Use of laser-assisted photodynamic therapy for leukoplakia in the larynx

Photodynamic therapy is a method for achieving selective tissue destruction of neoplastic and atypical proliferative cells using a chemical photosensitizer, which accumulates within the tumor, and a light source to activate a free radical cascade. This method has been used for a variety of malignant and premalignant conditions. We have been using photodynamic therapy in the larynx for intractable and difficult keratosis with atypia using a nebulized formulation of aminolevulinic acid activated with the 585-nm pulse dye laser (Cynosure, Chelmsford, MA). We can perform this procedure in the office under local anesthesia using a flexible nasopharyngoscope with a 2.5-mm working channel. We have found it to be a valuable adjunct for patients with widespread keratosis and dysplasia. In this article, we describe our methodology and application of this technology.