A Systematic Review on the Effectiveness of Photodynamic Therapy in the Treatment of Oral Precancerous Lesions and Oral Cancers.

Abstract

Photodynamic therapy (PDT) has gained prominence as a minimally invasive treatment for various oral precancerous lesions and cancers, offering a targeted therapeutic approach with limited side effects. Among the commonly used photosensitizers, 5-aminolevulinic acid (ALA) has shown promise when activated by specific light sources. A comprehensive review of the literature was conducted, focusing on studies that utilized ALA-PDT for oral potentially malignant disorders (OPMDs) and early-stage oral cancers. Key data were extracted, including lesion type, number of treatment sessions, light power density, side effects, and recurrence rates. Comparative analysis was performed to identify consistent trends and variations across different lesion types. The review included data from 11 studies. Oral verrucous hyperplasia (OVH) and oral erythroleukoplakia (OEL) were found to respond favorably to fewer than seven weekly ALA-PDT sessions. Oral leukoplakia demonstrated better outcomes with twice-weekly treatments. Additionally, methylene blue-mediated PDT showed marked improvement in oral lichen planus, with no reported adverse effects. While overall efficacy and safety were confirmed, inconsistencies emerged regarding optimal laser power density and recurrence risks, underscoring the need for individualized protocols. In conclusion, ALA-PDT appears to be an effective and well-tolerated treatment for several oral precancerous lesions. Lesion-specific characteristics and treatment parameters play a critical role in achieving complete regression. Standardized guidelines and further research are warranted to refine PDT protocols and enhance clinical outcomes.