A randomized controlled clinical trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients

Dragieva, Galya; Prinz, Bettina; Hafner, Jürg; Dummer, Reinhard; Burg, Günter; Binswanger, U; Kempf, Werner

doi:10.1111/j.1365-2133.2004.06054.x

Cited by 132 publications

(102 citation statements)

References 25 publications

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“…Of the 37 post-PDT SCC, 30 (81%) were invasive and 7 (19%) were microinvasive and, of the 48 SCC outside a PDT field, 34 (74%) were invasive and 12 (26.09%) microinvasive. However, no experimental studies have demonstrated an excess risk of developing SCC after PDT in that patient population (14,(27)(28)(29). In addition, as we observed more SCC outside the PDT field than in the PDT field, this emphasizes that our population had a higher risk of SCC development.…”

Section: Resultssupporting

confidence: 49%

Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients

Ratour-Bigot

Chemidling²,

Montlahuc³

et al. 2016

Acta Derm Venerol

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Bowen's disease (BD) is an intra-epidermal carcinoma of the skin, which, if untreated, may progress to invasive squamous cell carcinoma (SCC) in 3-5% of cases (1). BD can occur anywhere on the skin in adults, especially in elderly people. BD usually presents as an asymptomatic circular erythematous scaly patch localized on a sunexposed area. Typically, BD has an excellent prognosis because of its slow evolution and good response to treatment. Although surgery is often the best treatment option for BD, new therapies have emerged in recent years. Alternatives to surgery, such as photodynamic therapy (PDT), cryosurgery, 5-fluorouracil and imiquimod, have been proposed for BD, especially when it is located in sensitive surgical areas (face, fingers, etc.) (1-11). PDT is also used in the treatment of actinic keratoses (AK) and superficial basal cell carcinomas. Its use in other fields of dermatology is under evaluation (12).PDT is based on the application of a photosensitizing product or its precursor, which is activated by a light source of an appropriate wavelength according to the absorption spectrum of the photosensitizer and offers sufficient penetration. Its activation causes the selective destruction of malignant cells via production of reactive oxygen species (ROS). Methyl aminolevulinate (MAL) in its hydrochloride form is a photosensitizing product for cutaneous application, marketed under the name of Metvixia ® . Irradiation is performed using a light source with a wavelength between 570 and 670 nm within the absorption spectrum of porphyrins. PDT using Metvixia ® is abbreviated MAL PDT. The light energy absorbed by the photoactive porphyrin is transferred to oxygen, generating ROS. Two MAL PDT sessions 8 days apart are recommended for the treatment of BD.The effectiveness (complete clearance) of PDT for the treatment of BD is approximately 80%, with recurrences in 10-20% of cases (8,11,13). Side-effects are essentially local erythema, oedema, warmth, burning, tingling and painful sensations (13,14).PDT is considered to be a safe treatment, although its carcinogenic risk has never been studied. However, several cases of SCC after PDT have been reported in the literature (15, 16). We studied the occurrence of SCC following PDT treatment in a series of 105 patients with BD. METHODSA monocentric retrospective study of patients with cutaneous BD treated by PDT between 2007 and 2013 was conducted in the Department of Dermatology at Saint Louis Hospital, Paris, France. Data studied were the patients' age, sex, history of SCC, immunosuppression, location of BD treated by PDT, number of treated lesions, number of PDT sessions performed, response to PDT at 3 months, and occurrence of SCC on a PDT field or outside a PDT field. The fields treated with PDT were classified into 4 regions: head and neck, trunk, upper limbs and lower limbs. The efficacy of PDT on BD 3 months after therapy was qualified as complete response (CR) when complete regression of the lesion occurred, partial response (PR) when part of the BD lesi...

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Section: Resultssupporting

confidence: 49%

Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients

Ratour-Bigot

Chemidling²,

Montlahuc³

et al. 2016

Acta Derm Venerol

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“…101 MAL-PDT led to complete short-term clearance of treated lesions in >70% of OTRs. 102,103 In addition, over the course of 1 year, a single session of MAL-PDT significantly delayed the appearance of new lesions relative to placebo treatment. 104 Over the longer term (≥2 years), MAL-PDT did not appear to reduce the incidence of AKs 105 or SCCs.…”

Section: Aks In Organ Transplant Recipientsmentioning

confidence: 99%

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

et al. 2015

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Background Actinic keratosis (AK) and cheilitis (AC) are lesions that develop on photodamaged skin and may progress to form invasive squamous cell carcinomas (SCCs). Objective To provide guidance to Canadian health care practitioners regarding management of AKs and ACs. Methods Literature searches and development of graded recommendations were carried out as discussed in the accompanying introduction (chapter 1 of the NMSC guidelines). Results Treatment of AKs allows for secondary prevention of skin cancer in sun-damaged skin. Because it is impossible to predict whether a given AK will regress, persist, or progress, AKs should ideally be treated. This chapter discusses options for the management of AKs and ACs. Conclusions Treatment options include surgical removal, topical treatment, and photodynamic therapy. Combined modalities may be used in case of inadequate response. AKs are particularly common following the longterm immunosuppression in organ transplant patients, who should be monitored frequently to identify emerging lesions that require surgery.

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“…MAL-PDT was statistically more effective than placebo-PDT and more effective than more than one cycle of freezing/thawing with liquid nitrogen spray. 23 Dragieva et al 24 evaluated the efficacy of PDT with MAL in transplant patients. Complete regression of the 129 lesions or a reduction in their number and size occurred in a maximum period of 16 weeks following the end of treatment.…”

Section: Figurementioning

confidence: 99%

Terapia fotodinâmica: revisão da literatura e documentação iconográfica

Issa

Manela-Azulay

2010

An. Bras. Dermatol.

101

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Photodynamic therapy (PDT) consists of a chemical reaction activated by light energy that is used to selectively destroy tissue. The reaction requires a photosensitizer in the target tissue, a light source and oxygen. The most extensively studied photosensitizing agents for PDT are 5-aminolevulinic acid for the treatment of actinic keratosis and methyl-aminolevulinate, which has been approved for the treatment of actinic keratosis, basal cell carcinoma and Bowen's disease. The light sources used in photodynamic therapy should emit light at wavelengths within the absorption spectrum of the photosensitizer used in PDT treatment. Light emitting diode (LED) lamps are indicated for the photodynamic treatment of nonmelanoma skin cancer. PDT should be considered as a therapeutic option, particularly in the case of patients with superficial, multiple or disseminated lesions and for immunosuppressed patients. More recently, PDT has been indicated for a wide range of dermatological conditions such as photo-damaged skin, acne, hidradenitis, scleroderma, psoriasis, warts and leishmaniosis, among others. This article provides an extensive review of photodynamic therapy, its mechanisms, indications and results. Keywords: 5-aminolevulinate synthetase; Photochemotherapy; Review Resumo: A terapia fotodinâmica é uma reação química ativada por luz usada para destruição seletiva de um tecido e requer um agente fotossensibilizante no tecido-alvo, uma fonte de luz e oxigênio. Estão disponíveis, no momento, o ácido 5-aminolevulínico para tratamento de ceratoses actínicas e o metilaminolevulinato, aprovado para tratamento de ceratoses actínicas, carcinoma basocelular e doença de Bowen. As fontes de luz utilizadas para a terapia fotodinâmica devem emitir comprimentos de onda no espectro de absorção do fotossensibilizante escolhido. As lâmpadas LED (light emitting diode) são as indicadas para terapia fotodinâmica tópica no tratamento do câncer de pele não melanoma. A terapia fotodinâmica deve ser considerada, em particular, para pacientes que apresentam lesões superficiais, múltiplas, disseminadas e para pacientes imunossuprimidos. Mais recentemente, a terapia fotodinâmica tem sido indicada no tratamento do fotoenvelhecimento, acne, hidrosadenite, esclerodermia, psoríase, verrugas, leishmaniose, entre outras. Por este trabalho será possível ter acesso a uma extensa revisão da literatura sobre terapia fotodinâmica, seus mecanismos, indicações e resultados, seguida de comentários e críticas pertinentes ao assunto. Palavras-chave: 5-aminolevulinato sintetase; Fotoquimioterapia; Revisão

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A randomized controlled clinical trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients

Abstract: Photodynamic therapy using methyl aminolaevulinate is a safe and effective treatment for actinic keratoses in transplant recipients. It may also reduce the risk of transformation of actinic keratoses to invasive, potentially fatal, squamous cell carcinoma.

Cited by 132 publications

References 25 publications

Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients

Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

Terapia fotodinâmica: revisão da literatura e documentação iconográfica

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