Efficacy of Topical Photodynamic Therapy (PDT) with toluidine blue with six months followup: A case report
-
1
Second University of Naples, Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Italy
-
2
University of Milano-Bicocca, Department of Medicine and Surgery, Italy
Aim. This study aims to evaluate the efficacy of photodynamic therapy (PDT), in a patient with multiple white lesions, through computerized image analysis.
Materials and Methods. This study was approved by the ethics committee of the University of Campania "Luigi Vanvitelli". The patient, with a previous diagnosis of oral lichen planus (OLP), is a 67-year-old man, relating to UOC of Odontostomatologic Pathology of the University of Campania “Luigi Vanvitelli”. The patient showed multiple and bilateral oral white lesions spread throughout the oral mucosa. The patient is an allergic subject, an ex-smoker, with a history of pulmonary emphysema; after being subjected to an incision biopsy with histologic diagnosis of homogeneous oral cavity leukoplakia, with no signs of dysplasia the adherent gingiva of the left upper hemimascellar has been treated with five cycles of photodynamic therapy.The target area was colored by topical toluidine blue application; a LED source of 630 nm wavelength has been used directly on the targeted area for 2 minutes and 30 seconds, as reported by the literature. Follow-up control was performed two weeks after each intervention. The acquired images were processed using an image computational analysis software (ImageJ) to obtain the measurements of the areas of the treated regions of interest (ROI) at t0 and in the different therapeutic applications (t1, ..., t6); 3 months (t7) and 6 months (t8) followup images were recorded. Three different operators performed computerized analysis; the repeated analysis of the measurements made it possible to optimize the reproducibility of the data, by calculating the mean and standard deviations. The statistical analysis of the measurements through the Kruskal-Wallis and Bonferroni test for multiple comparisons (p ≤ 0.05) determined the differences between the data obtained in the different application times.
Results. At t0 the target area was 68.53 ± 21.27 mm2; after first therapy session, size of lesion was reduced of 13.21% (t1); from t1 and t2 (with the second cycle of PDT), the area of the lesion dramatically decreased from 59.48±10.43 mm2 to 28.28 ± 8.92 mm2 (-52.46% - p = 0.013); from t2 and t3 lesion reduction was of 14.43% (p ≥ 0.05), from t3 and t4 the reduction was of 38,27% (p ≥ 0.05), and the next PDT cycle obtained a decrease of 36.08% (p ≥ 0.05); the last treatment reduced the area of 43.67% (p ≥ 0.05). From t0 to t6 the area of the lesion has been reduced by 68.53 ± 21.27 mm2 to 5.38 ± 1.04 mm2 (-92.15%; p ≤ 0.01). Three-month follow-up showed a slight increase in the lesion surface of 21.80% and the 6-month follow-up showed a further increase in the treated area of 24.06% compared to the previous follow-up. Despite this, from t0 to t8 a reduction of the area of 86.78% (p ≤ 0.01) compared to the initial lesion persists.
Discussion. Photodynamic Therapy (PDT) has shown promising results as a minimally invasive treatment of oral lesions and can be used alone or in combination with other conventional treatments. A previous study showed how PDT had a quick and significant beneficial effect on the control of the main symptoms and signs of oral lesions with minimal adverse effects [3]. The potential of toluidine blue in PDT has been confirmed by its ability to induce an in vitro phototoxic effect against different varieties of cell lines. The data presented in this case report are in line with the literature. PDT is a useful tool for complex patients who cannot undergo to ambulatory, it is well tolerated by the patient for the short duration of each cycle and is characterized by a low cost and ease of execution. Interesting we found a considerable reduction in the area of the lesion at the second application of PDT; Despite the 6-month follow-up there showed a little relapse, the difference between t0 and t8 was clinically and statistically significative. Moreover, at each check the patient showed complete healing and also he never showed any pain during the treatment. Furthermore, the computerized analysis that we performed on the obtained images allows the acquisition of more precise data and therefore validation through statistical analysis of the technique and can be a valid aid in subsequent studies with different study design. The limits and disadvantages of this methodical in the treatment of white lichenoid type lesions are represented by the need for multiple sessions due to the reduced light spot size and the difficulty in having a correct histological examination. Minimal invasive techniques are needed because surgery may not apply to all cases. Although further studies would be needed, PDT fits on new non-invasiveness horizons, also being part of a non-invasive diagnostic iter, as a promising and hopeful minimally invasive approach for the treatment of oral disorders.
References
1. Di Stasio D, Romano A, Gentile C, Maio C, Lucchese A, Serpico R, Paparella R, Minervini G, Candotto V, Laino L. Systemic and topical photodynamic therapy (PDT) on oral mucosa lesions: an overview. J Biol Regul Homeost Agents. 2018Jan-Feb;32(2 Suppl. 1):123-126.
2. Aghahosseini F, Arbabi-Kalati F, Fashtami LA, Djavid GE, Fateh M, Beitollahi JM. Methylene blue-mediated photodynamic therapy: a possible alternative treatment for oral lichen planus. Lasers Surg Med. 2006 Jan;38(1):33-8.
3. Jerjes W, Upile T, Abbas S, et al. Photodynamic therapy role in the premalignancy/malignancy of the head and neck. Oncology News 2008.
Keywords:
Photodynamic therapy,
White lesions,
minimally invasive treatment,
Toluidine blue,
Computer analysis
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Oral Diseases
Citation:
Russo
D,
Romano
A,
Salerno
C,
Lauritano
D,
Paparella
R and
Di Stasio
D
(2019). Efficacy of Topical Photodynamic Therapy (PDT) with toluidine blue with six months followup: A case report.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00022
Copyright:
The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers.
They are made available through the Frontiers publishing platform as a service to conference organizers and presenters.
The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated.
Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed.
For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions.
Received:
11 Oct 2018;
Published Online:
09 Dec 2019.
*
Correspondence:
Dr. Diana Russo, Second University of Naples, Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Naples, Campania, 80138, Italy, marcomascitti86@hotmail.it