Metastatic head and neck malignancy treated using MRI guided interstitial laser phototherapy: An initial case report
Corresponding Author
Dan J. Castro MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, CA 90024-1624Search for more papers by this authorRobert B. Lufkin MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorRomaine E. Saxton PhD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorAnthony Nyerges MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorJacques Soudant MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorLester J. Layfield MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorBradley A. Jabour MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorPaul H. Ward MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorHooshang Kangarloo MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorCorresponding Author
Dan J. Castro MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, CA 90024-1624Search for more papers by this authorRobert B. Lufkin MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorRomaine E. Saxton PhD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorAnthony Nyerges MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorJacques Soudant MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorLester J. Layfield MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorBradley A. Jabour MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorPaul H. Ward MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorHooshang Kangarloo MD
Division of Head and Neck Surgery (Otolaryngology) (D.J.C., R.E.S., P.H.W.), Departments of Radiology (R.B.L., H.K., B.A.J.), Pathology (L.J.L.), and Anesthesiology (A.N.), UCLA School of Medicine, Los Angeles
The Department of Otolaryngology—Head and Neck Surgery (J.S.), Pitie-Salpettriere Medical Center, Paris, France
Search for more papers by this authorAbstract
Interstitial laser phototherapy (ILP) guided by magnetic resonance imaging (MRI) may become an attractive adjunctive modality for the treatment of deep and surgically inaccessible tumors of the head and neck when accurate methods of laser dosimetry and “real-time” monitoring techniques with the MRI are introduced. We recently demonstrated in ex vivo and in vivo models, a linear relationship between levels of laser energies, thermal profiles, MR signal intensity changes, and histopathological tissue damage. Results of treatment in a patient with an unresectable large right jugulodigastric metastatic squamous carcinoma using new approach of MRI guided ILP are now reported. The patient complained of significant right-sided neck pain and headaches secondary to a rapidly growing metastatic lymphadenopathy which recurred after previous surgery, radiation, and chemotherapy. Two treatment sessions were used at an interval of 2 weeks. Each treatment was performed in the MRI suite under heavy sedation. Using a 600-μm bare fiber of the Nd:YAG laser implanted interstitially under MR guidance, the metastatic node was treated at three sites. T1- and T2-weighted images were performed prior to, immediately after, 24 and 48 hours, and 4, 5, 7, 9, 16, and 25 days post-treatment. Successful relief of pain and growth arrest of this node was observed after the second treatment and at the 3-month follow-up. These results demonstrate that this technique of ILP guided by MRI may be feasible in humans, and will become clinically practical when appropriate methods of dosimetry and instrumentation are developed.
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