Photodynamic therapy of oral leukoplakia and oral lichen planus using methylene blue: A pilot study

Savarimuthu Wilfred Prasanna,S Ganesan,Prakasa Rao Aruna,Ekta Ingle,Dornadula Koteeswaran,Chidambaranathan Pravada

doi:10.1142/s1793545815400052

Abstract

Premalignant lesions like oral lichen planus (OLP), oral leukoplakia (OL) has a fair probability of transforming into malignancy and they are perverse toward conventional therapies. Photodynamic therapy (PDT) has been considered as an alternative/complimentary therapeutic modality for the management of premalignant lesions. In this study, methylene blue-mediated photodynamic therapy (MB-PDT) was used as a possible alternative method for the treatment of OLP and OL. A total of 15 OLP lesions and 13 OL lesions were enrolled in the study. The patients were irradiated using metal halide lamp filtered at 630 ± 10 nm, with a light exposure dose of 120 J/cm2 per sitting. For the OLP lesions, MB-PDT was performed once a week for four weeks and for the OL lesions, MB-PDT was performed twice a week for three weeks. Lesions were evaluated pre- and post- and at follow-up sessions by changes in sign and symptom scores, and size of lesions. We have observed a 53.3% of complete reduction in the treated OLP lesions and their decrease in size, sign and symptom score after treatment and at follow-up session was statistically significant. We have also observed complete response for one OL lesion of the 13 treated lesions. The result indicates that MB-PDT is an effective modality in management of OLP and OL. Among the two types of premalignancies treated with MB-PDT, OLP lesions responded much better than that of OL.

Highlights

Oral cancer is regarded as the most common cancer in India, and it accounts for one-third of total oral cancer occurrences in the world.[1]
A detailed history of the signs, symptoms and duration of the lesions, past medical and dental history were evaluated by oral medicine specialists. The proposal of this Methylene Blue (MB)-Photodynamic therapy (PDT) study was approved by Meenakshi Academy of Higher Education and research ethics committee and the study has been conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki
MB-PDT of oral lichen planus (OLP) For all the selected 15 OLP lesions, MB-PDT was performed for 4 weeks at the rate of one sitting per week by orally allowing MB to adsorb on the surface of the lesion followed by irradiation of red light

Summary

Introduction

Oral cancer is regarded as the most common cancer in India, and it accounts for one-third of total oral cancer occurrences in the world.[1] The primary etiology in the occurrence of oral lesions is strongly connected with the use of tobacco. The risk factor increases up to 38 times for heavy smokers when compared with nonsmoker.[2,3] Besides tobacco-related oral cancers, vitamin deciency, consumption of alcohol and betel nut may be the possible reasons for the hike in cancer etiology.[4] In spite of employing various therapeutic advancements such as radiotherapy, chemotherapy or improvement in surgical excision, the survival rate of oral cancers shows only marginal improvement in the past few decades.[5,6] The limitation in achieving appreciable therapeutic e±cacy is overcome by early detection.[7] Besides early diagnosis, there is a need to improve the current therapeutic modalities of oral lesions at their premalignant level itself. It is worth to note that many of the precancerous lesions such as oral leukoplakia (OL) and oral lichen planus (OLP) are not having denitive treatment protocols.[7,8]

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Discussion

Conclusion