or oral mucosa. The efficacy was evaluated based on the clinical response and complications of the patients.

Results: All patients were treated with four courses (bi-weekly) of ALA-PDT with three courses of TPF containing ICT. After treatment, the overall response rate was 90.9%. Then ten patients with surgery experienced radical surgery alone or combined with radiotherapy except a patient with serious heart condition. In the follow-up period of 26-43 months (median duration of 34.1 months), no local recurrence was observed in cases. Only one patient (9.1%) died of unrelated myocardial infarction.

Conclusion: Topical ALA-PDT proved to be a safe treatment in OSCC patients with locally advanced sites, which could be an appropriate addition to ICT. Despite the short observation period and small sample size, it seems justified to conduct prospective studies for the evaluation of the efficacy and safety of topical ALA-PDT synchronized with ICT followed by surgery.

Keywords: Aminolevulinic acid; Induction chemotherapy; Locally advanced; Oral squamous cell carcinoma; Photodynamic therapy.