Long‐term efficacy of photodynamic therapy with methyl aminolevulinate in treating Bowen's disease in clinical practice: A retrospective cohort study (2006‐2017)

Abstract

Background: Photodynamic treatment with methyl aminolevulinate (MAL-PDT) is considered an effective and highly recommended treatment for Bowen's disease.However, its long-term efficacy remains to be established, as significant differences have been reported in this respect. Objective:The aim of the present study was to describe the results of a retrospective analysis of patients with Bowen's disease treated with MAL-PDT during the period 2006-17 at the Costa del Sol Hospital (Marbella, Spain). Material and Methods: This study is based on a retrospective descriptive analysis of the clinical records of patients treated with MAL-PDT from June 2006 to September 2017. The analysis was based on calculating the mean and standard deviation values for the quantitative variables, and frequency distributions for the qualitative ones.The survival curves were plotted by the Kaplan-Meier method, and the log-rank test was used to assess differences in survival between groups. A cox regression analysis was performed to clarify the significant prognostic factors. Results:A total of 537 tumours with histologically confirmed Bowen's disease were treated with MAL-PDT. Recurrence-free survival at one year was 88%, and at 5 years, 71%. Tumour size >300 mm 2 (≥21 mm in diameter P = 0.019), its location in the upper extremities (P = 0.029) and patient's age <70 years (P = 0.028) were all associated with an increased risk of recurrence. Limitations:Given the retrospective design of our study, the possible existence of information bias cannot be ruled out. Conclusions:Although it is an appropriate treatment option for patients with Bowen's disease, MAL-PDT presents a risk of recurrence of almost 30% at 5 years. Larger lesions (>300 mm 2 ; ≥21 mm in diameter) are more likely to recur than smaller ones. Therefore, appropriate selection is needed of the tumour to be treated, and prolonged follow-up should be provided.

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

“…In addition, our study suggested that PDT could achieve better efficacy within fewer rounds of treatment compared with conventional therapies (cryotherapy and 5-FU), an observation that had not been reported by the 2 meta-analyses [26, 27]. We also observed that PDT resulted in less recurrence of lesions than other treatments, an observation contrary to those of other reports [15, 27]. PDT is preferred over other cosmetic therapies because it always has better cosmetic outcomes.…”

“…Given this mechanism of action, PDT has several potential advantages over other treatments, such as excellent functional and cosmetic outcomes, and the ability to treat surrounding field cancerization [12,13]. Although PDT had been recommended in the treatment of BD [12][13][14], some scholars warned against a high recurrence rate of PDT in BD treatment and suggested careful selection or longer follow-up [8,15]. In addition, in order to improve the efficacy of PDT, researchers combined PDT with other treatments, such as ablative fractional CO 2 laser (AFL) [16,17] and plum-blossom needle (PBN) [18], in the management of BD and obtained better out-comes.…”

Mitotic Catastrophe Induced in HeLa Tumor Cells by Photodynamic Therapy with Methyl-aminolevulinate

“…Up to now, a few PSs have been clinically approved, including MAL, precursor of the endogenous PS PpIX, which presents a huge relevance in the topical treatment of non-melanoma skin cancer and the precancerous lesion actinic keratosis [34,35]. Despite of being currently a common treatment, cases of resistance or recurrence have been described [36,37]. Therefore, deeper knowledge of cellular mechanisms underlying cancer cell death is needed in order to prevent negative responses to PDT and to improve this therapy.…”

Bowen's Disease: Literature Review

“…Также имеется сообщение об успешном применении геля, содержащего ингенол мебутат, для лечения очагов болезни Боуэна небольших размеров [46]. 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]. В настоящее время используются прекурсоры местного фотосенсибилизатора -5-аминолевулиновая кислота (ALA) и метиламинолевулинат (MAL) [49]. После местного применения и накопления в опухолевых очагах ALA и MAL превращаются в фотоактивные порфирины (протопорфирин IX) с более высокой селективностью для неопластических поражений.…”