Photodynamic therapy as the "last hope" for tongue-based carcinoma

Introduction

The management of base of tongue carcinoma continue to be a major challenge in head and neck oncology. Our aim in this prospective study was to evaluate the outcome following ultrasound-guided interstitial photodynamic therapy (US-iPDT) of stage IV tongue base carcinoma. Patients’ reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.

Material/methods

Thirty-three consecutive patients were referred to the UCLH Head and Neck Centre for treatment of advanced tongue base cancer. Two-thirds of the patients had not been offered further treatment. It was decided that the only available option is to offer US-iPDT under general anaesthesia, using mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 18 months (Min 8, Max 44).

Results

11/14 patients who presented with breathing problems reported improvement after treatment. Also, 28/33 reported improvement of swallowing. Improvement of speaking was reported by 15/18 patients.

Clinical assessment showed that two-thirds of the patients had “good response” to the treatment and a third reported “moderate response”. Radiological assessment comparing imaging 6-week post-PDT to the baseline showed stable pathology with no change in size in 6 patients, minimal response in 7 patients, moderate response in 12 patients and significant response in 5 patients.

Eleven patients died; Seven of which due to locoregional metastasis. Kaplan-Meir survival curve was generated from the survival and follow-up data.

Conclusions

Photodynamic therapy is a successful palliative modality in the treatment of advanced tongue base carcinoma.