Advertisement

Annals of Surgical Oncology

, Volume 20, Issue 9, pp 3076–3082 | Cite as

mTHPC-mediated Photodynamic Therapy of Early Stage Oral Squamous Cell Carcinoma: A Comparison to Surgical Treatment

  • Sebastiaan A. H. J. de Visscher
  • Lieuwe J. Melchers
  • Pieter U. Dijkstra
  • Baris Karakullukcu
  • I. Bing Tan
  • Colin Hopper
  • Jan L. N. Roodenburg
  • Max J. H. Witjes
Head and Neck Oncology

Abstract

Background

mTHPC-mediated photodynamic therapy (PDT) is used for treatment of early head and neck squamous cell carcinoma. This study is a retrospective comparison of PDT with transoral surgery in the treatment of early primary squamous cell carcinoma of the oral cavity/oropharynx.

Methods

PDT data were retrieved from four study databases; surgical results were retrieved from our institutional database. To select similar primary tumors, infiltration depth was restricted to 5 mm for the surgery group. A total of 126 T1 and 30 T2 tumors were included in the PDT group, and 58 T1 and 33 T2 tumors were included in the surgically treated group.

Results

Complete response rates with PDT and surgery were 86 and 76 % for T1, respectively, and for T2 63 and 78 %. Lower local disease-free survival for PDT compared to surgery was found. However, when comparing the need for local retreatment, no significant difference for T1 tumors was found, while for T2 tumors surgery resulted in significantly less need for local retreatment. No significant differences in overall survival between surgery and PDT were observed.

Conclusions

PDT for T1 tumors results in a similar need for retreatment compared to surgery, while for T2 tumors PDT performs worse. Local disease-free survival for surgery is better than for PDT. This may be influenced by the benefit surgery has of having histology available. This allows an early decision on reintervention, while for PDT one has to follow a wait-and-see policy. Future prospective studies should compare efficacy as well as morbidity.

Keywords

Oral Squamous Cell Carcinoma mTHPC Elective Neck Dissection Regional Metastasis Infiltration Depth 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors declare no conflict of interest.

References

  1. 1.
    Haddad RI, Shin DM. Recent advances in head and neck cancer. N Engl J Med. 2008;359:1143–54.PubMedCrossRefGoogle Scholar
  2. 2.
    Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371:1695–709.PubMedCrossRefGoogle Scholar
  3. 3.
    Brown JS, Shaw RJ, Bekiroglu F, Rogers SN. Systematic review of the current evidence in the use of postoperative radiotherapy for oral squamous cell carcinoma. Br J Oral Maxillofac Surg. 2012;50:481–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Inagi K, Takahashi H, Okamoto M, Nakayama M, Makoshi T, Nagai H. Treatment effects in patients with squamous cell carcinoma of the oral cavity. Acta Otolaryngol Suppl. 2002;(547):25–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Wolfensberger M, Zbaeren P, Dulguerov P, Muller W, Arnoux A, Schmid S. Surgical treatment of early oral carcinoma-results of a prospective controlled multicenter study. Head Neck. 2001;23:525–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Shah JP, Gil Z. Current concepts in management of oral cancer—surgery. Oral Oncol. 2009;45:394–401.PubMedCrossRefGoogle Scholar
  7. 7.
    Bessell A, Glenny AM, Furness S, et al. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev. 2011;(9):CD006205.Google Scholar
  8. 8.
    Capote A, Escorial V, Munoz-Guerra MF, Rodriguez-Campo FJ, Gamallo C, Naval L. Elective neck dissection in early-stage oral squamous cell carcinoma—does it influence recurrence and survival? Head Neck. 2007;29:3–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Fasunla AJ, Greene BH, Timmesfeld N, Wiegand S, Werner JA, Sesterhenn AM. A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck. Oral Oncol. 2011;47:320–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Biazevic MG, Antunes JL, Togni J, de Andrade FP, de Carvalho MB, Wunsch-Filho V. Immediate impact of primary surgery on health-related quality of life of hospitalized patients with oral and oropharyngeal cancer. J Oral Maxillofac Surg. 2008;66:1343–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Chandu A, Smith AC, Rogers SN. Health-related quality of life in oral cancer: a review. J Oral Maxillofac Surg. 2006;64:495–502.PubMedCrossRefGoogle Scholar
  12. 12.
    Copper MP, Tan IB, Oppelaar H, Ruevekamp MC, Stewart FA. Meta-tetra(hydroxyphenyl)chlorin photodynamic therapy in early-stage squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 2003;129:709–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Copper MP, Triesscheijn M, Tan IB, Ruevekamp MC, Stewart FA. Photodynamic therapy in the treatment of multiple primary tumours in the head and neck, located to the oral cavity and oropharynx. Clin Otolaryngol. 2007;32:185–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Hopper C, Kubler A, Lewis H, Tan IB, Putnam G. mTHPC-mediated photodynamic therapy for early oral squamous cell carcinoma. Int J Cancer. 2004;111:138–46.PubMedCrossRefGoogle Scholar
  15. 15.
    Karakullukcu B, van Oudenaarde K, Copper MP, et al. Photodynamic therapy of early stage oral cavity and oropharynx neoplasms: an outcome analysis of 170 patients. Eur Arch Otorhinolaryngol. 2011;268:281–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Karakullukcu B, Stoker SD, Wildeman AP, Copper MP, Wildeman MA, Tan IB. A matched cohort comparison of mTHPC-mediated photodynamic therapy and trans-oral surgery of early stage oral cavity squamous cell cancer. Eur Arch Otorhinolaryngol. 2013;270:1093–7.PubMedCrossRefGoogle Scholar
  17. 17.
    European Medicines Agencies. H-C-318 Foscan European public assessment report, 2009.Google Scholar
  18. 18.
    Kubler AC, de Carpentier J, Hopper C, Leonard AG, Putnam G. Treatment of squamous cell carcinoma of the lip using Foscan-mediated photodynamic therapy. Int J Oral Maxillofac Surg. 2001;30:504–9.PubMedCrossRefGoogle Scholar
  19. 19.
    de Visscher SA, Dijkstra PU, Tan IB, Roodenburg JL, Witjes MJ. mTHPC mediated photodynamic therapy (PDT) of squamous cell carcinoma in the head and neck: a systematic review. Oral Oncol. 2013;49:192–210.PubMedCrossRefGoogle Scholar
  20. 20.
    Weishaupt KR, Gomer CJ, Dougherty TJ. Identification of singlet oxygen as the cytotoxic agent in photoinactivation of a murine tumor. Cancer Res. 1976;36:2326–9.PubMedGoogle Scholar
  21. 21.
    Dewaele M, Maes H, Agostinis P. ROS-mediated mechanisms of autophagy stimulation and their relevance in cancer therapy. Autophagy. 2010;6:838–54.PubMedCrossRefGoogle Scholar
  22. 22.
    Buytaert E, Dewaele M, Agostinis P. Molecular effectors of multiple cell death pathways initiated by photodynamic therapy. Biochim Biophys Acta. 2007;1776:86–107.PubMedGoogle Scholar
  23. 23.
    Dougherty TJ, Gomer CJ, Henderson BW, et al. Photodynamic therapy. J Natl Cancer Inst. 1998;90:889–905.PubMedCrossRefGoogle Scholar
  24. 24.
    Henderson BW, Dougherty TJ. How does photodynamic therapy work? Photochem Photobiol. 1992;55:145–57.PubMedCrossRefGoogle Scholar
  25. 25.
    Senge MO, Brandt JC. Temoporfin (Foscan(R), 5,10,15,20-tetra(m-hydroxyphenyl)chlorin)—a second-generation photosensitizer. Photochem Photobiol. 2011;87:1240–96.PubMedCrossRefGoogle Scholar
  26. 26.
    Plaetzer K, Krammer B, Berlanda J, Berr F, Kiesslich T. Photophysics and photochemistry of photodynamic therapy: fundamental aspects. Lasers Med Sci. 2009;24:259–68.PubMedCrossRefGoogle Scholar
  27. 27.
    D’Cruz AK, Robinson MH, Biel MA. mTHPC-mediated photodynamic therapy in patients with advanced, incurable head and neck cancer: a multicenter study of 128 patients. Head Neck. 2004;26:232–40.PubMedCrossRefGoogle Scholar
  28. 28.
    Hopper C. Photodynamic therapy: a clinical reality in the treatment of cancer. Lancet Oncol. 2000;1:212–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Fan KF, Hopper C, Speight PM, Buonaccorsi GA, Bown SG. Photodynamic therapy using mTHPC for malignant disease in the oral cavity. Int J Cancer. 1997;73:25–32.PubMedCrossRefGoogle Scholar
  30. 30.
    Henderson BW. Photodynamic therapy—coming of age. Photodermatology. 1989;6:200–11.PubMedGoogle Scholar
  31. 31.
    Yow CM, Chen JY, Mak NK, Cheung NH, Leung AW. Cellular uptake, subcellular localization and photodamaging effect of temoporfin (mTHPC) in nasopharyngeal carcinoma cells: comparison with hematoporphyrin derivative. Cancer Lett. 2000;157:123–31.PubMedCrossRefGoogle Scholar
  32. 32.
    Kubler AC, Stenzel W, Ruhling M, Meul B, Fischer J. Experimental evaluation of possible side effects of intra-operative photodynamic therapy on rabbit blood vessels and nerves. Lasers Surg Med. 2003;33:247–55.PubMedCrossRefGoogle Scholar
  33. 33.
    Wright KE, Liniker E, Loizidou M, Moore C, Macrobert AJ, Phillips JB. Peripheral neural cell sensitivity to mTHPC-mediated photodynamic therapy in a 3D in vitro model. Br J Cancer. 2009;101:658–65.PubMedCrossRefGoogle Scholar
  34. 34.
    Hornung R, Walt H, Crompton NE, et al. m-THPC-mediated photodynamic therapy (PDT) does not induce resistance to chemotherapy, radiotherapy or PDT on human breast cancer cells in vitro. Photochem Photobiol. 1998;68:569–74.PubMedCrossRefGoogle Scholar
  35. 35.
    Dougherty TJ, Marcus SL. Photodynamic therapy. Eur J Cancer. 1992;28A:1734–42.PubMedCrossRefGoogle Scholar
  36. 36.
    Nieuwenhuis EJ, Castelijns JA, Pijpers R, et al. Wait-and-see policy for the N0 neck in early-stage oral and oropharyngeal squamous cell carcinoma using ultrasonography-guided cytology: is there a role for identification of the sentinel node? Head Neck. 2002;24:282–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Altman DG, Machin D, Bryant T, Gardner S. Statistics with confidence: confidence intervals and statistical guidelines. 2nd ed. London: BMJ Books; 2000.Google Scholar
  38. 38.
    Hicks WL Jr, Loree TR, Garcia RI, et al. Squamous cell carcinoma of the floor of mouth: a 20-year review. Head Neck. 1997;19:400–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Nason RW, Binahmed A, Pathak KA, Abdoh AA, Sandor GK. What is the adequate margin of surgical resection in oral cancer? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:625–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA. The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2003;32:30–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol. 2006;42:229–39.PubMedCrossRefGoogle Scholar
  42. 42.
    Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW. Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg. 1986;152:345–50.PubMedCrossRefGoogle Scholar
  43. 43.
    Shingaki S, Suzuki I, Nakajima T, Kawasaki T. Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas. Oral Surg Oral Med Oral Pathol. 1988;66:683–8.PubMedCrossRefGoogle Scholar
  44. 44.
    O-charoenrat P, Pillai G, Patel S, et al. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol. 2003;39:386–90.PubMedCrossRefGoogle Scholar
  45. 45.
    Po Wing Yuen A, Lam KY, Lam LK, et al. Prognostic factors of clinically stage I and II oral tongue carcinoma—a comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck. 2002; 24:513–20.PubMedCrossRefGoogle Scholar
  46. 46.
    Melchers LJ, Schuuring E, van Dijk BA, et al. Tumour infiltration depth >/=4 mm is an indication for an elective neck dissection in pT1cN0 oral squamous cell carcinoma. Oral Oncol. 2012;48:337–42.PubMedCrossRefGoogle Scholar
  47. 47.
    Batsakis JG. Surgical excision margins: a pathologist’s perspective. Adv Anat Pathol. 1999;6:140–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Woolgar JA, Triantafyllou A. A histopathological appraisal of surgical margins in oral and oropharyngeal cancer resection specimens. Oral Oncol. 2005;41:1034–43.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Sebastiaan A. H. J. de Visscher
    • 1
  • Lieuwe J. Melchers
    • 1
  • Pieter U. Dijkstra
    • 1
    • 2
  • Baris Karakullukcu
    • 3
  • I. Bing Tan
    • 3
  • Colin Hopper
    • 4
  • Jan L. N. Roodenburg
    • 1
  • Max J. H. Witjes
    • 1
  1. 1.Department of Oral and Maxillofacial Surgery, Division of Oncology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  2. 2.Department of Rehabilitation Medicine, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  3. 3.Department of Head and Neck Oncology, The Netherlands Cancer InstituteAntoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  4. 4.Department of Head and NeckUniversity College HospitalLondonUK

Personalised recommendations