True leukoplakia vaporization methods by CO2 laser: clinical trial

• Published in: Annali di stomatologia Vol. 8; p. 20
• Main Authors: Bellisario, A, Palaia, G, Mohsen, M, Caputo, M, Romeo, U
• Format: Journal Article
• Language: English
• Published: Rome CIC Edizioni Internazionali 01-01-2017
• Subjects: Biopsy; Cancer; Carbon dioxide; Carbon dioxide lasers; Clinical trials; Data processing; Diagnostic systems; Dysplasia; Genetic modification; Lasers; Lesions; Leukokeratosis; Oral cavity; Periodontics; Risk analysis; Risk factors; Safety margins; Vaporization; Variance analysis; Japan; Italy
• ISSN: 1824-0852; 1971-1441

True Leukoplakia (TL) is the most common potentially malignant epithelial disorder of oral cavity, defined by the World Health Organization in 2005 as a white plaque of questionable risk having excluded other known diseases or disorders that carry no increased risk for cancer. There is no evidence, in literature, of the existence of a treatment that can significantly reduce the recurrence rate and risk of neoplastic evolution of TL. For this reason the aims of this clinical trial are to investigate the efficacy of laser vaporization in the management or TLs without epithelial dysplasia and to evaluate the need to extend or not, by vaporization, beyond the clinical margin of the lesion, according to the concept of field cancerization (FC). FC considers TL a complex lesion, characterized by the presence of genetically modified cells even beyond the area with alterations evidenced by clinical or histopathological examination. Thirty-six TLs, diagnosed through a cold blade incisional biopsy as non-dysplastic, were included in the study and were divided into 3 groups: group A (11 TLs vaporized by CO2 laser, without extension or with extension up to 1 mm beyond the clinical margin of the lesion); group B (9 TLs vaporized by CO2 laser, with a 3 mm extension); control group (16 TLs, not treated but monitored for 6 months after the sole removal of risk factors, achieved during the diagnostic phase for all the 36 lesions analyzed). Gioups A and B were treated by CO2 laser, (SmartXide®, DEKA, Florence, Italy, 10600nm), 4.5 Watt power in pulsed wave (80 Hz, fluence 44,78 J/cm2), 400 |am spot diameter. In group B TLs, before vaporization, a 3 mm widening margin was registered by a periodontal probe and demarcated using a sterile dermographic pencil. Controls at 1 week, 3 weeks, 3 months and 6 months after therapy were performed for both groups of vaporized lesions. Photos were taken always using the same device (Nikon D200, Nikon Corporation, Tokyo, Japan) and statistical data processing was performed through the Analysis of Variance ANOVA. Sixteen of the 36 lesions healed completely after 6 months: 6 of group A (55%), 6 of group B (67%) and 4 of control group (25%). Concerning recurrence data, 5 recurrences of group A (2 partial and 3 complete) and 3 of group B (3 partial) were recorded. According to the results of this study, it is preferable to adopt an interventionist approach in the management of TLs without epithelial dysplasia and it is advisable to adopt 3 mm safety margins in vaporization procedures. It is important to emphasize that Tl laser vaporization is a specialist treatment that can be adopted only by professionists able to discriminate when a surgical approach is needed.