Photodynamic therapy in the treatment of recurrent nasopharyngeal cancer

Nasopharyngeal carcinoma (NPC) is a condition that predominantly affects the population of South China (2–3 cases/100 000). At the present time, the conventional treatment of NPC is with chemoradiotherapy. This has revolutionised the prognosis and 5-year survival rates are of the order of 50–70%, size dependent. Treatment of recurrence is however difficult. Surgery is an option but suited to small localised recurrence; re-irradiation can cause demyelination and chemotherapy has very small complete response rates. Photodynamic therapy (PDT) is approved for the treatment of advanced or recurrent head and neck cancers.

We describe a series of 5 patients treated with PDT for recurrent NPC all of whom had unsuccessful conventional therapy. The patients were treated with Foscan 0.15 mg/kg, 4 days prior to illumination with red light of 652 nm from a diode laser. The technique of light application is described as well as the clinical response.

Of the 5 patients treated, local control was achieved in 4/5 patients. A standard regimen of controlled exposure to light was followed over a 4–6 weeks period and no phototoxic events were recorded. Apart from transient pain and swelling, there were no complications or side effects from the treatment itself. It should be noted that some patients underwent more than one PDT treatment.

In this group who had failed previous conventional therapy, PDT is clearly a useful therapeutic option. It has low morbidity, is repeatable and is not prejudiced by prior therapy.