Contemporary minimally invasive therapeutics in the management of tissue pathologies

The aim of this thesis was to investigate and evaluate the effect of photodynamic therapy (PDT) in the management of tissue pathologies as well as the advances in photodynamic applications. Firstly, 5-ALA-PDT and mTHPC-PDT were applied in the management of superficial tissue disease. This includes oral dysplasia (147 patients), early stage oral squamous cell carcinoma (38 patients), actinic keratosis (62 patients), basal cell carcinoma (148 patients) and cutaneous squamous cell carcinoma (22 patients). The outcome from these studies indicated that this intervention could be used as an alternative to conventional therapy with reduced overall morbidity. Furthermore, PDT treatment of 18 patients with peri-orbital cutaneous carcinoma resulted in excellent therapeutic and cosmetic outcome. Secondly, mTHPC-PDT was applied in the management of deep-seated tissue disease guided by ultrasound technology. Feasibilty of this technique was demonstrated in a pilot study (21 patients). Its success has resulted in the treatment of 68 patients with various deep-seated pathologies, which was increased to 110 patients with long-term follow up. Other treated pathologies included vascular anomalies (43 patients), nasopharngeal carcinoma (7 patients) as well as tongue base carcinoma (21 patients, increased to 33 patients). The evidences supported the use of PDT in the management of advanced and recurrent tissue disease, as well as being an excellent palliation modality. Thirdly, patients' quality of life was assessed in 38 patients using a modified questionnaire from the University of Washington. PDT was found to be an acceptable and satisfactory intervention for all patients questioned. Lastly, 11 patients were subjected to photochemical internalisation (PCI) as part of a phase I clinical trial to assess the safety of a new photosensitiser ‘TPCS2a’. The photosensitiser was found to be safe and the PCI intervention was found to be effective in eliminating advanced and recurrent head and neck and breast pathologies with minimal adverse events.