Comparison of 10 efficient protocols for photodynamic therapy of actinic keratosis: How relevant are effective light dose and local damage in predicting the complete response rate at 3 months?

Vignion‐Dewalle, Anne‐Sophie; Baert, Gregory; Thecua, Elise; Lecomte, F.; Vicentini, C.; Rached, Henry Abi; Mortier, Laurent; Mordon, Serge

doi:10.1002/lsm.22827

Cited by 17 publications

(21 citation statements)

References 57 publications

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“…The authors concluded that protocols that achieve high complete response rates at 3 months and low pain scores should be preferred regardless of the effective light dose and local damage. 16 Our protocol with half-time red light conventional illumination obtains lower pain scores with similar response to complete time of illumination. To our knowledge, this form of perform PDT in patient has not been published.…”

Section: Although Daylight Also Include Blue and Green Light (Visiblementioning

confidence: 73%

“…In this way, a recent study based in a mathematical model compared 10 different protocols of illumination, including conventional red light PDT, daylight PDT and blue light. The authors concluded that protocols that achieve high complete response rates at 3 months and low pain scores should be preferred regardless of the effective light dose and local damage . Our protocol with half‐time red light conventional illumination obtains lower pain scores with similar response to complete time of illumination.…”

Section: Discussionmentioning

confidence: 99%

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Split‐face study comparing conventional MAL photodynamic therapy in multiple actinic keratosis with complete time vs. half‐time red light LED conventional illumination

Fernández‐Guarino

Fonda‐Pascual

Gomez

et al. 2019

Acad Dermatol Venereol

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Background Conventional photodynamic therapy (PDT) with methylaminolevulinic acid (MAL) and daylight PDT have demonstrated similar efficacy in the treatment of actinic keratosis (AK). The reason for the use of daylight is to reduce pain during illumination but daylight has the limitation of the weather conditions. The difference in the doses of red light applied between these two methods suggests that an intermediate dose with red light conventional illumination could be effective in PDT of AK. Objective To compare the efficiency of conventional MAL‐PDT with half‐time conventional red light illumination in patients with multiple AK. Material and methods Adult patients with more than five symmetrically distributed AK were selected. After randomization, one area was treated with conventional PDT (Aktilite®, 630 nm, 37 J/cm2, 8 min), while the contralateral was illuminated half time (Aktilite®, 630 nm, 37 J/cm2, 4 min). Patients evaluated pain in each different side. Patients were evaluated at baseline, 3 and 6 months after PDT treatment by a blinded dermatologist. A questionnaire to be done at home 24 h after completing treatment was deliver to the patients to evaluate any side‐effects. Results A total of 774 lesions were treated, 385 with conventional PDT and 389 with half‐time PDT (P > 0.05). Conventional PDT was 85% of complete response of AK (327/385) at 3 months, and half‐time PDT was 82% (319/389). At 6 months, conventional PDT was 70% (268/385) of complete response and half‐time PDT was 65% (252/389). Pain during illumination was significantly lower in the VAS with the half‐time protocol with a mean of 5.59 (SD 1.48) vs. 6.41 (SD 1.66) in conventional PDT. No difference in adverse effects was found between protocols. Conclusion Conventional PDT with half‐time illumination in multiple actinic keratosis is as effective as complete time illumination and decreased pain significantly.

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Section: Although Daylight Also Include Blue and Green Light (Visiblementioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Split‐face study comparing conventional MAL photodynamic therapy in multiple actinic keratosis with complete time vs. half‐time red light LED conventional illumination

Fernández‐Guarino

Fonda‐Pascual

Gomez

et al. 2019

Acad Dermatol Venereol

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“…Moreover, these two PpIX-weighted metrics are increasingly used in most recent papers. 10,[17][18][19] Assuming spectral irradiances with constant shapes but different amplitudes, the ratio between two PpIX-weighted irradiances is equal to the ratio between the two corresponding irradiances. As a result, irradiances could be converted into PpIX-weighted irradiances by applying the rule of three to data reported in a recent study.…”

Section: Irradiance and Ppix-weighted Irradiancementioning

confidence: 99%

“…As a result, irradiances could be converted into PpIX-weighted irradiances by applying the rule of three to data reported in a recent study. 19 Computed to the spectral irradiance measured from the Aktilite CL 128 by O'Gorman et al, 20 these data consist of an irradiance of 85.39 mW/cm 2 and its associated PpIX-weighted irradiance of 1.44 mW/cm 2 . The significance level was set at a two-sided alpha level of 0.05.…”

Section: Irradiance and Ppix-weighted Irradiancementioning

confidence: 99%

Photodynamic therapy for actinic keratosis of the forehead and scalp with the Aktilite CL 128: Is there a cut‐off value for PpIX‐weighted irradiance for effective treatment?

Vicentini

Vignion‐Dewalle

Thecua

et al. 2019

Photoderm Photoimm Photomed

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Background/purpose: Photodynamic therapy (PDT) is an established treatment for actinic keratosis (AK). Among the approved protocols in Europe, the most widely used involves irradiation with the Aktilite CL 128 (C-PDT). We aimed to assess the heterogeneity of irradiance over the treatment area when using C-PDT. We also investigated whether there is a cut-off value for protoporphyrin IX (PpIX)-weighted irradiance that may predict the treatment outcome of C-PDT.Methods: An Ophir PD300 photodiode sensor connected to an Ophir Laser Star power meter was used to measure the irradiance delivered to 114 AKs of the scalp and forehead of 19 patients treated with C-PDT. The PpIX-weighted irradiances were deduced and cross-referenced with the complete responses at 3 months.Results: From the measured irradiances ranging from 0.25 to 60 mW/cm 2 (average: 31.94 mW/cm 2 ), a standard deviation of 17.17 mW/cm 2 was computed. Irradiance heterogeneity over the treatment area during C-PDT was demonstrated. The 66/114AKs with a complete response at 3 months (57.89%) received a mean PpIX-weighted irradiance of 0.52 mW/cm 2 vs 0.56 mW/cm 2 for the resistant 48/114 AKs (42.11%).No significant effect of PpIX-weighted irradiance on the complete response at 3 months was found (odds ratio for a 0.1-unit change, 0.96; 95% confidence interval, 0.83 to 1.10; P = 0.53). Therefore, no cut-off value for PpIX-weighted irradiance that predicts treatment outcome could be identified. Conclusions:A device enabling homogeneous irradiation at a lower irradiance than the Aktilite CL 128 may therefore be suitable. This lower irradiance may further increase the treatment tolerance by patients. K E Y W O R D S actinic keratosis, Aktilite CL 128, complete response, photodynamic therapy, PpIX-weighted irradiance | 233 VICENTINI ET al.

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“…Therefore, with the aid of computer modelling, doses may be estimated below the skin surface, including the impact that wavelength-dependent attenuation of daylight at such depths may have on PpIX-effective light dose. Vignion-Dewale et al used mathematical modelling to demonstrate local damage in tissue for ten different PDT modalities and found that DPDT may have as much local damage (singlet oxygen generation) and PpIX-effective light dose delivered as conventional PDT regimens at a depth of 100 µm [28]. Actinic keratoses are superficial and are thus equally treatable with either less penetrating blue or more deeply penetrating red light during PDT [29].…”

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confidence: 99%

Measuring Daylight: A Review of Dosimetry in Daylight Photodynamic Therapy

et al. 2019

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Successful daylight photodynamic therapy (DPDT) relies on the interaction of light, photosensitisers and oxygen. Therefore, the ‘dose’ of light that a patient receives during treatment is a clinically relevant quantity, with a minimum dose for effective treatment recommended in the literature. However, there are many different light measurement methods used in the published literature, which may lead to confusion surrounding reliable and traceable dose measurement in DPDT, and what the most appropriate method of light measurement in DPDT might be. Furthermore, for the majority of practitioners who do not carry out any formal dosimetry and for the patients receiving DPDT, building confidence in the evidence supporting this important treatment option is of key importance. This review seeks to clarify the methodology of DPDT and discusses the literature relating to DPDT dosimetry.

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Comparison of 10 efficient protocols for photodynamic therapy of actinic keratosis: How relevant are effective light dose and local damage in predicting the complete response rate at 3 months?

Abstract: Protocols that achieve high complete response rates at 3 months and low pain scores should be preferred regardless of the effective light dose and local damage. Lasers Surg. Med. 50:576-589, 2018. © 2018 Wiley Periodicals, Inc.

Cited by 17 publications

References 57 publications

Split‐face study comparing conventional MAL photodynamic therapy in multiple actinic keratosis with complete time vs. half‐time red light LED conventional illumination

Split‐face study comparing conventional MAL photodynamic therapy in multiple actinic keratosis with complete time vs. half‐time red light LED conventional illumination

Photodynamic therapy for actinic keratosis of the forehead and scalp with the Aktilite CL 128: Is there a cut‐off value for PpIX‐weighted irradiance for effective treatment?

Measuring Daylight: A Review of Dosimetry in Daylight Photodynamic Therapy

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