Prospective evaluation of 110 patients following ultrasound-guided photodynamic therapy for deep seated pathologies

Abstract

Photodynamic therapy, the fourth oncological interventional modality has proved its success in the management of variety of pathologies involving the human body. Our aim in this prospective clinical study was to continue evaluating the outcome following ultrasound-guided interstitial PDT of pathologies involving the human body. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome. One hundred and ten patients were referred to the UCLH Head and Neck Centre, London for treatment of various deep-seated pathologies. These included tumours in the head and neck as well as vascular anomalies of the limbs. After multidisciplinary discussion, all patients underwent interstitial photodynamic therapy (iPDT) under general anaesthesia, using 0.15mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 26 months. Four out of five patients who presented with visual problems reported improvement after treatment. Also, 27/32 reported improvement of breathing. Improvement of swallowing was reported by 30/37 patients; while speech improvement was evident in 22/29 patients and 43/52 reported reduction in the disfigurement caused by their pathology. Seven out of nine patients with impeded limb function reported some degree of improvement. Clinical assessment showed that nearly half of the patients had "good response" to the treatment and 5 became disease free. Moderate clinical response was reported by 39 patients. Radiological assessment comparing radiological imaging 6-week post-PDT to the baseline showed moderate response in 45 patients and significant response in 32 patients. This study on 110 patients with deep-seated pathologies undergoing interstitial photodynamic therapy provided further evidence that PDT is a useful modality in the management of these pathologies that are otherwise resistant to conventional treatments, and with minimal side effects.