Photodynamic therapy for skin carcinomas: A systematic review and meta-analysis

Abstract

BackgroundPhotodynamic therapy (PDT) is increasingly used for the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). However, it is unknown whether photodynamic therapy is more effective than other commonly used treatment modalities for these cancers.PurposeThe aim of this study was to determine the relative efficacy and safety of PDT compared with placebo or other interventions for the treatment of skin carcinomas.MethodsSearches were performed in PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases. We included randomized controlled trials comparing the PDT with other interventions in adults skin BCC or SCC that reported on lesion response, recurrence, cosmetic appearance, or safety outcomes.ResultsSeventeen unique randomized controlled trials, representing 22 study arms from 21 publications were included. The included trials included 2,166 participants, comparing methyl aminolevulinic (MAL) PDT (six studies) or aminolevulinic acid (ALA) PDT (two studies). Comparators included placebo, surgery, hexaminolevulinic (HAL) PDT, erbium: yttrium-aluminum-garnet ablative factional laser (YAG-AFL) PDT, fluorouracil, and imiquimod. There were few studies available for each comparison. Mantel-Haenszel fixed effects risk ratios were calculated for response, recurrence, cosmetic outcomes, and adverse events. MAL-PDT had similar response rates to surgery, ALA-PDT, fluorouracil and imiquimod at 3- and 12 months post-intervention. The rate of recurrence was similar, showing few differences at 12 months, but at later time points (24–60 months), fewer lesions recurred with surgery and imiquimod than with PDT. PDT also caused more adverse events and pain than other interventions. However, PDT treatment was more likely to receive a “good” or “excellent” rating for cosmetic appearance than surgery or cryotherapy.ConclusionThis systematic review and meta-analysis demonstrates that the choice of treatment modality for BCC or SCC is best chosen in the context of the location and size of the lesion, the socioeconomic circumstances of the patient, as well as the patient’s preferences. We call for more high quality studies to be done, in order to enable more reliable interpretations of the data.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=368626, identifier CRD42022368626.

Sustained resolution of nonmelanoma skin cancer with photodynamic therapy using 10% 5-aminolevulinic acid hydrochloride gel: A retrospective case series

“…Successful use of PDT for BCC, SCC, and SCCIS has been documented in the literature. 5 , 10 Our retrospective case series similarly reports 10 cases of NMSC that resolved with an average of 2 sessions of blue light PDT with 10% ALA gel and range of 1 to 4 sessions. Notably, no evidence of recurrence occurred at > 5 years after the final treatment session.…”

“…A meta-analysis of 17 unique randomized controlled trials (RCTs) of PDT for BCCs and SCCs in adults showed that PDT was more likely to receive a “good” or “excellent” rating for cosmetic outcome than surgery or cryotherapy. 5 PDT may therefore offer a good option for NMSC lesions on the face or other cosmetically sensitive locations. Additionally, PDT has been studied extensively as an effective field cancerization therapy for AKs.…”

“… 4 The use of PDT in NMSC has been documented in the literature. 5 To our knowledge, sparse data exist regarding recurrence of the NMSC. This retrospective case series demonstrates sustained eradication of 10 NMSC lesions using blue light PDT with 10% ALA gel with no evidence of recurrence after 5 years.…”

Simulating photodynamic therapy for the treatment of glioblastoma using Monte Carlo radiative transport

“…This then induces a reaction within the cell, causing toxic singlet oxygen species to form locally, resulting in the cell's death. 5 PDT is used and being investigated as a targeted and minimally invasive treatment option for many areas of oncology such as for skin, 6 head and neck, 7 bladder, 8 lung, 9 and esophageal cancers. 10 There are several clinical trials, past, present, and future, aiming to explore the potential of PDT for GBM treatment.…”

Composite Nanoplatforms Based on Nanocalcium Peroxide for Cancer Treatment: From Monotherapy to Combination Therapy

“…Furthermore, PDT remains effective for tumor recurrence after radiotherapy and chemotherapy, delivering remarkable therapeutic outcomes. [56,57] PDT operates through the photosensitization reaction with the involvement of oxygen molecules and biological effects. Upon laser irradiation with a specific wavelength, the photosensitizer absorbs energy and then transfers it to the surrounding oxygen molecules.…”