Photodynamic therapy of oral cancer: photosensitisation with systemic aminolaevulinic acid.

Abstract

Photodynamic therapy with intravenous photosensitising drugs has been shown to be effective in the ablation of superficial cancers, but long-lasting photosensitivity is a serious disadvantage. Similar photosensitivity is a feature of certain types of porphyria. We present the first report of tumour necrosis brought about by photodynamic activation of a temporary endogenous porphyrin accumulation, after an oral dose of the haem precursor, 5-aminolaevulinic acid. In 4 patients, quantitative fluorescence microscopy showed that accumulation of the photoactive intermediate protoporphyrin IX peaked after 4-6 h in 4 oral cavity squamous cell carcinomas, returning to background in 24 h. Irradiation with non-thermal red laser light caused tumour necrosis in 3 patients.