49. Sentinel lymph node biopsy in thyroid carcinoma and decision for selective modified radical neck dissection

Abstract

Background: Laser surgery and photodynamic therapy of tumors, which arise in the outer ear, especially in ear canal, has great potential. It enables to provide a minimally invasive therapy. The aim of this work was to report our experience using lasers and light emitting diode (LED) systems in treatment of outer ear cancer. Material and methods: From 2002 to 2011 the total of 82 patients with 115 epithelial malignant tumors located in ear canal (23) and external ear (92) underwent laser treatment. The histological verification revealed 93 basal cell carcinomas in 71 patients and 22 squamous cell carcinomas in 16 patients. The study population included 45 men and 37 women with a median age of 73 years (range, 46-95 years). Surgical laser treatment was applied for all these patients (115 lesions). The most of patients underwent photodynamic therapy (PDT). I/v PDT was provided for 16 patients with advanced (T4) cancer. For patients with T1 cancer topical PDT was provided. For patients with T2-3 cancer both: I/v PDT and topical PDT was provided. Fluorescence diagnostics measurements were performed in all patients for whom PDT was applied. This method was applicable for detecting early superficial tumors, margins of tumors and follow-up after therapy. Usually patients underwent PDT 2-5 days after laser surgery. Results: The immediate results of the surgical laser treatment revealed a complete disappearance of more than 90% of all malignant lesions. Patients were followed up for the period from 9 to 122 months. The average follow up of these patients was 49 months. During this period the recurrent disease was noticed in 16 patients. In these cases PDT or laser surgery, together with PDT was repeated. There was progression of the disease in 4 patients. And they died: 34; 61; 63 months and 8 years after the beginning of treatment. Conclusions: Laser surgery together with PDT is the method of choose for the treatment of outer ear cancer. PDT is the alternative method of treatment for cancer patients with advanced recurrent disease in ear canal. It enables to avoid an aggressive surgical treatment. Fluorescence diagnostics can be used for complete visualization of malignant skin lesions. It has been shown to be highly effective in malignant superficial lesion diagnostics.