Complete response of extramammary Paget's disease with imiquimod and <scp>PDT</scp>: Report of two cases

Apalla, Zoe; Lallas, Aimilios; Tsorova, Angeliki; Nikolaidou, Christina; Vakirlis, Efstratios; Ioannides, Demetris; Sotiriou, Eleni

doi:10.1111/phpp.12386

Cited by 13 publications

(6 citation statements)

References 8 publications

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“…A 2011 review identified 23 case reports and case series that showed complete remission in 77 out of 133 lesions on 99 patients at one year of follow‐up. Recent case reports published in 2014 and 2018 reported 4 cases of widespread or recurrent Paget's disease that demonstrated complete response to PDT at up to 36 months of follow‐up . Studies comparing recurrence rates in patients receiving PDT versus surgery are sparse; however, a pilot study of 13 patients randomized to surgery or four sessions of ALA‐PDT followed by surgery resulted in local recurrence rate of 9.1% at one year compared to 25% ( P = 0.0042) .…”

Section: Efficacy For Solid Tumorsmentioning

confidence: 99%

Photodynamic therapy for solid tumors: A review of the literature

Yanovsky

Bartenstein

Rogers

et al. 2019

Photoderm Photoimm Photomed

170

102

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Photodynamic therapy (PDT) utilizes a sensitizer agent and light to produce selective cell death. Dermatologists are familiar with PDT for the treatment of actinic keratoses and early nonmelanoma skin cancers, and recent studies have elucidated that PDT has resulted in improved morbidity and secondary outcomes for the treatment of various cancerous and precancerous solid tumors. Light source and dosimetry may be modified to selectively target tissue, and novel techniques such as fractionation, metronomic pulsation, continuous light delivery, and chemophototherapy are under investigation for further optimization of therapy. This article aims to review the expanding indications for PDT and demonstrate the potential of this modality to decrease morbidity and increase quality of life for patients. To illustrate these new indications, we provide a focused review of the latest literature on PDT for dermatologic and other solid tumors including gastrointestinal, peritoneal, lung, genitourinary, brain, breast, and head and neck. Data on efficacy, survival, and side effects vary across tumor types but support PDT for the treatment of numerous solid tumors. With new advances in PDT, indications for this therapeutic modality may expand.

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Section: Efficacy For Solid Tumorsmentioning

confidence: 99%

Photodynamic therapy for solid tumors: A review of the literature

Yanovsky

Bartenstein

Rogers

et al. 2019

Photoderm Photoimm Photomed

170

102

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“…PVD can remain undiagnosed for several years, so frequently it is recognized as an extensive vulvar lesion which needs the use of demolition surgery and subsequent plastic-reconstruction [21]. Therefore, the search for serological markers to assist the early detection of PVD, would allow the identi cation of limited and non-invasive forms and the use of alternative approaches such as imiquimod and photodynamic treatment (currently off label) [22].…”

Section: Discussionmentioning

confidence: 99%

Are HE4 and CA 125 suitable to detect a Paget disease of the vulva?

Dellino

Gargano

Carriero

et al. 2020

Preprint

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Background: Paget disease is a rare neoplasia, most commonly diagnosed in postmenopausal women and which can be identified in the breast (mammary Paget disease) or in other locations (extramammary Paget’s disease) such as ano-genital skin (Paget disease of the vulva -PVD). This condition is associated with low mortality, but a late diagnosis and recurrence can negatively impact the prognosis. Therefore, the main objective of this study is to evaluate if the human epididymis protein 4 (HE4) and cancer antigen125 (CA125) can promote recognition of PVD in early stages and during the relapses.Materials and Methods: we have conducted a prospective, observational and laboratory-based study, that included 50 patients, whose 25 healthy women represented the control group and 25 PVD patients, which have been operated in our Oncology Institute, from May 2017 to September 2019. Both in control group and in PVD patients, the CA-125 and HE4 were evaluated before surgery and after 6 months. Finally, a comparison of markers serum level, both between before/after surgery and with control group, and a ROC (Receiver Operating Characteristic) curve were performed.Results: Dosing the markers in PVD patients, 3/25 (12%) showed a higher value of CA125 and 11/25 (44%) an increased HE4. In addition, after surgical treatment there were no statistically significant difference between levels of CA-125 (p= 0.3) and HE4 (p=0.19). On the other hand, comparing HE4 in PVD patients with the control group, a statistically significant difference was found (p-value= 0.0036). Contrary, comparing CA-125 in PVD patients with the control group (p-value= 0.1969), no statistically significant difference was evidenced. Moreover, ROC (Receiver Operating Characteristic) curve showed low sensitivity and specificity for CA125 with area under curve (AUC) =0.5608. Instead, the ROC curve of HE4 revealed a sensitivity and specificity of 76% and 88% respectively (AUC= 0.7408) using a cut-off at 90 pmol/L.Conclusions: Despite the limited cases, our data showed that CA125 is not a sensitive marker for PVD. On the other hand, in 44% of PVD we’ve seen an increase in HE4. So, this could be a starting point for further research that could confirm the possibility to use this marker in order to support PVD early identification.

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“…Different alternative treatments to surgery such as imiquimod therapy, [18–20] as already mentioned, or photodynamic treatment are under investigation. [18–20]…”

Section: Discussionmentioning

confidence: 99%

Paget disease of the vulva an analysis of 24 cases

Loiacono

Traversi²,

Deliso

et al. 2019

Medicine

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Paget's disease can arise in the breast (mammary Paget disease) or in other locations (extramammary Paget disease) such as anogenital skin in both males and females (Paget disease of the vulva [PDV]). Underlying adenocarcinoma can be found in some cases. This study aims to report clinical aspects, surgical procedures, outcomes, and recurrences of patients with PDV.A retrospective chart review was conducted on patients with pathologically confirmed diagnosis of PDV managed at the Department of Obstetrics and Gynecology, University of Bari, and the “Giovanni Paolo II” National Cancer Institute in Bari, between 1998 and 2018.Records of 24 cases of PDV were examined. Median age of the patients at diagnosis was 69.3 (range 38–84), diagnosis of synchronous cancer was made in 2 cases and in 2 other cases of metachronous disease. Three patients had previously been diagnosed with other oncological diseases. All patients underwent surgery including wide local excision (6), simple vulvectomy (8), and extended vulvectomy (10). Lymphadenectomy was performed in 2 cases and reconstructions with advancement flaps in 7 cases. Four patients were found to have invasive disease and 1 had inguinal node involvement. Positive margins were found in 11 patients. Wound dehiscence and urethral stenosis were found in 4 and 1 case each. Eight recurrences (33.33%) were observed, regardless of positive surgical margins.PDV has a low rate of malignancy but a high rate of recurrence. It should be diagnosed early to avoid repeated surgery and to reduce symptoms and morbidity.

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Complete response of extramammary Paget's disease with imiquimod and PDT: Report of two cases

Cited by 13 publications

References 8 publications

Photodynamic therapy for solid tumors: A review of the literature

Photodynamic therapy for solid tumors: A review of the literature

Are HE4 and CA 125 suitable to detect a Paget disease of the vulva?

Paget disease of the vulva an analysis of 24 cases

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