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Multifocal recurrence of in-situ squamous cell cancer of the oral cavity, pharynx and vocal cord
following surgical failure can be a therapeutic dilemma. Salvage surgery or radiation may be an option but
morbidity can be significant. We evaluated the potential role of low dose Photofrin (1.2mg/Kg)
Photodynamic Therapy for this cohort of patients.
A total of 25 patients with multifocal recurrent in-situ squamous cell cancer of the oral cavity,
pharynx and vocal cord who had failed local resection, and where additional surgery or radiation therapy
would likely result in permanent morbidity, were offered Photodynamic Therapy. PDT consisted of off
label infusion of Photofrin (1.2mg/kg) followed 48 hours later by illumination at 630nm employing a light
diffuser (300J) and/or microlens (150Jcm2).
All patients completed their prescribed PDT and no patient has been lost to follow up (minimum 1
year). No photosensitivity reactions were noted. No significant morbidity was seen. All patients were able
to maintain oral nutrition. Procedure related pain was well controlled by one week of oral narcotics. At
one month post PDT all patients were biopsy negative in the treatment region and no failures within the
treatment region have been noted. No fibrosis or permanent PDT morbidity has been seen with follow up to
three years. Vocal cord and voice function were excellent.
Three patients developed new regions of in-situ disease outside the PDT fields, two underwent additional
PDT and one had laser resection.
Low dose Photofrin PDT offers excellent palliation and durable local control of recurrent in-situ
squamous cell cancers of the oral cavity, pharynx and true cords. This is a well tolerated therapy. Low
dose Photofrin appears to improve selectivity and minimize normal tissue injury. It should be tested in a
larger patient population.
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