Onco-preventive management of oral leukoplakia lesions by topical 5-ALA-mediated photodynamic therapy: A systematic review of clinical trials

Oral leukoplakia is the most prevalent potentially malignant disorder of the oral mucosa globally and its management remains a challenge. Photodynamic therapy is a minimally invasive alternative method in the treatment of premalignant lesions; and the use of the topical 5-ALA photosensitizer plus irradiation with light emitting diode (LED) or laser light has been one of the most recommended approaches for the treatments of oral leukoplakia by photodynamic therapy. The present study was carried out to determine its clinical efficacy as a chemoprevention alternative in the different clinical forms of oral leukoplakia. An exhaustive search of scientific articles published in the last 30 years in English was carried out, using keywords with the MeSH guideline, about the use of topical 5-ALA-mediated photodynamic therapy as a photosensitizer and under low intensity laser radiation or light LED as a source of illumination, in different digital bases. The systematic review under PRISMA guidance recognized an efficacy of 88.6% for this mode of phototherapy in the management of oral leukoplakia, with a greater effect size in the homogeneous clinical forms with dysplastic changes, regardless of the type of light source. However, the evidence used in this analysis was moderate. Based on the results of the present study, we can conclude that topical 5-ALA-mediated photodynamic therapy appears to be a high-performance alternative in the oncopreventive management of oral leukoplakia lesions. However, we recommend running controlled and randomized clinical trials with homogeneous methodologies that allow us to generate a met analysis with a high level of evidence.