The role of lasers in otolaryngology.
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Biomedical subjects
Publications and source records attributed to J A Carruth.
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Photodynamic therapy utilizes a tumour-localizing photosensitive substance which, when activated by light of an appropriate wavelength, releases cytotoxic substances causing destruction of the malignant tumour with preservation of surrounding normal tissues. In this technique the only drug/light combination which has been regularly used to date is that of haematoporphyrin derivative and red light at a wavelength of 630 nm usually produced by a dye or gold vapour laser. A pilot/feasibility study was set up in Southampton in 1983, with ethical permission, to treat tumours of the skin and head and neck which had failed all other treatment modalities or for which there was no practical alternative therapy. Thirty-eight patients were treated in this study and all tumours showed a response; significant palliation was achieved in a number of patients. Basal cell carcinomas and the multiple lesions of Bowen's disease were found to be particularly suitable for this form of therapy and prolonged local control was achieved in a number of patients.
An account is given of how Photodynamic Therapy (PDT) may be used in the diagnosis and treatment of cancer of the head and neck. The role and mode of action of the tumour sensitising agent, Haematoporphyrin derivative (HPD), are shown and the current use of lasers as suitable light sources will be discussed. Individual cases are used to illustrate the current state of this form of treatment and an indication of future developments is provided.
This paper presents 35 patients with carcinoma of the tongue who have been treated in Southampton using the Carbon Dioxide laser. The treatment programme for each individual patient was determined by radiotherapists and surgeons in a combined head and neck/oncology clinic. T1 carcinomas were treated by primary laser excision biopsy whereas larger tumours were treated first by conventional radiotherapy unless there was a significant contraindication to this treatment modality. Of 10 patients with T1 lesions nine are alive and well and disease free, but one patient died of other causes with no sign of recurrence. The minimum follow-up period has been two years. Of 25 patients with T2 and T3 lesions treated either before or after radiotherapy, nine are alive and disease-free, eleven died of disease and five patients died of other causes with no evidence of recurrence.
We report here the use of photodynamic therapy to treat two patients with multiple lesions of Bowen's disease. A total of over 500 lesions were treated, less than 10% requiring two treatments, and at follow-up 6 months later no lesions remained in either patient. The only important side-effect of treatment was a marked photosensitivity reaction. We consider photodynamic therapy an efficient treatment for Bowen's disease; multiple lesions can be treated in a short treatment session, without local anaesthesia, and healing occurs within 2 weeks.
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Treatment of the port wine stain with the argon laser still remains more of an art form than a scientific technique. Already, some very satisfactory results are being obtained, and these will be improved by greater accuracy in predicting those patients who will respond well to argon laser therapy and by the development of an optimal treatment technique.
Photodynamic therapy is a new and exciting treatment modality for many forms of localised malignant disease. A considerable amount of laboratory and clinical research has been carried out using the tumour sensitiser haematoporphyrin derivative activated by red light at a wavelength of 630 n commonly produced by either an argon/dye laser or a pulsed gold vapour laser. It appears certain that continuing research will produce better tumour sensitisers activated by different wavelengths of light, but it will be several years before any new drug/light combination is ready for clinical trials. This paper presents an overview of the current situation and a summary of some of the exciting results that are being obtained in clinical trials throughout the world.
Conventional open treatment for laryngeal stenosis involves major surgery. Seventeen patients with various pathologies, who needed tracheostomy to relieve their laryngeal stenosis, have been assessed following endoscopic treatment with the CO2 laser. Following an initial direct laryngoscopy, 3 of the patients were considered to be unsuitable for laser treatment. The remaining 14 patients had the stenosed area excised until it was felt that the airway was sufficiently patent to allow closure of the tracheostomy. Eight of the patients were successfully decannulated. The CO2 laser may be used endoscopically to treat certain patients with laryngeal stenosis, who would otherwise require open operation or a permanent tracheostomy.
The role of the Carbon Dioxide laser in the performance of laryngeal microsurgery is discussed with reference to its advantages over conventional techniques. The need to excise lesions rather than to vaporise them is stressed and additional instrumentation is described.
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Within the past few years photoradiation therapy has emerged as a promising new treatment for many forms of localized malignant disease and a number of clinical trials are now in progress. The pilot study described in this paper is the first clinical trial of photoradiation therapy to be carried out in Great Britain. Although it is not possible to draw significant conclusions from the results obtained, it has been shown that all the tumours responded to treatment and in four patients who had tumours which were suitable for photoradiation therapy, complete tumour regression was obtained. Further trials are in progress and others are planned in a number of centres.
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The role of the argon laser for the treatment of port wine stain (PWS) is reviewed in relation to the Southampton regime, which is based on finding the minimal blanching power. Both the advantages and limitations of this form of treatment are discussed, stressing the importance of first obtaining a satisfactory test patch.
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