Office-Based Photodynamic Therapy Using Locally Applied 5-Aminolevulinic Acid and 635nm Laser for Laryngeal Leukoplakia
Office-Based Photodynamic Therapy Using Locally Applied 5-Aminolevulinic Acid and 635nm Laser for Laryngeal Leukoplakia
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使用局部应用 5-氨基乙酰丙酸和 635nm 激光治疗喉白斑的办公室光动力疗法
DOI：
10.1002/ohn.169
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通讯作者：
Gelin Li
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作者：
Chi Zhang;Jingting Zhong;Jack J. Jiang;Qian Hou;Hui Ren;Matthew Silverman;Gelin Li
光动力疗法（PDT）是一种微创治疗方法，具有很强的组织选择性和非热效应。我们的目的是调查的有效性在办公室的方法利用光动力疗法与局部应用5-氨基乙酰丙酸（ALA）和635 nm半导体激光治疗喉白斑.Study DesignRetrospective cohort study.SettingOutpatient clinic‐tertiary medical center.MethodsThis study回顾了32例喉白斑患者，包括11例术后复发病例。所有手术均在局部麻醉下在办公室环境中进行。15% ALA溶液通过柔性喉镜局部应用于病变。使用635 nm二极管激光器通过400 μm光纤进行光照射。功率密度为165 mW/cm 2，达到100 J/cm 2。结果平均随访时间为7. 91 ± 4. 83（3 - 18）个月。进行了39例手术，包括27例患者的1次治疗、3例患者的2次治疗和2例患者的3次治疗。总有效率为96.875%（31/32），其中完全缓解26例（81.25%），部分缓解5例（15.625%），无效1例（3.125%）。结果表明，PDT选择性地消除了白斑，而不影响固有层，周围正常粘膜保持不受伤害。PDT治疗后嗓音障碍指数-10、抖动、微光和谐波噪声比评分明显改善。结论基于Office的PDT治疗喉白斑是一种有效、可重复、实用的方法。ALA的局部应用足以实现光动力学反应。光动力疗法可选择性地消除喉白斑，同时保护喉正常结构。
ObjectivePhotodynamic therapy (PDT) is a minimally invasive method with strong tissue selectivity and nonthermal effects. We aim to investigate the efficacy of an in‐office method utilizing PDT with local application of 5‐aminolevulinic acid (ALA) and 635 nm diode laser for treating laryngeal leukoplakia.Study DesignRetrospective cohort study.SettingOutpatient clinic‐tertiary medical center.MethodsThis study reviewed 32 patients with laryngeal leukoplakia, including 11 recurrent cases after surgery. All the procedures were performed in an office setting under topical anesthesia. Fifteen percent ALA solution was locally applied to the lesion through a flexible laryngoscope. Light illumination was performed using a 635 nm diode laser through a 400 μm optic fiber. The power density was 165 mW/cm2to reach 100 J/cm2. Results of laryngostroboscopy and voice evaluation during follow‐up were collected.ResultsThe mean follow‐up was 7.91 ± 4.83 (3‐18) months. Thirty‐nine procedures were performed, including 1 session for 27 patients, 2 sessions for 3 patients, and 3 sessions for 2 patients. The total response rate was 96.875% (31/32), including complete responses in 26 (81.25%) patients, partial responses in 5 patients (15.625%), and no response in 1 patient (3.125%). It appeared that PDT selectively eliminated the leukoplakia without affecting lamina propria and the surrounding normal mucosa remained unharmed. Scores of Voice Handicap Index‐10, jitter, shimmer, and harmonic‐to‐noise ratio were significantly improved after PDT.ConclusionOffice‐based PDT is an effective, repeatable, and practical method for treating laryngeal leukoplakia. Local application of ALA is sufficient to achieve photodynamic reactions. PDT could eliminate laryngeal leukoplakia selectively while protecting the normal laryngeal structure.