June 9, 2008 When Sammie Bush mentioned to his doctor that he sometimes felt something in the back of his throat, he didn't expect to learn that he had cancer or that he would be the first patient at the University of Illinois Medical Center at Chicago to undergo photodynamic therapy -- a new procedure that uses light to destroy cancer.
Bush's physician, Dr. H. Steven Sims, assistant professor of otolaryngology and director of UIC's Chicago Institute for Voice Care, determined that surgery would not be enough to completely remove Bush's cancer.
Using a laser technique that pinpoints cancer cells, Sims removed the cancer from around Bush's vocal folds without affecting his ability to use his voice. The worst side effects may be a sore throat for few weeks, and the need to cover up to avoid sunburn.
Photodynamic therapy has been used in other contexts, but its use to treat cancers of the throat is recent, said Sims. "Most importantly, the sensitivity of the voice box to other cancer treatments makes this treatment option particularly significant," he said.
Bush was given a light-activated drug intravenously on Tuesday, May 13. The drug is taken up by all cells, and Bush immediately became photosensitive, or very vulnerable to sunlight, and had to take precautions against the sun.
"In two days, the normal cells will have cleared the drug, but the cancerous cells will still carry it," said Sims. "We had Mr. Bush come in on that Thursday, when we applied laser light of a specific wavelength through a thin, lighted tube, called a laryngoscope, causing a biochemical reaction in the cancerous cells that have retained the drug."
The cells disintegrate harmlessly in a few days.
Most other cancer protocols require repeated patient visits over a period of weeks or months, along with multiple procedures "which can be debilitating and costs which can be crippling," said Sims. "That isn't necessary for patients who undergo photodynamic therapy, however. It's possible with this technique to treat the cancer in one go."
Not only is photodynamic therapy fast, non-surgical and minimally invasive, but cure rates for oral and laryngeal cancers, after one treatment, are currently in the 90th to 94th percentiles, Sims said.
"Best of all, normal tissues around the malignancies are left undamaged," Sims said. "If we had had to use radiation, Mr. Bush would have spent far longer in treatment, and the deterioration of his voice might have been worse, at least for a time. For patients who may use their voices professionally, this surgery can also mean that they can get back to work with minimal retraining and loss of time."
Patients remain photosensitive for four to six weeks following the procedure, and their skin is too sensitive for commercial sunblock to adequately protect them.
"I was sorry I couldn't barbecue this weekend," said Bush, who had to satisfy his craving for ribs with takeout for Memorial Day. His throat is still a bit sore when he swallows, but otherwise he says he feels fine.
Sims said radiation and chemotherapy save lives and are important weapons in the fight against cancer. "But it's wonderful that medicine now offers options that don't carry some of the debilitating side effects associated with many other types of chemotherapy."
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