Original Investigation |

Adjuvant Intraoperative Photodynamic Therapy in Head and Neck Cancer

Nestor R. Rigual, MD1,2,3; Gal Shafirstein, DSc1,2,3; Jennifer Frustino, PhD4; Mukund Seshadri, PhD5; Michele Cooper, RN3; Gregory Wilding, PhD6; Maureen A. Sullivan, DDS7; Barbara Henderson, PhD2,3
[+] Author Affiliations
1Department of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, New York
2Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, New York
3Photodynamic Therapy Center, Roswell Park Cancer Institute, Buffalo, New York
4Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, Massachusetts
5Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Buffalo, New York
6Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Center of Excellence, Buffalo, New York
7Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, New York
JAMA Otolaryngol Head Neck Surg. 2013;139(7):706-711. doi:10.1001/jamaoto.2013.3387.
Text Size: A A A
Published online

Importance  There is an immediate need to develop local intraoperative adjuvant treatment strategies to improve outcomes in patients with cancer who undergo head and neck surgery.

Objectives  To determine the safety of photodynamic therapy with 2-(1-hexyloxyethyl)-2-devinyl pyropheophorbide-a (HPPH) in combination with surgery in patients with head and neck squamous cell carcinoma.

Design, Setting, and Participants  Nonrandomized, single-arm, single-site, phase 1 study at a comprehensive cancer center among 16 adult patients (median age, 65 years) with biopsy-proved primary or recurrent resectable head and neck squamous cell carcinoma.

Interventions  Intravenous injection of HPPH (4.0 mg/m2), followed by activation with 665-nm laser light in the surgical bed immediately after tumor resection.

Main Outcomes and Measures  Adverse events and highest laser light dose.

Results  Fifteen patients received the full course of treatment, and 1 patient received HPPH without intraoperative laser light because of an unrelated myocardial infarction. Disease sites included larynx (7 patients), oral cavity (6 patients), skin (1 patient), ear canal (1 patient), and oropharynx (1 patient, who received HPPH only). The most frequent adverse events related to photodynamic therapy were mild to moderate edema (9 patients) and pain (3 patients). One patient developed a grade 3 fistula after salvage laryngectomy, and another patient developed a grade 3 wound infection and mandibular fracture. Phototoxicity reactions included 1 moderate photophobia and 2 mild to moderate skin burns (2 due to operating room spotlights and 1 due to the pulse oximeter). The highest laser light dose was 75 J/cm2.

Conclusions and Relevance  The adjuvant use of HPPH-photodynamic therapy and surgery for head and neck squamous cell carcinoma seems safe and deserves further study.

Trial Registration  clinicaltrials.gov Identifier: NCT00470496

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours


Place holder to copy figure label and caption
Figure 1.
Photodynamic Therapy Illustrated by Process Layout

Photodynamic therapy requires the 3 elements of light, photosensitizer, and oxygen. Light of a specific wavelength activates a specific photosensitizer. This activation results in the creation of singlet oxygen, which in turn destroys tissue by intracellular oxidation, shutdown of the microvasculature, and concomitant upregulated immune response at the tumor site and humorally.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Finger and Nail Burn From Prolonged Exposure to Red Pulse Oximeter Light
Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles