Pain during photodynamic therapy is associated with protoporphyrin IX fluorescence and fluence rate

Wiegell, Stine Regin; Skiveren, Jette; Philipsen, Peter Alshede; Wulf, Hans Christian

doi:10.1111/j.1365-2133.2008.08451.x

Cited by 120 publications

(128 citation statements)

References 20 publications

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“…The interindividual difference in size might have biased the results by influencing the pain intensity [4,5]. However, other authors have already shown that the pain intensity is strongly dependent on the localization [2,4,6]. A cosmetic unit is easy to determine in clinical practice and subsumes both individual size and localization of the treated area.…”

Section: Discussionmentioning

confidence: 99%

“…The main adverse effect in PDT treatment is pain. It has been shown that pain intensity depends on the localization [2,3], size [3,4,5], histological type [4], redness [5] and protoporphyrin IX (PpIX) fluorescence [6] of the treated lesion. Also different light sources [7,8,9], fluence rates [6] and photosensitizing agents [10,11] affect the pain additionally.…”

Section: Introductionmentioning

confidence: 99%

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Treatment with 5-Aminolaevulinic Acid Methylester Is Less Painful than Treatment with 5-Aminolaevulinic Acid Nanoemulsion in Topical Photodynamic Therapy for Actinic Keratosis

et al. 2011

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Background: Topical photodynamic therapy (PDT) is an excellent treatment option for actinic keratosis (AK). Pain is one of the major adverse effects. Objective: To compare the pain intensity during the extensive treatment of cosmetic units using 5-aminolaevulinic acid methylester (MAL) or 5-aminolaevulinic acid nanoemulsion (BF-200-ALA). Methods: 173 patients with 965 treated areas were enrolled in this retrospective monocentric study. All patients had multiple AKs and received an extensive treatment of the photodamaged area. 424 areas were treated with MAL and 541 with BF-200-ALA. Pain was rated using a standardized visual analogue scale (VAS). The number of PDT treatment interruptions was documented. Results: PDT with MAL led to a lower mean VAS score (5.0 vs. 5.8), a lower number of treatment interruptions (13.2 vs. 19.9%) and a lower amount of patients experiencing severe pain (25.0 vs. 36.0%) compared to PDT with BF-200-ALA. Conclusion: Our data shows that PDT using MAL is less painful than PDT using BF-200-ALA resulting in a significantly lower mean VAS score (p < 0.001), significantly fewer patients experiencing severe pain (p < 0.001) and a significantly (p < 0.05) lower number of treatment interruptions. Differences in selectivity for tumour cells and transport of ALA in peripheral neurons may play a role.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment with 5-Aminolaevulinic Acid Methylester Is Less Painful than Treatment with 5-Aminolaevulinic Acid Nanoemulsion in Topical Photodynamic Therapy for Actinic Keratosis

et al. 2011

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“…Based on previous studies [13,15,21], the aim of this work is to implement fluorescence imaging in a clinical protocol to improve the clinical outcome. In our multi-center clinical trial of PDT for skin cancer in Brazil, we have added three fluorescence measurements during PDT implementation.…”

Section: Introductionmentioning

confidence: 99%

Fluorescence guided PDT for optimization of the outcome of skin cancer treatment

et al. 2015

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The photodynamic therapy (PDT) is an alternative technique that can be used for treating superficial basal cell carcinoma (sBCC), Bowen's disease and actinic keratosis with highefficiency. The objective of this study is to present a method where fluorescence imaging together with for PDT as a monitoring guidance in real time. Confirming that the lesion is well prepared and the photosensitizer shows a homogenous distribution, the outcome after few PDT sessions will be more predictable and the recurrence is minimized. Our proposition in this study is use the widefield fluorescence imaging to evaluate the PDT protocol in situ and in real time for each lesion. This evaluation procedure is performed in two steps: first with the monitoring of the production of protoporphyrin IX (PpIX) induced by methyl aminolevulinate (MAL), a derivative of 5-aminolevulinic acid (ALA) and second with the detection of PpIX photobleaching after illumination. The fluorescence images provide information correlated with distinct clinical features and with the treatment outcome. Eight BCC lesions are presented and discussed in this study. Different fluorescence patterns of PpIX production and photobleaching could be correlated with the treatment response. The presented results show the potential of using widefield fluorescence imaging as a guidance tool to customized PDT. This procedure is being incorporated to the main PDT skin cancer protocol applied in Brazil with an excellent outcome.

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“…Even though this results in a slightly more shallow treatment due to the dominating absorbing features of PpIX in the blue wavelength range (figure 1 c) many efficient results have been reported. [5][6][7][8][9] Daylight has been shown to be associated with a lower experienced pain 10 and the preferred choice of treatment by the majority of patients. 3 In the work presented here we compare daylight PDT to conventional PDT where the artificial light source Aktilite is adopted (Akitlite, Photocure ASA, Norway 11 ).…”

mentioning

confidence: 99%

New insights into photodynamic therapy treatment through the use of 3D Monte Carlo radiation transfer modelling

Campbell

Wood

Brown

et al. 2016

Photonic Therapeutics and Diagnostics XII

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Photodynamic therapy (PDT) has been theoretically investigated using a Monte Carlo radiation transfer (MCRT) model. By including complex three dimensional (3D) tumour models a more appropriate representation of the treatment was achieved. The 3D clustered tumour model was compared to a smooth model, resulting in a significantly deeper penetration associated with the clustered model. The results from the work presented here indicates that light might penetrate deeper than suggested by 2D or simple layered models.

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Pain during photodynamic therapy is associated with protoporphyrin IX fluorescence and fluence rate

Abstract: Pain during PDT was correlated with the PpIX fluorescence in the treatment area prior to illumination. Pain was reduced using a lower fluence rate during PDT of acne.

Cited by 120 publications

References 20 publications

Treatment with 5-Aminolaevulinic Acid Methylester Is Less Painful than Treatment with 5-Aminolaevulinic Acid Nanoemulsion in Topical Photodynamic Therapy for Actinic Keratosis

Treatment with 5-Aminolaevulinic Acid Methylester Is Less Painful than Treatment with 5-Aminolaevulinic Acid Nanoemulsion in Topical Photodynamic Therapy for Actinic Keratosis

Fluorescence guided PDT for optimization of the outcome of skin cancer treatment

New insights into photodynamic therapy treatment through the use of 3D Monte Carlo radiation transfer modelling

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