Low irradiance compared with conventional photodynamic therapy in the treatment of actinic keratoses

Gholam, Patrick; Bosselmann, Ina; Enk, Alexander; Dick, Julika

doi:10.1111/phpp.12431

Cited by 13 publications

(29 citation statements)

References 18 publications

(40 reference statements)

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“…In this study, the effect of the irradiance on CR at 3 months following C-PDT was demonstrated to be non-significant. This finding supports previous studies that have demonstrated similar efficacy for red-light photoactivation at irradiances of 15.4 mW/cm 2 [6], 12.3 mW/cm 2 [7] and 1.3 mW/cm 2 [8], respectively, compared to C-PDT.…”

Section: Discussionsupporting

confidence: 92%

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Photodynamic therapy for actinic keratosis: a trend towards a decrease in irradiance without loss of efficacy for a better tolerability

Vignion‐Dewalle

Vicentini

Baert

et al. 2019

17th International Photodynamic Association World Congress

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Photodynamic therapy (PDT) is an established treatment for actinic keratosis (AK). The conventional approved PDT protocol in Europe (C-PDT) involves red-light photoactivation at irradiances higher than 60 mW/cm 2 , making the treatment painful. Several clinical studies have reported similar efficacy and better tolerability when using red-light photoactivation at lower irradiances. The aim of the study was to investigate whether there is a minimum irradiance threshold for red-light photoactivation above which there is no further improvement in efficacy. A photodiode sensor connected to a power meter was used to measure the irradiance delivered to 114 AKs on the scalp and forehead of 19 patients during C-PDT using the Aktilite CL 128 (Galderma SA, Switzerland). The widely ranging measured irradiances, resulting from the heterogeneous photoactivation over the treatment area provided by the Aktilite CL 128, were cross-referenced with the clinically evaluated complete responses (CR) at 3 months. The 66 AKs in CR at 3 months received an average irradiance of 30.9 mW/cm 2 (standard deviation: 16.7 mW/cm 2) compared to 33.3 mW/cm 2 (standard deviation: 17.9 mW/cm 2) for the 48 AKs in incomplete response. No significant effect of the irradiance on the CR at 3 months was found (odds ratio for a 6 mW/cm 2-unit change, 0.96; 95% confidence interval, 0.83 to 1.10; p=0.53). No minimum irradiance threshold could therefore be determined in the considered irradiance range. A red-light device enabling homogeneous irradiation at a lower irradiance than the Aktilite CL 128 may therefore provide similar efficacy and higher treatment tolerability than C-PDT.

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Section: Discussionsupporting

confidence: 92%

“…Due to the irradiances higher than 60 mW/cm 2 generated by the lamp, C-PDT is known to be painful [5]. Very recently, red-light photoactivation at irradiances of 15.4 mW/cm 2 [6], 12.3 mW/cm 2 [7] and 1.3 mW/cm 2 [8] respectively, has demonstrated similar efficacy and strong pain reduction compared to C-PDT.…”

Section: Introductionmentioning

confidence: 99%

Photodynamic therapy for actinic keratosis: a trend towards a decrease in irradiance without loss of efficacy for a better tolerability

Vignion‐Dewalle

Vicentini

Baert

et al. 2019

17th International Photodynamic Association World Congress

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“…Gholam et al have also evaluated Li‐PDT using the BF‐RhodoLED® lamp system with an irradiance of 15.4 mW/cm 2 for 40 min in order to achieve a light dose of 37 J/cm 2 . Thirty‐one patients were enrolled (Gholam et al, ). Li‐PDT resulted in significant less pain scores than C‐PDT (2.8 for Li‐PDT vs. 7.6 for C‐PDT) while maintaining a similar efficacy 4 weeks after treatment: percentage reduction of 69.9% for Li‐PDT versus 74.3% for C‐PDT.…”

Section: Data Reported For the Clinical Studies Included In The Reviementioning

confidence: 99%

“…Pain scores (0–10) versus irradiance (mW/cm 2 ). Data were obtained from Gholam et al (), Ibbotson and Ferguson (), and Vicentini et al ()…”

Section: Data Reported For the Clinical Studies Included In The Reviementioning

confidence: 99%

Low‐irradiance red light compared to conventional red light in photodynamic therapy of actinic keratosis: A way to reduce pain during treatment

Mordon

Vignion‐Dewalle

2019

Dermatologic Therapy

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“…Although often described as very painful by patients, PDT remains one of the first line treatments, especially for the management of multiple actinic keratosis because it allows to treat large areas with a satisfactory response rate and excellent cosmetic results. Several recent studies [14][15][16] have shown that the use of a reduced dose and/or irradiance provide similar efficacy, with a limited pain. Furthermore, classical light sources used for the photodynamic treatment are usually planar while the targeted surfaces are mainly curvy [17].…”

Section: Key Points For Pdt On Empdmentioning

confidence: 99%

Light emitting fabrics for photodynamic treatment of vulvar primary extramammary Paget's disease

Thecua

Lecomte

Ziane

et al. 2019

17th International Photodynamic Association World Congress

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Primary Extramammary Paget's disease (EMPD) is a rare cancer that mainly affects the genital region including vulvar and perianal areas.Without treatment, vulvar EMPD progresses and presents always more erythematous and pruritic plaques, which may become ulcerated and erosive. To control disease progression and symptoms usually experienced by patients, surgical excision is the mainstay of treatment. Unfortunately, even after large surgical excision with intra-operative margin control, recurrences are common [1]. For recurrent patients which undergo multiple resections, severe functional and sexual alterations are described.Only few data are available on the efficacy of alternative conservative treatments, such as laser ablation, radiotherapy, topical chemotherapy and photodynamic therapy (PDT) [2]. To date, none of them can be considered as a solid alternative to surgical excision yet [3]. Nonetheless, multiple clinical cases suggest that PDT could provide the opportunity to treat subclinical lesions, and give some relief on patient's symptoms of the disease [4][5][6].Unfortunately, the benefits of using photodynamic therapy for vulvar EMPD remains a challenge to demonstrate, because of the inhomogeneous illumination of vulvar and perianal areas, and the extreme pain that patients usually experienced during the illumination procedure that may lead to premature end of treatment [7,8].Resulting from the knowledge of previous works on actinic keratosis of the scalp treatment with PDT, light emitting fabrics (LEF) technology could address both of the hereinbefore described issues [9][10][11][12]. A new medical device based on LEF named PAGETEX® dedicated to illumination of vulvar and perianal areas has been developed. The device delivers a homogeneous red light (635 nm) with a low irradiance during 2h30, for a total fluence of 12 J/cm². The PAGETEX® device is being assessed in a clinical study (NCT03713203) which aims to establish PAGETEX®-PDT efficacy and tolerability.

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Low irradiance compared with conventional photodynamic therapy in the treatment of actinic keratoses

Cited by 13 publications

References 18 publications

Photodynamic therapy for actinic keratosis: a trend towards a decrease in irradiance without loss of efficacy for a better tolerability

Photodynamic therapy for actinic keratosis: a trend towards a decrease in irradiance without loss of efficacy for a better tolerability

Low‐irradiance red light compared to conventional red light in photodynamic therapy of actinic keratosis: A way to reduce pain during treatment

Light emitting fabrics for photodynamic treatment of vulvar primary extramammary Paget's disease

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