Laser therapy decreases oral leukoplakia recurrence and boosts patient comfort: a network meta-analysis and systematic review.

BACKGROUND: Oral leukoplakia (OLK) is a prevalent precancerous lesion with limited non-pharmacological treatment options. Surgery and various lasers are the mainstay of treatment; however, their relative efficacy and optimal choice remain unclear. This first network meta-analysis compared the effects of different lasers and surgical excision on post-treatment recurrence and comfort in OLK patients. METHODS: We searched four databases for relevant randomized controlled trials (RCTs) up to April 2023. The primary outcome was post-treatment recurrence, and secondary outcomes included intraoperative hemorrhage and postoperative pain scores. The Cochrane Risk of Bias tool was used to assess the study quality. Meta-analysis and network meta-analysis were employed to determine efficacy and identify the optimal intervention. RESULTS: A total of 11 RCTs including 917 patients and 1138 lesions were included. Er,Cr:YSGG laser treatment showed significantly lower recurrence rates compared to CO2 laser (OR: 0.04; 95% CI: 0.01-0.18), CO2 laser with margin extension (OR: 0.06; 95% CI: 0.01-0.60), Er:YAG laser (OR: 0.10; 95% CI: 0.03-0.37), electrocautery (OR: 0.03; 95% CI: 0.00-0.18), and standard care (OR: 0.08; 95% CI: 0.02-0.33). Er,Cr:YSGG laser also ranked the best for reducing recurrence, followed by standard care and CO2 laser combined with photodynamic therapy (PDT). Er:YAG and Er:Cr:YSGG lasers minimized bleeding and pain, respectively. None of the interventions caused severe adverse effects. CONCLUSION: For non-homogeneous OLK, Er:YAG, Er:Cr:YSGG, and CO2 laser combined with PDT offer promising alternatives to surgical excision, potentially reducing recurrence and improving patient comfort. Further high-quality RCTs are necessary to confirm these findings and determine the optimal laser-PDT combination for OLK treatment.

Management of oral leukoplakia with an 808-nm high-power diode laser: a single-center experience.

PURPOSE: High-power diode laser emerges as a promising approach to the treatment of oral leukoplakia (OL); however, its short- and long-term effects have been barely explored. This study evaluated the postoperative endpoints and the recurrence rate of high-power diode laser treatment in a well-defined series of patients with OL. METHODS: A prospective analysis was performed on 22 individuals comprising 31 OL. The lesions were irradiated using the following protocol: Indium-Gallium-Arsenide diode laser, 808 nm, continuous-wave mode, 1.5-2.0 W, 780.0 ± 225.1 J, and 477.1 ± 131.8 s. Postoperative pain was assessed with a visual analog scale at three endpoints. Clinical follow-up was performed on all patients and the Kaplan-Meier test was used to analyze the probability of recurrence. RESULTS: The series consisted mostly of women (72.7%) with a mean age of 62.8 years. A single laser session was performed in 77.4% of cases. The median score on the scale that assessed pain on the 1st, 14th and 42nd postoperative day was 4, 1, and 0, respectively. The mean follow-up period per lesion was 28.6 months (range: 2-53 months). A complete response was observed in 93.5% of OL cases, while 6.5% had recurrence. The probability of recurrence at 39 months was 6.7%. No patient experienced malignant transformation. CONCLUSION: High-power diode laser for the treatment of OL is safe and effective during the trans- and postoperative period. These findings represent an alternative approach to the management of OL, mainly because a low recurrence rate was observed.

Comparison of Er:YAG and Er,Cr:YSGG Laser in the Treatment of Oral Leukoplakia Lesions Refractory to the Local Retinoid Therapy.

Objective: The aim of this study was to compare the efficacy of Er:YAG and Er,Cr:YSGG laser in the treatment of oral leukoplakia refractory to conventional retinoid therapy. Materials and methods: The study sample consisted of 54 patients (16 men and 38 women) who were histopathologically diagnosed with oral leukoplakia that was refractory to conventional retinoid therapy. Patients were randomly allocated into two groups according to the type of the laser used for treatment of oral leukoplakia: Group 1. Er:YAG laser; Group 2. Er,Cr:YSGG laser. Patients were recalled at 6 months and 1 year after treatment to evaluate possible recurrence and assess the patients' postoperative quality of life. Results: After initial ablation, the degree of residual lesion was significantly greater in the Er:YAG laser group (74.1%), compared with the Er,Cr:YSGG group (18.5%) (p = 0.0001). Six months and 1 year after the second ablation, there was no lesion recurrence in either laser group. Fourteen days after the initial ablation, the visual analog scale (VAS) pain rating and the total oral health impact profile score fell significantly in both groups (p < 0.0001). However, in the Er,Cr:YSGG laser group, the average value of the VAS rating was significantly lower than in the Er:YAG laser group (p = 0.039). Conclusions: The Er:YAG and Er,Cr:YSGG lasers showed similar efficacy in the treatment of oral leukoplakia and resulted in full postoperative recovery without recurrence after 1 year of follow-up.

Treatment Outcome of Oral Leukoplakia with Er:YAG Laser: A 5-Year Follow-Up Prospective Comparative Study.

Objective: The purpose of this prospective analysis was to evaluate the efficacy of erbium-substituted yttrium aluminum garnet (Er:YAG) laser compared with that of conventional surgery, regarding the long-term outcome of nondysplastic oral leukoplakias (OL). Background: To date, this comparison has never been performed. Methods: Patients were randomly allocated to two different groups: some underwent surgical excision with traditional scalpel (Group TrSc) and others underwent an ablative session with Er:YAG laser (Group Las), with these modalities: 1.5-W power, 150-mJ pulse energy, 10-Hz frequency, 500-µs pulse duration, and 0.9-mm spot size. During the follow-up period, the evolution of the OL was listed as (1) healing: if novel lesions did not appear in the same place of the surgery and (2) recurrence: if a new mucosal change has been detailed in the equivalent place of the primary disease. Results: One hundred seventeen lesions were treated. Fifty-eight lesions underwent surgery with traditional scalpel, whereas 59 underwent laser surgery. Follow-up ranged from 24 to 108 months (median of 58). Healing was detailed for 52.99% (n = 62) of the 117 OL, with no statistical differences between the two randomized groups. Conclusions: It seems reasonable to consider the Er:YAG laser as effective as traditional scalpel in terms of healing for OL, with the same rate of recurrences in a period of almost 5 years.

Clinical evaluation of photodynamic therapy efficacy in the treatment of oral leukoplakia.

BACKGROUND: The aim of the study was clinical evaluation of photodynamic therapy efficacy in the treatment of oral leukoplakia lesions. METHODS: Twenty-three consecutive patients aged 21-79 were included to the study. In all patients 44 homogeneous, flat leukoplakia lesions were clinically diagnosed and confirmed histopathologically. Photodynamic therapy was performed with the use of Photolon(®) photosensitizer, containing 20% Chlorine-e6 and 10% dimethyl sulfoxide and a semiconductor laser, with power up to 300mW and a wavelength of 660nm. Ten illumination sessions were conducted with the use of superficial light energy density of 90J/cm(2). RESULTS: At baseline the mean size of leukoplakia lesion was 6.5±5.10cm(2) while after photodynamic therapy 3±2.99cm(2). Significant reduction (on average by 53.8%) of leukoplakia lesions sizes was observed after therapy. Twelve (27.27%) lesions had been completely cured, 22 (50%) partially cured, although 10 (22.73%) lasted unchanged. The efficacy of PTD was comparable in women and men irrespective of age. There have been no adverse site effects during therapy noted. CONCLUSIONS: Within the limits of the study it can be concluded that photodynamic therapy with the use of Chlorine-e6 can lead to considerable reduction of oral leukoplakia lesions size thus may be useful in clinical practice. However there is a need of further studies on larger number of cases and longer follow-up time.

Photodynamic therapy outcome for oral dysplasia.

INTRODUCTION: Photodynamic therapy (PDT) is a minimally invasive surgical intervention used in the management of tissue disorders. It can be applied before, or after, any of the conventional modalities, without compromising these treatments or being compromised itself. MATERIALS AND METHODS: In this prospective study, a total of 147 consecutive patients with oral potentially malignant disorders were treated with surface illumination PDT, using 5-ALA or mTHPC as the photosensitizer. The average age was 53 ± 8.9 years. The patients' recovery was uneventful and no complications reported. Comparisons with the clinical and histopathological features and rate of recurrence as well as malignant transformation were made. The patients were followed-up for a mean of 7.3 years. ANALYSIS AND RESULTS: Homogenous leukoplakias were identified in 55 patients, non-homogenous leukoplakias in 73 patients, whereas 19 patients had erythroplakias. Ex- and current lifelong smokers formed 84.4% of the recruited patients. While people who currently smoke and drink formed 38.1% (56 patients) of the cohort. Erythroplakias were mainly identified in heavy lifelong smokers. The most common identified primary anatomical locations were the lateral border of tongue, floor of mouth and retromolar area. Moderate dysplasia was identified in 33 patients while 63 patients had severe dysplasias; and 32 patients had a histopathological diagnosis of carcinoma in situ. The rate of recurrence in laser surgery was approximately 11.6%. Malignant transformation was observed in 11 patients (7.5%), in the tongue, floor of mouth and retromolar area. Recurrence and malignant transformation was mainly identified in erythroplakias and non-homogenous leukoplakias. The final outcome of the cohort showed that 11 (7.5%) suffered from progressive disease, 5 (3.4%) had stable disease, 12 (8.2%) were considered partially responsive to the therapy. Complete response was identified in 119/147 patients (81%). CONCLUSION: 5-ALA-PDT and/or mTHPC-PDT offer an effective alternative treatment for oral potentially malignant disorders.

Comparison of clinical outcomes of oral erythroleukoplakia treated with photodynamic therapy using either light-emitting diode or laser light.

BACKGROUND AND OBJECTIVES: Topical 5-aminolevulinic acid-mediated photodynamic therapy (topical ALA-PDT) using a 635-nm light-emitting diode (LED) light is an effective treatment modality for oral verrucous hyperplasia. This study tested whether topical ALA-PDT using either the LED or laser light was also an effective treatment modality for oral erythroleukoplakia (OEL) lesions. STUDY DESIGN/MATERIALS AND METHODS: In this prospective but non-randomized study, 20 OEL lesions were treated with topical ALA-PDT using the 635-nm LED light and 26 OEL lesions were treated with topical ALA-PDT using the 635-nm laser light. The difference in clinical outcomes was compared between the two groups by Fisher exact test. RESULTS: We found that the 20 LED light-treated OEL lesions showed complete response (CR) in 17 and partial response (PR) in 3. The 17 CR OEL lesions required an average of 3.7 (range, 2-7) treatments of ALA-PDT to achieve CR of the lesions. The 26 laser light-treated OEL lesions showed CR in 25 and PR in 1. The 25 CR OEL lesions needed an average of 3.3 (range, 2-6) treatments of ALA-PDT to achieve CR of the lesions. There was no significant difference in PDT outcomes between the 20 LED light-treated and 26 laser light-treated OEL lesions (P = 0.303). When the 42 CR OEL lesions were pooled together, we found that smaller lesions (greatest diameter <1.5 cm) and lesions with thinner surface keratin (keratin layer < or =30 microm) needed significantly fewer mean treatment number of PDT to achieve a CR than the larger lesions (P = 0.000) and lesions with thicker surface keratin (P = 0.000), respectively. CONCLUSIONS: Topical ALA-PDT using either the LED or laser light is an effective treatment modality for OEL lesions. There is no significant difference in clinical outcomes of OEL lesions treated with PDT using either the LED or laser light.

[Reconstructive plastic repair in cancer of the lips]. / Plastia reconstructiva în cancerul buzelor.

Lips neoplasm represent 20% from all maxillo-facial cancers, more than 90% being localized on the inferior lip. This paper present the results of the reconstructive surgery on 208 patients treated over 10 years (1984-1993) at the Bucco-Maxillo-Facial Surgery Clinic from Iasi. The procedures were different according with the dimensions of the tumor and several other factors regarding there histopathological type, moment of the diagnostic, age etc.

[Cutaneo-mucous precancer, treatment using CO2 laser]. / Precáncer cutaneomucoso, tratamiento con láser de CO2.

It indicates the methodologic in work and study, that the compose 51 patients constituted for 20 cases with queratomas, 10 of cheilitis, 13 of leucoplasias and 8 of melanosis precancerous of Dubreuilh. Immediately, it described the fundamentals of the laser carbon dioxide its bases parametrica in the treatment especially for those pathologic precancerous of the skin and the results obtained, with its advantages and disadvantages.

Late occurring recurrence of oral cancer after combined treatment with bleomycin and radiotherapy.

Among 11 patients with oral cancer that disappeared after combined treatment with bleomycin and radiotherapy without surgery, one had an early recurrence and three had recurrences after 2 years or more. These late occurring recurrences were microcancers on mucous membranes that were thought to have been cured. Two of the three patients whose tumors recurred and another patient were found to have epithelial dysplasia at 1 year and 2 months, 4 years and 2 months, and 1 year and 3 months later, respectively. Among 59 patients who underwent surgery after the combined treatment, no viable cancer cells were found in the resected specimens of 20 patients, but moderate or severe epithelial dysplasia was noted in ten of the 20 patients. The present findings imply that patients in whom an apparent cure has been brought about by conservative treatment may harbor latent malignancy.