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Peralta-Mamani M, Silva BMDA, Honório HM, Rubira-Bullen IRF, Hanna R, Silva PSSDA. CLINICAL EFFICACY OF PHOTODYNAMIC THERAPY IN MANAGEMENT OF ORAL POTENTIALLY MALIGNANT DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2024; 24:101899. [PMID: 38821659 DOI: 10.1016/j.jebdp.2023.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 06/02/2024]
Abstract
OBJECTIVES Despite phototherapy (in the form of photodynamic therapy (PDT)-mediated oxidative stress) being utilized in the management of oral potentially malignant disorders (OPMDs), the evidence of certainty remains unclear. Hence, this systematic review and meta-analysis (PROSPERO # CRD42021218748) is aimed to evaluate the clinical efficacy of PDT-induced oxidative stress in OPMDs METHODS: PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases were searched without restriction of language or year of publication. In addition, gray literature was searched and a manual search was performed. Two independent reviewers screened all the studies, assessing data extraction, risk of bias and certainty of evidence. A narrative synthesis was carried out. For the meta-analysis, random effects were considered to determine the prevalence of a total and a partial remission (PR) of oral potentially malignant disorders (OPMDs). The certainty of evidence was explored using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Twenty-three studies were included in the qualitative and quantitative syntheses. A total of 880 patients were included (564 males; 218 females) with an age range between 24 and 89-years-old. The results showed the prevalence of the total and partial remissions respectively for the following OPMLs: actinic cheilitis (AC): 69.9% and 2.4%; oral leukoplakia (OL): 44% and 36.9%; oral verrucous hyperplasia (OVH): 98.5%; oral erythroleukoplakia (OEL): 92.1% and 7.9%. The prevalence of no remission of OL was 18.8%. CONCLUSIONS PDT demonstrated significant results in clinical remission of OPMDs and most of the eligible studies have shown a total or a partial remission of the included lesions, but at a low or a very low certainty of evidence. Hence, further clinical studies with robust methodology are warranted to offer further validated data. Also, further evidence is required to understand further the mechanism of PDT-induced oxidative stress.
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Affiliation(s)
- Mariela Peralta-Mamani
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil
| | - Bruna Machado DA Silva
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil
| | | | - Reem Hanna
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Department of Restorative Dental Sciences, UCL-Eastman Dental Institute, Faculty of Medical Sciences, London, UK; Department of Oral Surgery, King's College Hospital NHS Foundation Trust, London UK.
| | - Paulo Sergio Santos DA Silva
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil
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Buján Bonino C, Rodríguez-Blanco I, Sánchez-Aguilar Rojas D, Vázquez Veiga HA, Flórez Á. Topical and Intralesional Immunotherapy for the Management of Skin Cancer in Special Locations: Lips and Eyelids. Cancers (Basel) 2023; 15:5018. [PMID: 37894385 PMCID: PMC10604909 DOI: 10.3390/cancers15205018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
The use of topical and intralesional immunotherapy in the treatment of cutaneous malignant neoplasia in sensitive areas such as the lips and eyelids is discussed. Surgery may not be feasible or may result in deformities in these areas, making alternative treatment options necessary. A narrative literature review was conducted using MEDLINE (PubMed) as the main literature database, collecting available evidence of experiences with various topical and intralesional therapies in the aforementioned anatomical locations, ranging from case reports to clinical trials. The clearance rates and potential adverse reactions of therapeutic options such as imiquimod 5%, 5-fluorouracil (5-FU), photodynamic therapy (PDT), ingenol mebutate (IM), diclofenac, intralesional methotrexate, and interferon are reviewed. Although limited by their heterogeneity and the scarcity of clinical trials, these studies point towards promising response rates and minimal adverse effects, making these treatments viable options in selected cases.
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Affiliation(s)
- Cecilia Buján Bonino
- Department of Dermatology, University Hospital of Santiago de Compostela, 36001 Santiago de Compostela, Spain
| | - Isabel Rodríguez-Blanco
- Department of Dermatology, University Hospital of Santiago de Compostela, 36001 Santiago de Compostela, Spain
| | | | - Hugo A. Vázquez Veiga
- Department of Dermatology, University Hospital of Santiago de Compostela, 36001 Santiago de Compostela, Spain
| | - Ángeles Flórez
- Department of Dermatology, University Hospital of Pontevedra, 36162 Pontevedra, Spain
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saúde—Universidade de Vigo (SERGAS—UVIGO), 36213 Vigo, Spain
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Arisi M, Galli B, Pisani EG, La Rosa G, Licata G, Rovaris S, Tomasi C, Rossi M, Venturini M, Spiazzi L, Calzavara-Pinton P. Randomized Clinical Trial of Conventional versus Indoor Daylight Photodynamic Therapy for Treatment of Actinic Cheilitis. Dermatol Ther (Heidelb) 2022; 12:2049-2061. [PMID: 35907163 PMCID: PMC9464288 DOI: 10.1007/s13555-022-00783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Actinic cheilitis (AC) is the biologic precursor of invasive squamous cell carcinoma (SCC) of the vermilion, and different treatment options have been investigated, but their efficacy is hampered by local inflammation, pain and slow recovery. Daylight photodynamic therapy (dl-PDT) has been demonstrated to represent a valuable treatment option for AC, but its feasibility is limited by weather conditions and latitude. Methods Our study proposed to compare the efficacy and tolerability of conventional photodynamic therapy (c-PDT) and indoor daylight photodynamic therapy (idl-PDT) with a white LED lamp for the treatment of AC. Sixteen patients were enrolled in the study: 8 (50%) treated with c-PDT and 8 (50%) treated with idl-PDT. All patients completed the study protocol. Results Both idl-PDT and c-PDT were demonstrated to be highly effective in terms of reduction of the cumulative lesional area and severity of the clinical score. Neither treatment was inferior to the other. The inflammatory reaction and the pain scores were milder with idl-PDT, whereas the cosmetic outcome was not different. Conclusion The present findings confirm that idl-PDT can represent a valid therapeutic strategy for AC patients as well, despite the procedural difficulties and the risk of poor tolerability related to the body site.
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Affiliation(s)
- Mariachiara Arisi
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Benedetta Galli
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
| | - Edoardo Guasco Pisani
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
| | - Giuseppe La Rosa
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
| | - Gaetano Licata
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
| | - Sara Rovaris
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
| | - Cesare Tomasi
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
| | - Mariateresa Rossi
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
| | - Marina Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - PierGiacomo Calzavara-Pinton
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1, 25123, Brescia, Italy
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Effects of Blue Light on the Skin and Its Therapeutic Uses: Photodynamic Therapy and Beyond. Dermatol Surg 2022; 48:802-808. [DOI: 10.1097/dss.0000000000003500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yang Y, Shen S, Wang P, Wang X. Efficacy of photodynamic therapy in actinic cheilitis: a systematic review. Photodiagnosis Photodyn Ther 2022; 38:102782. [PMID: 35218940 DOI: 10.1016/j.pdpdt.2022.102782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) has gradually developed into a promising modality for actinic cheilitis (AC), and many new PDT strategies are emerging. However, comprehensive reviews evaluating the efficacy of PDT strategies for AC are lacking. OBJECTIVE To systematically review the safety and efficacy of PDT strategies for AC. METHODS A systematic review was conducted using three databases to compare several types of PDT for AC in terms of clinical response (CR), histopathology response (HR), cosmetic result, and adverse events. RESULTS A total of 19 studies were included, and 292 subjects were finally enrolled. The complete CR rate of ALA-patch PDT, traditional photodynamic therapy (T-PDT), and daylight photodynamic therapy (DL-PDT) was 80.00% (24/30), 65.14% (114/179), and 76.74% (33/43), respectively. The rate of painless patients was 87.10% (27/31) in DL-PDT, whereas the rate was only 31.25% (15/48) in T-PDT. The rates of moderate and severe local phototoxicity were 47.78% (43/90) in T-PDT, 0.00% (0/23) in DL-PDT, and 21.05% (4/19) in ALA-patch PDT. CONCLUSION Published literature suggests that ALA-patch PDT seem to achieve high complete CR rate. Besides, DL-PDT might be a well-tolerated therapy compared with T-PDT and ALA-patch PDT. However, these assumptions are made based on very limited data. It is necessary to conduct a long-term larger sample randomized controlled trial to further evaluate the efficacy and adverse events of various PDT schemes for AC.
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Affiliation(s)
- Yuling Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai
| | - Shuzhan Shen
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai.
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Binnal DA, Tadakamadla DJ, Rajesh DG, Tadakamadla DSK. Photodynamic therapy for oral potentially malignant disorders: A Systematic Review and Meta-analysis. Photodiagnosis Photodyn Ther 2022; 37:102713. [PMID: 34999271 DOI: 10.1016/j.pdpdt.2022.102713] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of Photodynamic Therapy (PDT) in the treatment of Oral Potentially Malignant Disorders (OPMDs) patients. METHODOLOGY An electronic search was conducted to retrieve articles published until September 2021. Meta-analyses were conducted for the outcomes of complete response (CR) and any response (AR) after treatment with PDT using data from single-arm studies, case series and non-randomised controlled trials (NRCTs). RESULTS In total, 49 articles were included. RCTs revealed insignificant mean difference (MD) in efficacy index between PDT and comparison groups (MD: 1.32; 95% CI:-28.10-30.72, p=0.930). The likelihood of CR (OR:0.84; 95% CI: 0.42-1.71, p=0.637) or AR (OR:2.10; 95% CI: 0.31-14.25, p=0.448) was not different in PDT group when compared with any comparison treatments in NRCTs. CR/AR among single arm studies was 60.6% (95% CI: 50.5-70.7, P<0.001) and 93.7% (95% CI:91.5-95.8, P<0.001) respectively. Higher prevalence of CR and AR was observed for dysplasia or carcinoma insitu (CIS) (CR: 81%, 95% CI: 70.8-91.3, P<0.001; AR: 94.3%; 95% CI: 89-99.6, P<0.001) and actinic cheilitis (AC) (CR: 73.9%, 95% CI: 65.9-81.9, P<0.001; AR:97%; 95% CI:94.9-99, P<0.001). CONCLUSIONS More than half of the patients receiving PDT showed CR, with more than 90% responding to the treatment. PDT was most effective on oral dysplasias, followed by AC.
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Affiliation(s)
- Dr Almas Binnal
- Associate Professor, Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore - 575001, Manipal Academy of Higher Education, Manipal, Karnataka, India-576104.
| | | | - Dr Gururaghavendran Rajesh
- Professor and Head, Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore - 575001, Manipal Academy of Higher Education, Manipal, Karnataka, India-576104.
| | - Dr Santosh Kumar Tadakamadla
- Senior Research Fellow, National Health and Medical Research Council Early Career Fellow, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Australia.
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Wang P, Zhang G, Zhang L, Zhou Z, Shi L, Zeng Q, Zhu L, Wang X. 5-Aminolevulinic acid photodynamic therapy for early-stage lip squamous cell carcinoma. Photodiagnosis Photodyn Ther 2021; 35:102321. [PMID: 34015543 DOI: 10.1016/j.pdpdt.2021.102321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of the lip removed by surgery may cause lip dysfunction and scar. ALA-PDT (5-Aminolevulinic acid photodynamic therapy) is a minimally invasive treatment for superficial SCC in situ. However, few studies reported the use of topical ALA-PDT to manage lip SCC. METHODS Between 2015 and 2017, 6 patients with Tis to T2 lip squamous cell carcinoma without evidence of lymph node spread, were treated with topical ALA-PDT at Shanghai Skin Disease Hospital. Clinical responses and side effect were evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) at 1 month, 6 months, 12 months and 24 months after ALA-PDT. RESULTS All of the 6 patients achieved complete response (CR) by 2-7 sessions of ALA-PDT. There was no relapse during 24 months follow up for 4 patients. Two out of 6 patients relapsed at 10 months and 20 months post PDT but achieved CR again by 1-3 more sessions of PDT. There was no functional or aesthetic problem. CONCLUSION Topical 5-Aminolevulinic acid photodynamic could be considered a potential alternative therapeutic option for early-stage lip squamous cell carcinoma without lymph node spread.
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Affiliation(s)
- Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongxia Zhou
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingyu Zeng
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lude Zhu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.
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Actinic cheilitis or discoid lupus erythematosus? Arch Dermatol Res 2021; 313:889-890. [PMID: 33625556 DOI: 10.1007/s00403-021-02192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
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Andreadis D, Pavlou AM, Vakirlis E, Anagnostou E, Vrani F, Poulopoulos A, Kolokotronis A, Ioannidis D, Sotiriou E. Actinic cheilitis may resemble oral lichenoid-type lesions or discoid lupus erythematosus. Arch Dermatol Res 2021; 313:891-892. [PMID: 33625557 DOI: 10.1007/s00403-021-02194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloníki, Greece.
| | - Achilleia -Maria Pavlou
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Efstratios Vakirlis
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Anagnostou
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Fotini Vrani
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Poulopoulos
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Alexandros Kolokotronis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Dimitrios Ioannidis
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elena Sotiriou
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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