Treatment of superficial basal cell carcinomas using topically applied delta-aminolaevulinic acid and a filtered xenon lamp

Wennberg, Ann‐Marie; Lindholm, Lars-Erik; Alpsten, M.; Larkö, Olle

doi:10.1007/s004030050103

Cited by 28 publications

(44 citation statements)

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“…The clinical studies listed in table 3 can be subdivided into those where irradiation was carried out with a laser [5, 9, 11, 14]and those where a filtered or unfiltered lamp was used [3, 10, 12, 13, 15]. The most important differences between a laser and a lamp are the narrow spectral distribution and the high degree of spatial collimation of the former.…”

Section: Discussionmentioning

confidence: 99%

Photodynamic Therapy of Superficial Basal Cell Carcinomas Using Topical 5-Aminolevulinic Acid in a Nanocolloid Lotion

Hürlimann¹,

Hänggi²,

Panizzon³

1998

Dermatology

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Background: Photodynamic therapy (PDT) of superficial basal cell carcinomas using endogenous protoporphyrin IX generated by topically applied 5-aminolevulinic acid (5-ALA) is an innovative and clinically encouraging approach. Objective: This paper reports on the first results of an ongoing clinical study on photodynamic therapy of 55 basal cell carcinomas in 19 patients. Methods: Because of the chemical instability of 5-ALA, a novel nanocolloid lotion was developed. This formulation was applied to the lesions under occlusive dressing 6 h before irradiation with visible light from an unfiltered halogen lamp. Light-induced fluorescence was used to ascertain the superficial extension of the tumors. The response to the therapy was assessed by visual inspection and in 13 patients also by biopsies. Results: After a single treatment, 47 (85%) basal cell carcinomas showed a complete response at a follow-up time of at least 6 months. For the remaining 8 (15%) lesions, a partial response was observed, indicated by a marked reduction of the tumor size. The treatment modality without local anesthetics was well tolerated by all patients, with only slight discomfort during light irradiation. Conclusion: Our results indicate that 5-ALA-PDT with our novel formulation, a nanocolloid lotion, is a highly effective and convenient therapy for the treatment of superficial basal cell carcionomas. Its use in the treatment of nodular tumors needs further investigations.

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Section: Discussionmentioning

confidence: 99%

Photodynamic Therapy of Superficial Basal Cell Carcinomas Using Topical 5-Aminolevulinic Acid in a Nanocolloid Lotion

Hürlimann¹,

Hänggi²,

Panizzon³

1998

Dermatology

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“…Another suggestion for achieving better penetration is the use of curettage before PDT. 22 Ongoing studies, for instance, show that intralesional application of ALA in aqueous solution 4 hours before exposure to light can lead to complete eradication of nonmelanoma skin cancer and a long-term disease-free state. 32 Furthermore, future studies will have to determine by direct comparison whether the use of monochromatic laser light is superior to that of polychromatic light in ALA-PDT.…”

Section: Commentmentioning

confidence: 97%

“…Wolf et al 5 previously reported a complete clinical response in 36 (97.3%) of 37 superficial BCC and 5 (83.3%) of 6 superficial SCC at 4 to 8 weeks after ALA-PDT. After a follow-up of 6 months, Wennberg et al 22 reported a 92% cure rate for superficial BCC and a 61% cure rate for Bowen disease by using a 20% ALA solution and a filtered xenon lamp as the light source. Lui et al, 23 who performed topical ALA-PDT with polychromatic visible light greater than 570 nm, achieved a clinical complete response in 7 (88%) of 8 superficial BCC and in 2 (67%) of 3 superficial SCC; in contrast, however, only 4 (50%) of 8 superficial BCC and 2 (67%) of 3 SCC achieved a complete histological response.…”

Section: Commentmentioning

confidence: 99%

Long-term Follow-up and Histological Changes of Superficial Nonmelanoma Skin Cancers Treated With Topical δ-Aminolevulinic Acid Photodynamic Therapy

Fink‐Puches¹,

Soyer²,

Hofer³

et al. 1998

Arch Dermatol

145

101

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To investigate the immediate and longterm effects of photodynamic therapy with ␦-aminolevulinic acid (ALA-PDT) on superficial basal cell carcinomas (BCC) and superficial squamous cell carcinomas (SCC).Design: Retrospective study with 60 months of maximal follow-up.Setting: University-based hospital in Graz, Austria.Patients: Forty-seven subjects with a total of 95 superficial BCC and 35 superficial SCC.Interventions: A compound of 20% ␦-aminolevulinic acid was topically applied under an occlusive and lightshielding dressing before exposure to either UV-A or different wave bands of polychromatic visible light (fullspectrum visible light, Ͼ515, Ͼ570, or Ͼ610 nm).Main Outcome Measures: Primary tumor responses and recurrence rates in the long-term follow-up, as well as histological changes associated with ALA-PDT, were studied.Results: The complete primary response rate for all wave bands of light was 86% (82/95) for superficial BCC and 54% (19/35) for superficial SCC. There was no statisti-cally significant difference among the response rates to the different wave bands of light. After a median follow-up of 19 months (range, 3-60 months) for BCC and 8 months (range, 3-47 months) for SCC, the overall recurrence rate was 44% (36/81) and 69% (11/16), respectively. At 36 months after therapy, the projected disease-free rate was 50% (95% confidence interval, 43%-57%) for BCC vs 8% (95% confidence interval, 7%-9%) for SCC (PϽ.001, log-rank test). Histopathologic studies revealed a significant increase of fibrosis in the dermis after ALA-PDT and appearance of a sharp border between fibrotic and nonfibrotic tissue. In 15 of 16 BCC examined, the border between fibrotic and nonfibrotic tissue was deeper in the dermis than the maximum tumor thickness before therapy (PϽ.001, Wilcoxon signed rank test). Similar histopathologic observations were made in SCC. Conclusions:Our study revealed poor long-term cure rates for superficial BCC and SCC treated with topical ALA-PDT and visible light. The histopathologic observations showing remarkable fibrosis in the dermis indicated that the effect of ALA-PDT reached deeper than the initial depth of invasiveness of the neoplastic tissue, suggesting in turn that the poor long-term results of ALA-PDT cannot be explained by insufficient penetration of the therapy effect.

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“…42 A TFD também é considerada uma modalidade não invasiva para os CBCs superficiais, com vários estudos que suportam o seu uso. 28,[43][44][45] Em recente estudo multicêntrico conduzido por Basset-Seguin e cols, o índice de cura foi de 97% após 3 meses de seguimento. Em seguimento maior de 5 anos, a taxa de recorrência observada foi de 22%.…”

Section: Aplicações Clínicas Oncológicas Em Dermatologiaunclassified

Terapia fotodinâmica em dermatologia: princípios básicos e aplicações

Torezan

Niwa

Neto³

2009

An. Bras. Dermatol.

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Resumo:A terapia fotodinâmica envolve a administração de uma droga fotossensibilizante e sua ativação subsequente pela luz de comprimento de onda correspondente ao espectro de absorção do fotossensibilizador. Atualmente, a terapia fotodinâmica tópica é aprovada para o tratamento de condições oncológicas cutâneas como queratoses actínicas, doença de Bowen e carcinoma basocelular superficial em diversos países do mundo. Estudos multicêntricos controlados e randomizados demonstram a alta eficácia e resultado cosmético final superior dessa modalidade terapêutica em relação aos tratamentos convencionais. Para condições cutâneas não oncológicas, como acne vulgar, verrugas virais e esclerodermia localizada, há também relatos e série de casos confirmando o potencial terapêutico da terapia fotodinâmica. O desenvolvimento de fotossensibilizantes tópicos, ácido 5-aminolevulínico (ALA) ou seu metiléster (MAL), frente aos derivados da hematoporfirina de aplicação sistêmica, permitiu um grande avanço na popularidade da TFD na dermatologia, uma vez que tanto ALA quanto MAL tópicos não induzem mais fotossensibilidade generalizada prolongada. A produção de intermediários reativos de oxigênio, como oxigênio singlet, depende da concentração, da localização do fotossensibilizante no tecido alvo, assim como da dose de luz utilizada. Tanto as lâmpadas de amplo espectro quanto os LEDs (do inglês light emitting diodes) constituem fontes de luz adequadas para que os efeitos citotóxicos da terapia fotodinâmica resultem na destruição do tumor ou seus efeitos imunomodulatórios atuem melhorando as condições inflamatórias cutâneas. Palavras-chave: Carcinoma basocelular; Carcinoma in situ; Fotoquimioterapia Abstract: Photodynamic therapy involves the administration of a photosensitizing drug and its subsequent activation by light at wavelengths matching the absorption spectrum of the photosensitizer. Currently, topical photodynamic therapy has received approval for the treatment of cutaneous oncologic conditions such as actinic keratoses, Bowen's disease and superficial basal cell carcinoma in many countries in the world. Multicenter randomized controlled studies have demonstrated high efficacy and superior cosmetic outcome over standard therapies. For many non-oncologic dermatological diseases such as acne vulgaris, viral warts and localized scleroderma, case reports and small series have confirmed the potential of photodynamic therapy. After the development of topical photosensitizers 5-aminolevulinic acid (ALA) or its methyl ester (MAL), photodynamic therapy has gained worldwide popularity in dermatology, as these drugs do not induce prolonged phototoxicity as the systemic photosensitizing hematoporphyrin derivatives do. The production of reactive oxygen intermediates such as singlet oxygen depends on the concentration and localization of the photosensitizer in the diseased tissue as well as the applied light dose. Either incoherent lamps or LED arrays are suitable for the cytotoxic effects resulting in tumor destruction or immunomodulator...

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Treatment of superficial basal cell carcinomas using topically applied delta-aminolaevulinic acid and a filtered xenon lamp

Abstract: Photodynamic therapy is well suited to the treatment of SBCCs giving good cosmetic results regardless of lesion size. The filtered xenon lamp proved to be particularly suitable for photodynamic therapy.

Cited by 28 publications

References 0 publications

Photodynamic Therapy of Superficial Basal Cell Carcinomas Using Topical 5-Aminolevulinic Acid in a Nanocolloid Lotion

Photodynamic Therapy of Superficial Basal Cell Carcinomas Using Topical 5-Aminolevulinic Acid in a Nanocolloid Lotion

Long-term Follow-up and Histological Changes of Superficial Nonmelanoma Skin Cancers Treated With Topical δ-Aminolevulinic Acid Photodynamic Therapy

Terapia fotodinâmica em dermatologia: princípios básicos e aplicações

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