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Clinical evaluation of a mobile, low-cost sysstem for fluorescence guided photodynamic therapy of early oral cancer in India

Siddiqui, Shahid Ali; Siddiqui, Shaista; Hussain, MA Bilal; Khan, Shakir; Liu, Hui; Akhtar, Kafil; Hasan, Syed Abrar; ... Hasan, Tayyaba; + view all (2022) Clinical evaluation of a mobile, low-cost sysstem for fluorescence guided photodynamic therapy of early oral cancer in India. Photodiagnosis and Photodynamic Therapy , Article 102843. 10.1016/j.pdpdt.2022.102843. (In press).

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Abstract

BACKGROUND: Morbidity and mortality due to oral cancer in India are exacerbated by a lack of access to effective treatments among medically underserved populations. We developed a user-friendly low-cost, portable fibre-coupled LED system for photodynamic therapy (PDT) of early oral lesions, using a smartphone fluorescence imaging device for treatment guidance, and 3D printed fibreoptic attachments for ergonomic intraoral light delivery. METHODS: 30 patients with T1N0M0 buccal mucosal cancer were recruited from the JN Medical College clinics, Aligarh, and rural screening camps. Tumour limits were defined by external ultrasound (US), white light photos and increased tumour fluorescence after oral administration of the photosensitising agent ALA (60 mg/kg, divided doses), monitored by a smartphone fluorescence imaging device. 100 J/cm2 LED light (635 nm peak) was delivered followed by repeat fluorescence to assess photobleaching. US and biopsy were repeated after 7-17 days. This trial is registered with ClinicalTrials.gov, NCT03638622, and the study has been completed. FINDINGS: There were no significant complications or discomfort. No sedation was required. No residual disease was detected in 22 out of 30 patients who completed the study (26 of 34 lesions, 76% complete tumour response, 50 weeks median follow-up) with up to 7.2mm depth of necrosis. Treatment failures were attributed to large tumour size and/or inadequate light delivery (documented by limited photobleaching). Moderately differentiated lesions were more responsive than well-differentiated cancers. INTERPRETATION: This simple and low-cost adaptation of image-guided PDT is effective for treatment of early-stage malignant oral lesions and may have implications in global health.

Type: Article
Title: Clinical evaluation of a mobile, low-cost sysstem for fluorescence guided photodynamic therapy of early oral cancer in India
Location: Netherlands
DOI: 10.1016/j.pdpdt.2022.102843
Publisher version: https://doi.org/10.1016/j.pdpdt.2022.102843
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Early Oral Cancer, India, Low cost treatment, PDT
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10146703
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