Photodynamic therapy with topical 5-aminolevulinic acid as a post-operative adjuvant therapy for an incompletely resected primary nasopharyngeal papillary adenocarcinoma: a case report.
OBJECTIVE
Surgical excision of primary nasopharyngeal papillary adenocarcinoma is sometimes incomplete with remaining microscopic disease. Post-operative radiotherapy only has limited efficacy but may cause many complications.


METHODS
Photodynamic therapy (PDT) was used as a post-operative adjuvant therapy for an incompletely resected primary nasopharyngeal papillary adenocarcinoma. A special form of 20% topical 5-aminolevulinic acid (5-ALA), which was originally a liquid form and became a gel form after applied on the nasopharynx, was used as the photosensitizer. A 2-mm optic fiber delivered the light (633 nm wavelength) to the lesion with a fluence rate of 100 mW/cm2 generated by a diode laser under 5 mm 0 degrees endoscope assistance. The total energy delivered was 150 joules/cm2.


RESULTS
No significant acute side effect was noted and the nasopharyngeal wound healed rapidly. The patient is alive without locoregional recurrence or distant metastasis for 5 years. Articulation, salivation, and swallowing functions are all well preserved.


CONCLUSIONS
Post-operative adjuvant PDT can successfully cure an otherwise difficult to treat disease with preservation of good life quality of the patient. Potential complications of PDT (e.g., photosensitivity) can be prevented by a special formulation of topical 5-ALA preparation.
Wang
Cheng-Ping
CP
Department of Otolaryngology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Chang
Yih-Leong
YL
Chen
Chin-Tin
CT
Yang
Ting-Hua
TH
Lou
Pei-Jen
PJ
D000231:Adenocarcinoma, Papillary / Q000188:drug therapy* / Q000601:surgery; D000287:Administration, Topical; D000328:Adult; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011182:Postoperative Care; D016896:Treatment Outcome
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid