Efficacy of Photodynamic Therapy for the Treatment of Bowen’s Disease: A Meta-Analysis of Randomized Controlled Trials

Abstract

<b><i>Background:</i></b> Photodynamic therapy is an established treatment option for Bowen’s disease. Our meta-analysis was aimed at evaluating the efficacy and recurrence of photodynamic therapy or other topical treatments (5-fluorouracil, cryotherapy) and of photodynamic therapy alone or in combination with other therapies (ablative fractional CO<sub>2</sub> laser or plum-blossom needle) for the treatment of Bowen’s disease. <b><i>Methods:</i></b> Trials that met our inclusion criteria were identified from PubMed, EMBASE, Web of Science, and Cochrane Library databases, and meta-analyses were conducted with RevMan V.5.4. The risk of bias was estimated with the Cochrane Collaboration’s risk of bias tools. Complete response rate, recurrence, pain/visual analogue scale score, cosmetic outcome, and adverse events were considered as outcomes. <b><i>Results:</i></b> Of the 2,439 records initially retrieved, 8 randomized controlled trials were included in this meta-analysis. According to our analyses, photodynamic therapy exhibited a significantly higher complete response rate (RR = 1.36, 95% CI [1.01, 1.84], <i>I</i><sup>2</sup> = 86%, <i>p</i> = 0.04), less recurrence (RR = 0.53, 95% CI [0.30, 0.95], <i>I</i><sup>2</sup> = 0%, <i>p</i> = 0.03), and better cosmetic outcome (RR = 1.34, 95% CI [1.15, 1.56], <i>I</i><sup>2</sup> = 0%, <i>p</i> = 0.0002) compared with other treatments. Moreover, there was a significant difference between the complete response rate of photodynamic therapy combined with ablative fractional CO<sub>2</sub> laser and that of photodynamic therapy (RR = 1.85, 95% CI [1.38, 2.49], <i>I</i><sup>2</sup> = 0%, <i>p</i> < 0.0001). Photodynamic therapy combined with ablative fractional CO<sub>2</sub> laser or plum-blossom needle also showed significantly less recurrence (RR = 0.21, 95% CI [0.09, 0.51], <i>I</i><sup>2</sup> = 0%, <i>p</i> = 0.0005) and a lower visual analogue scale score (RR = 0.51, 95% CI [0.06, 0.96], <i>I</i><sup>2</sup> = 0%, <i>p</i> = 0.03) than photodynamic therapy alone. However, there was no significant difference in the complete response rate between photodynamic therapy combined with ablative continuous CO<sub>2</sub> laser and photodynamic therapy combined with ablative fractional CO<sub>2</sub> laser (RR = 1.00, 95% CI [0.54, 1.86], <i>I</i><sup>2</sup> not applicable, <i>p</i> = 1.00). <b><i>Conclusions:</i></b> This meta-analysis shows that photodynamic therapy can be used in the treatment of Bowen’s disease with better efficacy, less recurrence, and better cosmetic outcomes than cryotherapy and 5-FU. Some methods, including ablative fractional CO<sub>2</sub> laser, can be applied in combination with photodynamic therapy to improve efficacy. However, which laser-assisted photodynamic therapy scheme has the most advantages in the treatment of Bowen’s disease warrants further exploration.

A Review of the Dermatologic Clinical Applications of Topical Photodynamic Therapy

“…In a meta-analysis of 4 RCTs with 292 patients, PDT had higher complete response rates (RR: 1.36; 95% CI: 1.01-1.84), reduced recurrence (RR 0.53; 95% CI 0.3-0.95), and improved cosmetic outcomes (RR 1.34; 95% CI: 1.15-1.56) compared to cryotherapy and 5-FU. 59 However, in comparison with surgical excision with a 5 mm safety margin, PDT has higher rates of treatment failure in a retrospective study of 608 patients with a median follow-up of 18 months (Hazard Ratio (HR): 2.71; 95% CI: 1.52-4.83). 60 It should also be noted that in a long-term follow-up study of MAL-PDT outcomes for BD, a sizeable recurrence rate of 71% at 5 years was noted and risk factors for recurrence included tumour size >300 mm 2 , upper extremity location, and age <70 years old.…”

Bowen's Disease: Literature Review

“…Фотодинамическая терапия являе тся хорошо зарекомендовавшим себя терапевтическим вариантом при актинических кератозах, базальноклеточном раке (узловой вариант) и при лечении болезни Боуэна [47][48][49][50]. Данная терапия основана на сочетании света и светочувствительных веществ (порфиринов) в присутствии кислорода, молекулам которого передается энергия фотонов, поглощенная порфиринами [51]. При этом образование цитотоксических форм кислорода (например, синглетного кислорода) и свободных радикалов приводит к гибели клеток [47].…”

“…Видимый синий свет, зеленый свет и красный свет от различных источников света используются для ФДТ с более глубоким проникновением света в кожу на более длинных длинах волн. В рандомизированном сравнительном исследовании при различных источниках света было показано, что красный свет, используемый для ФТД, был более эффективен при лечении болезни Боуэна, чем зеленый [51]. Помимо приведенных выше методов лечения болезни Боуэна, российские и зарубежные рекомендации включают в себя местное лечение иммуномодуляторами.…”

Research trends and hotspot analysis of fractional carbon dioxide laser: A bibliometric and visualized analysis via Citespace

“…In addition, since 2012, CO 2 fractional laser‐assisted drug delivery and its combination with drug therapy has appeared in the literature, such as CO 2 fractional laser use with botulinum toxin to treat crow's feet, 59,60 CO 2 fractional laser‐assisted transmission of ascorbic acid, 61 and its combination with triamcinolone acetonide for keloids and hypertrophic scars 62 . In recent years, CO 2 fractional laser has recently been applied as main and adjunctive treatments for a wide range of skin diseases, including cutaneous leishmaniasis, 63,64 adjuvant photodynamic therapy for toenail onychomycosis, 65 basal cell carcinoma, 66 Bowen's disease, 67 non‐melanoma skin cancer, 68 alopecia areata, 55 skin amyloidosis, 69 and acanthosis nigricans 70 . The experimental results show good application prospects worthy of further exploration and research.…”

“…The detailed keywords are further shown in Figure 8.acetonide for keloids and hypertrophic scars. 62 recent years, CO 2 fractional laser has recently been applied as main and adjunctive treatments for a wide range of skin diseases, including cutaneous leishmaniasis,63,64 adjuvant photodynamic therapy for toenail onychomycosis,65 basal cell carcinoma,66 Bowen's disease,67 nonmelanoma skin cancer, 68 alopecia areata, 55 skin amyloidosis,69 and acanthosis nigricans 70. The experimental results show good application prospects worthy of further exploration and research.Large-scale controlled trials with long-term follow-up are still lacking in clinical studies of CO 2 fractional laser, and its therapeutic effects on a variety of diseases need to be demonstrated in more clinical trials.…”