Photodynamic Therapy as an Effective Treatment for Cutaneous Lymphomas

Abstract

Topical photodynamic therapy (PDT) is a non-invasive treatment modality frequently used in dermatology to treat superficial skin cancers but also some inflammatory or infectious dermatoses. PDT appears a more and more promising therapeutic option also for cutaneous lymphomas, either of T- or B-cell origin. It is a well-tolerated treatment and has excellent cosmetic outcomes, less side effects compared to other therapies (steroids, surgery, radiotherapy, and so on), no particular contraindications, and is easily repeatable in case of relapses. However, how PDT works in the treatment of cutaneous lymphoproliferative diseases is poorly understood and the literature data are still controversial. Further randomized, controlled clinical trials involving a greater number of patients and centers with a long follow-up are necessary to assess the efficacy of PDT and establish a unique standardized treatment protocol in relation to the lymphomatous disease and the type, thickness, and location of the lesions.

An Update on Recent Advances of Photodynamic Therapy for Primary Cutaneous Lymphomas

“…The results are difficult to compare because of the different outcome measurements in these reports [ 41 , 45 ]. However, it is interesting to note that, recently, Caccavale et al reviewed PDT for MF in 60 patients with 81 patch/plaque lesions and one tumorous lesion with a complete response rate that ranged from 20–100% [ 46 ]. Intriguingly, the lesions of the tumor stage MF patient achieved complete response at 60 months follow-up after three sessions of methyl-aminolevulinate PDT [ 47 ].…”

“…The visible light allows for the selective destruction of the target tissues, which are usually malignant tumors or precancerous cells [ 51 ]. The specific mechanisms of PDT in treating CTCLs are still poorly understood, especially in the areas of the responses from inflammatory cells during the treatment process, as well as PDT’s contribution to neoplastic cell death in CTCL [ 46 ]. Despite this, past works have shown beneficial clinical effects while remaining tolerable for patients [ 48 ].…”

“…Despite this, past works have shown beneficial clinical effects while remaining tolerable for patients [ 48 ]. The successful application of PDT towards mycosis fungoides (MF), a subtype of CTCL, was first reported in 1994 by Wolf et al ( Figure 5 ) [ 46 , 52 ]. Since then, many other case reports also demonstrated successful outcomes [ 48 ].…”

“…PDT is a non-invasive, well-tolerated SDT with fewer side effects compared to steroid, surgery, chemotherapy, radiation, immunotherapy, and target therapy without specific contraindications and can be performed repeatedly in cases of the relapse of lymphomas. The average complete response rate is around 66% in early-stage MF [ 46 ].…”

“…reviewed PDT for MF in 60 patients with 81 patch/plaque lesions and one tumorous lesion with a response rate that ranged from 20-100% [46]. Intriguingly, the lesions of the tumor stage MF patient achieved complete response at 60 months follow-up after three sessions of methyl-aminolevulinate PDT [47].…”