Journal of Environmental Pathology, Toxicology and Oncology

ISSN for PRINT: 0731-8898

For Online Access

Best Paper Award Selection - Editorial Board Site

2008, Volume27

Issue 1

77 pages

Issue price - $202.00

Patricia S.P. Thong
Division of Medical Sciences, National Cancer Centre, Singapore

Malini Olivo
Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, National Cancer Centre, 169610 Singapore

Kiang-Wei Kho
Division of Medical Sciences, National Cancer Centre, Singapore

Ramaswamy Bhuvaneswari
Division of Medical Sciences, National Cancer Centre, Singapore

William W. L. Chin
Division of Medical Sciences, National Cancer Centre; and Department of Urology, Singapore General Hospital, Outram Road, 169608 Singapore

Kong-Wee Ong
Division of Medical Sciences, National Cancer Centre, Singapore

Khee-Chee Soo
Division of Medical Sciences, National Cancer Centre; and Department of Surgery, Singapore General Hospital, Singapore

Tumor response to photodynamic therapy (PDT) is dependent on treatment parameters used. In particular, the light fluence rate may be an important determinant of the treatment outcome. In this clinical case report, we describe the response of angiosarcoma to PDT carried out using different fluence rates and drug and light doses. A patient with recurrent multifocal angiosarcoma of the head and neck was recruited for PDT. A new generation chlorin-based photosensitizer, Fotolon, was administered at a dose of 2.0 to 5.7 mg/kg. The lesions were irradiated with 665 nm laser light for a light dose of 65 to 200 J/cm² delivered at a fluence rate of 80 or 150 mW/cm². High dose PDT carried out at a high fluence rate resulted in local control of the disease for up to a year; however, the disease recurred and PDT had to be repeated. PDT of new lesions carried out at a lower fluence rate resulted in tumor eradication. More significantly, it also resulted in spontaneous remission of neighboring and distant untreated lesions. Repeat PDT carried out on a recurrent lesion at a lower fluence rate resulted in eradication of both treated and untreated lesions despite the lower total light dose delivered. Immunohistochemical examination of biopsy samples implies that PDT could have activated a cell-mediated immune response against untreated lesions. Subsequent histopatho-logical examination of the lesion sites showed negative for disease. Our clinical observations show that lower fluence rate PDT results in better outcome and also indicate that the fluence rate, rather than the total light dose, is a more crucial determinant of the treatment outcome. Specifically, lower fluence rate PDT appears to activate the body's immune response against untreated lesions.

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