Research: ISSING and colleagues, Kl

Listed in Issue 19

Abstract

ISSING and colleagues, Klinik und Poliklinik fur Hals-, Nasen-, Ohrenkranke, Universitat Munchen, Germany studied the use of high-dose retinyl palmitate (a form of Vitamin A) in the treatment of leukoplakia, a white patch in the oral cavity or larynx which is a premalignant precursor of squamous cell carcinoma.

Background

Leukoplakia is tobacco-related and easily monitored. The rate of transformation of leukoplakia into invasive cancer, directly related to the degree of histologic abnormality, was 36% according to the largest and longest study in the US. Surgical removal is considered the best therapy; however patients operated for oral leukoplakia may develop local relapses, new leukoplakias or squamous cell carcinoma later on. The response rate observed with treatment of leukoplakia using retinoids is much greater than spontaneous regression which sometimes occurs.

Methodology

The study, using high-dose retinyl palmitate was conducted in 2 stages. During the first phase, patients underwent induction therapy with a high dose of Retinyl Palmitate (A-Mulsin Hochkonzentrat, Mucos Pharma, Geretsried, Germany) 300,000 IU daily for the first week, to 1,500,000 IU daily in the 5th week. Patients whose lesions progressed during this period were withdrawn from the study. During the second phase, patients whose lesions responded to treatment or remained stable were then assigned to a maintenance therapy. Median duration of treatment was 104 days (range 15-272).

Results

There was complete remission rate of 65% (20 out of 31 patients); partial remission in 8 patients (26%) and relapse in 3 patients (9%) during the 15 month follow-up. Relapses were seen mainly in patients with a history of carcinoma in situ or squamous cell carcinoma.

Conclusion

A major reason for using retinyl palmitate with patients with larynx leukoplakia was to avoid general anaesthesia in elderly patients at high risk for surgery. The results obtained in this study indicate that retinyl palmitate has substantial activity in larynx premalignancy. Due to its minor toxicity, it is an excellent candidate for a preventive agent for larynx cancer.

References

Issing WJ et al. High concentrate A-mulsin, a new therapy concept in laryngeal leukoplakia. Laryngorhinootologie 75(1): 29-33. Jan 1996.

Comment

Again, the very encouraging clinical application of a nutrient for the preventive and therapeutic treatment of precancerous cells. For those whose cancer doesn't respond or progresses, surgery is still the route. However it must be more pleasant to take Vitamin A than submit to oral surgery!

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