Article
Photodynamic Therapy in the Treatment of Recurrent Sino-nasal Skull Base Tumors
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Published: | April 14, 2014 |
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Introduction: 42–45% of sino-nasal malignancies recur within five years after surgery and adjuvant radiotherapy. Treatment options of recurrences are limited due to the close proximity of important structures. Radical surgery and/or re-radiation are often not feasible and are usually associated with a high risk of complications such as brain edema, brain necrosis, meningitis, heavy bleeding or liquor leakage. Positive surgical margins decrease the 5-year disease-free survival of sino-nasal tumors invading the skull base from 64% to 25%. Chemotherapy alone is not curative. Photodynamic therapy (PDT) a targeted treatment modality, which uses the effects of a photosensitizer activated by non-thermal light, can provide an additional margin of 5–10 mm after surgical resection in other head- and neck tumors.
Methods: Retrospective analysis of all patients with recurrent sino-nasal malignancies treated with PDT in the Netherlands Cancer Institute between 1998 and 2012 to evaluate safety concerns as well as the possible value of PDT in the treatment of cancer in this region. Seven patients were identified. Skull base or orbit involvement was seen in 6 and 3 patients, respectively. In one patient intracranial tumor tissue was treated. In two patients the internal carotid artery was exposed.
Results: No CSF leakage, meningitis or major bleeding occurred as direct consequence of PDT. One patient got meningitis following a debridement 1 year after PDT. She survived without any sequelae. Three patients suffered of temporary diplopia and all patients experienced facial edema and pain. This suggests that it is reasonably safe to apply PDT to sino-nasal tumors of the anterior skull base, which makes PDT a suitable option to treat resection margins when radical surgery is not possible.
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