Primary Prevention of Skin Dysplasia in Renal Transplant Recipients With Photodynamic Therapy: A Randomized Controlled Trial

Togsverd‐Bo, Katrine; Omland, Silje Haukali; Wulf, H; Sørensen, Søren Schwartz; Hædersdal, Merete

doi:10.1111/ajt.13358

Cited by 53 publications

(46 citation statements)

References 21 publications

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“…A randomised, single blinded, intra-individual trial of 25 renal transplant patients recently investigated repeated sessions of prophylactic PDT for prevention of field cancerization. After 3 years of follow up, there were significantly fewer AKs in PDT-treated compared to non-treated skin (8 vs. 43 respectively, p = 0.002) [85]. These findings were supported by Wulf et al in a randomised pilot study of 27 renal OTRs, showing a significantly longer mean time to occurrence of new lesions in areas treated with MAL-PDT [86].…”

Section: Organ Transplant Recipientsmentioning

confidence: 77%

Photodynamic Therapy and Non-Melanoma Skin Cancer

Griffin

Lear

2016

Cancers

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Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population. Photodynamic therapy (PDT) is gaining popularity for the treatment of basal cell carcinoma (BCC), Bowen’s disease (BD) and actinic keratosis (AK). A topical or systemic exogenous photosensitiser, results in selective uptake by malignant cells. Protoporphyrin IX (PpIX) is produced then activated by the introduction of a light source. Daylight-mediated MAL (methyl aminolaevulinate) PDT for AKs has the advantage of decreased pain and better patient tolerance. PDT is an effective treatment for superficial BCC, BD and both individual and field treatment of AKs. Excellent cosmesis can be achieved with high patient satisfaction. Variable results have been reported for nodular BCC, with improved outcomes following pretreatment and repeated PDT cycles. The more aggressive basisquamous, morphoeic infiltrating subtypes of BCC and invasive squamous cell carcinoma (SCC) are not suitable for PDT. Prevention of “field cancerization” in organ transplant recipients on long-term immunosuppression and patients with Gorlin syndrome (naevoid basal cell carcinoma syndrome) is a promising development. The optimisation of PDT techniques with improved photosensitiser delivery to target tissues, new generation photosensitisers and novel light sources may expand the future role of PDT in NMSC management.

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Section: Organ Transplant Recipientsmentioning

confidence: 77%

Photodynamic Therapy and Non-Melanoma Skin Cancer

Griffin

Lear

2016

Cancers

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“…Most studies, however, suggest that in these cases repeated PDT sessions are necessary, with the present consensus that PDT can prevent AKs, and potentially SCCs, in transplant recipients [15,16,17]. …”

Section: Discussionmentioning

confidence: 99%

Comparison of “Lesion-by-Lesion” and Field Photodynamic Therapy in the Prevention of Actinic Keratoses: A Randomized, Split-Face, Single-Blind Pilot Study

2016

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Background: Actinic keratoses (AKs) are often treated separately, lesion by lesion. However, in the past years, AKs have been described as a field disease and not limited to single clinically apparent lesions. Treatment should therefore target an area of field change which may reduce the risk of development of further AKs, second tumours, and local recurrence. Objective: The primary objective was to determine the number of new lesions at 9 months after methyl aminolevulinate photodynamic therapy (MAL-PDT). Secondary objectives were to determine the number of new lesions at 3 and 6 months after treatment and the percentage reduction of AKs from baseline at 3, 6, and 9 months after MAL-PDT. Methods: This was a single-centre, prospective, randomized, split-face, investigator-blinded pilot study with a study duration of 1 year. The study population comprised patients with AKs on the face or scalp, with a maximum of 10 AKs on each side. One side was treated with 1 session of “lesion-by-lesion” MAL-PDT (LT side) and the other side with 1 session of field MAL-PDT (FT side). Results: At 9 months the FT demonstrated significantly fewer new lesions. At every time point during the follow-up, we found a significant reduction in the number of AKs in the LT as well as in the FT sides. After 3 and 6 months we did not observe significant differences between the sides. However, after 9 months, the LT area showed significantly fewer remaining AKs, whereas the FT area demonstrated significantly fewer new lesions. Conclusions: Field treatment results in significantly fewer new AK lesions compared with lesion-by-lesion treatment.

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“…In hairless mouse models, both MAL‐PDT and hexylaminolaevulinate (HAL)‐PDT have separately been shown to delay the time to development of SCC, using repeated treatment regimens, although caution is required in extrapolating these data to the human setting; indeed, only marginal effects on delayed tumour development were seen with daylight PDT when using HAL . However, in a split‐face study involving 25 renal transplant recipients, repeated topical PDT at 6‐monthly intervals for 5 years delayed the development of AK when used as primary prevention, supporting an earlier randomized, within‐patient study . In this earlier study involving 81 patients with AK treated with either MAL‐PDT or lesion‐specific therapy such as cryotherapy, the former significantly reduced the development of new AK, although the effect was not maintained at longer‐term follow‐up over 2 years .…”

Section: Carcinogenesismentioning

confidence: 99%