Photodynamic Therapy: Influence of Clinical and Procedure Variables on Treatment Response in Basal Cell Carcinoma and Bowen Disease

Abstract

This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Acta Derm Venereol 2018; 98: 116-118 116 Photodynamic therapy (PDT) is one of the most commonly used non-invasive treatments in non-melanoma skin cancer (NMSC). High rates of complete remission can be obtained using PDT with methyl-aminolevulinate (MAL); for basal cell carcinoma (BCC) the response rate is 91% at 3 months and 76% at 5 years, with 5-year recurrence rates of 22% in superficial BCC (sBCC) and 14% in nodular BCC (nBCC) (1, 2), and for Bowen disease (BD) the rate ranges from 88% to 100% at 3 months with 68% to 89% of treated lesions remaining clear for 17 to 50 months, besides PDT provides excellent cosmetic results and a high patient satisfaction rate (1-3).The primary limiting factors for MAL-PDT are pain during irradiation, tumoural thickness, tumour location (reduced sustained clearance rates for H-zone lesions), and certain histological features of BCCs such as pigmentary, morphoeaform, and infiltrative variants are considered contra-indications to treatment (3). Although the PDT procedure has changed little since its introduction, we conducted a retrospective analysis to evaluate how individual procedural variables relating to PDT influence the clinical response of BCC and BD. MATERIALS AND METHODSThis retrospective observational study analysed clinical and procedural variables for all cases of BD, nBCC and sBCC treated with MAL-PDT at San Jorge Hospital (Huesca, Spain) between January 2006 and December 2015.Patients were treated with MAL-PDT (Metvix ® , Galderma, La Defense Cedex, France) following the standard procedure (3). Patients with nBCC first underwent curettage debulking of the lesions. After applying haemostatic pressure, MAL was applied to the lesion and a surrounding area of 1 cm in diameter, and was incubated for 3 h under occlusion. The treated area was illuminated with a coherent monochromatic diode light source (630 nm, 37 J/ cm 2 , Aktilite ® , PhotoCure ASA, Norway).The clinical records of all patients were reviewed and data gathered for the following variables: age at onset, sex, phototype (Fitzpatrick scale I-IV), predisposing factors, location, size and type of tumour. The following procedural variables were considered: number of PDT sessions; fluorescence emitted by the lesion in response to a Wood's lamp; interruption of illumination due to pain; analgesia prior to irradiation and pain score as evaluated using a visual analogue scale (0-10). Clinical response was evaluated at the end of patient follow-up.Statistical analyses were performed using the statistical package SPSS, version 19.0 (IBM, Armonk, NY, USA). Associations between qualitative variables were assessed using the Pearson chi-squared test or Fisher exact test. The normal distribution of quantitative variables was evaluated using the Kolmogorov-Smirnov test. Depending on the data distribution, associations between binary and quantitative variables were evaluated using either the Student's t-test or Mann-Whitney U-test. In cas...

Biomarkers of basal cell carcinoma resistance to methyl-aminolevulinate photodynamic therapy

“…According to our findings, the H area is the least suitable area for PDT, it can be explained because they are embryological fusion areas with a tendency to invade in depth or maybe the locations of lesions reflect accumulation of UV lesions and hence, status of mutations. [20] In our series of 472 tumors (BCC and Bowen disease) treated with MAL-PDT, we found that more advanced age was a predictor of a poor response. Supporting this view, Niessen et al .…”

Characterisation of resistance mechanisms developed by basal cell carcinoma cells in response to repeated cycles of Photodynamic Therapy

“…However, in some cases, resistance of BCCs to clinical treatments occurs 21–27 . In the case of PDT for BCC, detection of recurrences after treatment has been as high as up to 30% 28–30 . Therefore, understanding the resistant mechanisms to PDT constitutes a very important goal for the management of BCC.…”

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

“…However, studies based on longer follow-up periods are based on diverse methods, which makes comparison difficult. [4][5][6][7][8][9][10] The aims of the present study were to review usual clinical practice in the treatment of Bowen's disease with photodynamic therapy, over an extended study period (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) at a third-level hospital, to evaluate the long-term efficacy of photodynamic therapy with methyl aminolevulinate (MAL-PDT) and to identify the risk factors associated with the response rate.…”

“…Although it appears to be a highly effective treatment for this type of neoplasm (response rates vary from 52% to 100%), some research papers have reported significant long‐term recurrence. However, studies based on longer follow‐up periods are based on diverse methods, which makes comparison difficult …”