Comparison of cryotherapy and photodynamic therapy in treatment of oral leukoplakia

214 after treatment of glioma cells with phenytoin (Fig. 2). Levetiracetam affected neither the mitochondrial membrane potential nor PpIX synthesis. Conclusion: We showed an interaction of phenytoin with 5-ALA induced PpIX synthesis in different glioma cells. We assume that the damage of the mitochondrial membrane by reactive phenytoin metabolites inhibits PpIX synthesis. This premature damage compensates the reduced PpIX accumulation during PDT after phenytoin treatment. doi:10.1016/j.pdpdt.2011.03.296 P090 Apoptotic biomarker of topical photosan-mediated photodynamic therapy on DMBA-induced hamster buccal pouch precancerous lesions Y.-C. Hsu 1,2 1

Dept of Bioscience Technology, Chung Yuan Christian University, Taiwan, ROC 2 Center for Nanotechnology, Chung Yuan Christian University, Taiwan, ROC

Background: Based on our previous study that we have found that topical-photosan photodynamic therapy (PDT) is a novel with very effective treatment modality for hamster buccal pouches precancerous lesions using a 640-nm light-emitting diode (LED) Wonderlight. All the 14 precancerous lesions showed a complete histologically confirmed response to the lesions after an average of 3.79 PDT treatments. Normal and precancerous pouch mucosae in other hamsters received 17 or 19 treatments of topical photosanPDT showed no cumulative side effects. No recurrence of the lesions was found in these PDT-treated hamsters after a follow-up period of 70 weeks. Methods: Study of apoptotic biomarkers of topical photosanmediated PDT (topical photosan-PDT) using a 640-nm light-emitting diode (LED) Wonderlight were studied to understand the role of apoptosis biomarkers in such treatment. Western blots and assays were examined on the specific apoptotic and anti-apoptotic biomarkers (p53, caspase-3, -8, -9, bcl-2, bax, bad, VEGF). TUNEL and IHC assays were examined on specimens to study induced apoptotic mechanisms on topical photosan-PDT hamster precancerous lesions and normal side as control in vivo. Results: We found that caspase-3 enzyme assays reached its peak level in precancerous lesions about 48 h (range, 0—96 h) after topical application of photosan gel. Similar results of caspase-3 were found on western blots and IHC as well. Bcl-2/bax and other biomarkers were showed correlated results but not significant. TUNEL assays were conducted to confirm DNA fragmentation. Conclusions: Our major finding indicated that caspase-3 was a good indicator to serve as an effective biomarker for monitoring apoptotic cycle after each topical photosan-PDT for DMBA-induced hamster buccal pouch precancerous lesions to achieve PDT in a successful manner. doi:10.1016/j.pdpdt.2011.03.297

Poster Abstracts P091 Assessment of quality of life in patients undergoing photodynamic therapy W. Jerjes 1,2 , Z. Hamdoon 1,2 , T. Upile 1,2 , C. Hopper 2 1

Department of Head and Neck Surgery, Barnet and Chase Farm Hospitals NHS Trust, United Kingdom 2 UCL Department of Surgery, University College London Medical School, United Kingdom Introduction: The assessment of quality of life in patients undergoing photodynamic therapy (PDT) is dependent on many variables. Objective: The aim of this study was to evaluate the quality of life in patients undergoing PDT for head and neck pathologies. Materials and methods: We have developed the first quality of life questionnaire for patients undergoing photodynamic therapy. The questionnaire was then modified to be applicable for head and neck pathologies. Thirty-eight patients agreed to take part in this study. The quality of life was assessed before, during and up to 3 months after photodynamic therapy. Results: Pain was the main problem which peaked in the first 48—72 h. Swelling lasted for about 8 days. Patients experienced the greatest changes in functional scale in the fourth week following PDT. There was significant improvement of swallowing, speech and breathing in the majority of patients suffering from oral and oropharyngeal pathologies. Conclusion: The routine application of quality of life questionnaires in head and neck patients improves information regarding how and to what extent patients feel that treatment is improving their quality of life making it possible to support patients to their real needs. doi:10.1016/j.pdpdt.2011.03.298 P092 Comparison of cryotherapy and photodynamic therapy in treatment of oral leukoplakia A. Kawczyk-Krupka 1 , J. Waœkowska 2 , A. Kwiatek 1 , D. Straszak 1 , W. Siostrzonek 2 , S. Koszowski 2 , A. Siero˜ n1

RaczkowskaLatos 1 , R.

1 Medical Univ. of Silesia, Center for Laser Diagnostics and Therapy, Bytom, Poland 2 Medical University of Silesia, Oral Surgery Department, Bytom, Poland

Background: Oral leukoplakia is a pre-malignant lesion of the oral mucosa. The aim of this study is to compare the curative effects of photodynamic therapy and cryotherapy in the treatment of oral leukoplakia. Methods: The first group, treated by photodynamic therapy (␦aminolevulinic acid (ALA), 630—635 nm wavelength), consisted of 48 patients suffering from leukoplakia. The second group consisted of 37 patients treated using cryotherapy. Analyses and comparisons of the complete responses, recurrences, numbers of procedures and adverse effects after both PDT and cryotherapy were performed. Results: In the first group, a complete response was obtained in 83.3% of the patients, with one recurrence observed (8.3%) over a six-month period. In the second group, radical treatment was performed in 33 patients (89.3%), and recurrence was observed in four patients (10.7%). Conclusions: Photodynamic therapy and cryotherapy appear to be comparative methods of treatment that may both serve as alternatives for the traditional surgical treatment of oral leukoplakia. The advantages of PDT are connected with minimally invasive and localized character of the treatment and with not damage of collagenous tissue structures, therefore normal cells will repopulate

Poster Abstracts these structures. PDT is more convenient for patients, less painful, and more esthetic. doi:10.1016/j.pdpdt.2011.03.299 P093 The role of photodynamic therapy in multidisciplinary oncological care W. Jerjes 1,2 , Z. Hamdoon 1,2 , T. Upile 1,2 , C. Hopper 2 1

Department of Head and Neck Surgery, Barnet and Chase Farm Hospitals NHS Trust, United Kingdom 2 UCL Department of Surgery, University College London Medical School, United Kingdom Photodynamic therapy (PDT) remains an attractive therapeutic option in oncology. In principle, administration of the photosensitiser, followed by light application to the target ‘lesional’ area leads to a photochemical reaction. Several hours later, selective damage to the target tissue ensues. Photodynamic therapy is widely used in oncology both for primary curative treatment and palliation/salvage therapy. We review the role of photodynamic therapy in multidisciplinary oncological care. Multiple studies have showed that head and neck cancer responds favourably to PDT, particularly as primary and alternative treatment modality for early oral and laryngeal cancers. Photodynamic therapy (PDT) is currently being used in the treatment of many cancers including head and neck, skin, brain, lung, pancreas, intra-peritoneal cavity, breast and prostate. The excellent cosmetic outcome makes it valuable for skin cancer and its ability to preserve form and function makes it an excellent choice for cancerous lesions of the head, neck, and oral cavity. With endoscopic delivery of light to hollow structures, PDT has been successful in the treatment of early oesophageal cancer and lung cancer. PDT has a significant role in palliative therapy; it can reduce tumour size, control pain and stop bleeding in advanced cancers. The growing body of evidence of its efficacy suggests that it is destined to have a significant role in interventional oncology. Highquality trials are needed to compare PDT with relevant comparators for all meaningful outcomes, including QoL and adverse effects. doi:10.1016/j.pdpdt.2011.03.300 P094 Minimal interventions for vascular anomalies W. Jerjes 1,2 , T. Upile 1,2 , Z. Hamdoon 1,2 , C.A. Mosse 2 , S. Morley 2 , C. Hopper 2 1 Department of Head and Neck Surgery, Barnet and Chase Farm Hospitals NHS Trust, United Kingdom 2 UCL Department of Surgery, University College London Medical School, United Kingdom

Introduction: Photodynamic therapy has proved its successfulness in the management of variety of pathologies involving the human body. Our aim in this prospective clinical study is to assess the outcome following interstitial photodynamic therapy for patients with vascular anomalies. Materials and methods: Forty three patients were referred to the UCLH Head and Neck Centre for treatment of vascular anomalies of the head and neck, including: infantile and congenital haemangiomas, venous, lymphatic and arteriovenous malformations. After multidisciplinary discussion, all patients underwent interstitial photodynamic therapy under general anaesthesia, using 0.15 mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 21 months.

215 Results: Fifteen out of nineteen patients who presented with long-term pain reported improvement after treatment. Also, 7/8 reported significant reduction of bleeding related to their vascular anomaly. Improvement of swelling was reported by 28/35 patients; while reduction of infection episodes was evident in 8/11 patients and 31/36 reported reduction in the disfigurement caused by their pathology. Significant reduction of swallowing problems was reported in 9/12 patients, and breathing problems in 7/9 patients. Clinical assessment showed that half of the patients had ‘‘good response’’ to the treatment. Moderate clinical response was reported by 13 (30.2%) patients. Radiological assessment comparing imaging 6 weeks post-PDT to the baseline showed moderate response in 11 (25.6%) patients and significant response in 15 (34.9%) patients. Conclusion: This study on 43 patients with vascular anomalies undergoing interstitial photodynamic therapy provided evidence that PDT is a successful modality in the management of these pathologies. doi:10.1016/j.pdpdt.2011.03.301 P095 Optical coherence tomography in the evaluation of tongue papillae in healthy individuals Z. Hamdoon 1,2 , W. Jerjes 1,2 , T. Upile 1,2 , C. Hopper 2 1

Department of Head and Neck Surgery, Barnet and Chase Farm Hospitals NHS Trust, United Kingdom 2 UCL Department of Surgery, University College London Medical School, United Kingdom Although there have been several investigations involving the morphological features and the pathological changes in tongue papillae, highly accurate and sensitive tools in which morphology, volume and geometry of tongue papillae can be easily identified have not been developed yet. Objective: The aim of this study is to evaluate the tongue papillae in healthy individuals in terms of morphology, structure and volume of the peripheral taste organs using optical coherence tomography (OCT). Material and methods: Thirty-three healthy individuals participated in this study. Their papillae (fungiform and filliform) were subjected to in vivo OCT. The fungiform papillae investigated were selected based on the form and geometrical differences from that of the filliform ones. Two observers assessed the OCT images. Parameters measured included height and diameter of the fungiform papilla and diameter of the taste pore. Results: Observer’s agreement for differentiating between filliform and fungiform papillae was 100%. The dorsal surface of the anterior and posterior parts contained fungiform papillae, with the apical parts of these papillae containing hyper-reflective OCT signal (minimal keratin); the interpapillar space was covered by keratinfree squamous stratified epithelium. Taste pore was not easily seen by OCT with extreme difficulty to differentiate taste buds. Filiform papillae showed thorn-shaped projection(s) which were uniform in size. Each papilla consisted of a central body surrounded by several thread-like projections (secondary papillae). Conclusions: This technique provided information on papillae structure and volume which could be easily applied to early detection and monitoring of pathological processes. doi:10.1016/j.pdpdt.2011.03.302