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Meng Y, Chen S, Li P, Wang C, Ni X. Tumor Cell Membrane-Encapsulated MLA Solid Lipid Nanoparticles for Targeted Diagnosis and Radiosensitization Therapy of Cutaneous Squamous Cell Carcinoma. Mol Pharm 2024; 21:3218-3232. [PMID: 38885477 DOI: 10.1021/acs.molpharmaceut.3c01247] [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] [Indexed: 06/20/2024]
Abstract
Squamous cell carcinoma (SCC) is a common nonmelanoma skin cancer. Radiotherapy plays an integral role in treating SCC due to its characteristics, such as diminished intercellular adhesion, heightened cell migration and invasion capabilities, and immune evasion. These problems lead to inaccurate tumor boundary positioning and radiotherapy tolerance in SCC treatment. Thus, accurate localization and enhanced radiotherapy sensitivity are imperative for effective SCC treatment. To address the existing limitations in SCC therapy, we developed monoglyceride solid lipid nanoparticles (MG SLNs) and enveloped them with the A431 cell membrane (A431 CM) to create A431@MG. The characterization results showed that A431@MG was spherical. Furthermore, A431@MG had specific targeting for A431 cells. In A431 tumor-bearing mice, A431@MG demonstrated prolonged accumulation within tumors, ensuring precise boundary localization of SCC. We further advanced the approach by preparing MG SLNs encapsulating 5-aminolevulinic acid methyl ester (MLA) and desferrioxamine (DFO) with an A431 CM coating to yield A431@MG-MLA/DFO. Several studies have revealed that DFO effectively reduced iron content, impeding protoporphyrin IX (PpIX) biotransformation and promoting PpIX accumulation. Simultaneously, MLA was metabolized into PpIX upon cellular entry. During radiotherapy, the heightened PpIX levels enhanced reactive oxygen species (ROS) generation, inducing DNA and mitochondrial damage and leading to cell apoptosis. In A431 tumor-bearing mice, the A431@MG-MLA/DFO group exhibited notable radiotherapy sensitization, displaying superior tumor growth inhibition. Combining A431@MG-MLA/DFO with radiotherapy significantly improved anticancer efficacy, highlighting its potential to serve as an integrated diagnostic and therapeutic strategy for SCC.
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Affiliation(s)
- Yanyan Meng
- School of Pharmacy, Changzhou University, Changzhou 213164, China
- Department of Radiotherapy Oncology, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou 213003, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou 213003, China
- Changzhou Key Laboratory of Medical Physics, Changzhou 213003, China
| | - Shaoqing Chen
- Department of Radiotherapy Oncology, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou 213003, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou 213003, China
- Changzhou Key Laboratory of Medical Physics, Changzhou 213003, China
| | - Pengyin Li
- School of Pharmacy, Changzhou University, Changzhou 213164, China
- Department of Radiotherapy Oncology, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou 213003, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou 213003, China
- Changzhou Key Laboratory of Medical Physics, Changzhou 213003, China
| | - Cheli Wang
- School of Pharmacy, Changzhou University, Changzhou 213164, China
| | - Xinye Ni
- Department of Radiotherapy Oncology, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou 213003, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou 213003, China
- Changzhou Key Laboratory of Medical Physics, Changzhou 213003, China
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Trave I, Salvi I, Serazzi FA, Schiavetti I, Luca L, Parodi A, Cozzani E. The impact of occlusive vs non-occlusive application of methyl aminolevulinate on the efficacy and tolerability of daylight photodynamic therapy for actinic keratosis. Photodiagnosis Photodyn Ther 2024; 46:104049. [PMID: 38490345 DOI: 10.1016/j.pdpdt.2024.104049] [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: 02/08/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Conventional photodynamic therapy (c-PDT) is an effective treatment for actinic keratoses (AKs) and nonmelanoma skin cancer which exploits the photosensitizing properties of methyl aminolaevulinate (MAL). Daylight photodynamic therapy (DL-PDT) is an alternative to c-PDT which does not require the application of MAL in occlusion and that is better tolerated by patients. The impact of occlusion on the efficacy of DL-PD has not been investigated by previous studies. OBJECTIVE To compare the efficacy and tolerability of occlusive and non-occlusive DL-PDT. METHODS We conducted a prospective intraindividual left/right comparison study. AKs of the face or scalp were marked in two symmetrical treatment areas. The two target areas were randomly assigned to DL-PDT with occlusive and non-occlusive application of MAL. The efficacy and cosmetic outcome were determined by a "blinded" investigator. RESULTS Lesions in occluded areas showed a better response in the clearance rate of the lesions (65.5% vs 35.0 %, p < 0.001 %), and cosmetic outcome (P < 0.001). There was no difference in phototoxicity or pain between occluded and non-occluded areas. CONCLUSION The occlusive application of MAL improves the efficacy of DL-PDT in clearing AKs and does not increase the incidence of side effects.
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Affiliation(s)
- Ilaria Trave
- Section of Dermatology, DISSAL, IRCCS Ospedale Policlinico San Martino, University of Genoa, via A. Pastore 1, 16132, Genova 16044, Italy.
| | - Ilaria Salvi
- Section of Dermatology, DISSAL, IRCCS Ospedale Policlinico San Martino, University of Genoa, via A. Pastore 1, 16132, Genova 16044, Italy
| | | | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova 16132, Italy
| | - Laura Luca
- Section of Dermatology, DISSAL, IRCCS Ospedale Policlinico San Martino, University of Genoa, via A. Pastore 1, 16132, Genova 16044, Italy
| | - Aurora Parodi
- Section of Dermatology, DISSAL, IRCCS Ospedale Policlinico San Martino, University of Genoa, via A. Pastore 1, 16132, Genova 16044, Italy
| | - Emanuele Cozzani
- Section of Dermatology, DISSAL, IRCCS Ospedale Policlinico San Martino, University of Genoa, via A. Pastore 1, 16132, Genova 16044, Italy
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Zhang Y, Liu W, Wang Q. Positive effects of low-dose photodynamic therapy with aminolevulinic acid or its methyl ester in skin rejuvenation and wound healing: An update. JOURNAL OF BIOPHOTONICS 2023; 16:e202200293. [PMID: 36602479 DOI: 10.1002/jbio.202200293] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/28/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
In dermatology, photodynamic therapy (PDT) is widely used in skin tumors, infections, etc., because of the killing effect triggered by toxic reactive oxygen species (ROS). However, the ROS concentration is determined by various photosensitizer concentrations and formulations, as well as various irradiation parameters. Low-dose PDT leads to sufficiently low ROS level, which results in biological effects that are the exact opposite of the killing potency. Therefore, in recent years, low-dose PDT has been exploited in improving aging and wound. Low-dose ALA/MAL PDT might improve aging through promoting the proliferation of fibroblasts, blocking DNA damage, counteracting oxidative stress, inhibiting melanogenesis, and remodeling lymphatic vessels in aged skin. Promoting fibroblasts and epidermal stem cells proliferation and migration, promoting granulation tissue formation and angiogenesis and regulating the inflammatory process might be the mechanisms of low-dose ALA/MAL PDT in wound healing. Nevertheless, the positive effects of low-dose PDT have not been thoroughly investigated in dermatology, and high-quality studies are still needed to fill the relevant vacancy.
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Affiliation(s)
- YuWei Zhang
- The Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Liu
- The Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Qian Wang
- The Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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Romero MP, Posso V, Ureña V, Inada N, Bagnato V, Cabrera F. Clinical and histopathologycal study of actinic keratosis treatment with photodynamic therapy VS 5-fluorouracil in face cancerization field. Photodiagnosis Photodyn Ther 2022; 39:102967. [PMID: 35716996 DOI: 10.1016/j.pdpdt.2022.102967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
Actinic keratosis (AK) is one of the most frequent pathologies in clinical practice. The prevalence varies according to the area of incidence and age. Approximately 10% of the prevalence of AK occurs at 30 years of age and rises to 80% at 70 years of life. This study conducted a split-face analysis based on Photodynamic Therapy (MALA-PDT) and 5-fluorouracil (5-FU) treatments in patients with AK. Clinical and histopathological studies evaluated each treatment's efficiency and side effects. Six patients were recruited between 50 and 70 years of age for this. MALA-PDT was applied on the right side of the face. A biodistribution time of 2 hours, a dose of light of 36 J / cm2 (20 min irradiation), a spot for photoirradiation with a total area of 100 cm2, and a wavelength of 635 nm were used. (LINCE equipment MMOPTICS-Brazil). By fluorescence diagnosis, clinical and subclinical AK lesions were evidenced in the area called the "cancerization field." Two cycles of MALA-PDT were performed on each patient, and 5-FU was applied twice daily for 15 days. A 2-month follow-up post-MALA-PDT and post-5-FU was carried out. The treatment based on 5-Flu and MALA-PDT clinically shows the same response, but MALA-PDT is less aggressive than 5-FU. The treatment of AK based on MALA-PDT is a practical, cheap, and easy-to-use technique.
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Affiliation(s)
| | - Verónica Posso
- Servicio de Anatomía Patológica. Hospital Carlos Andrade Marín. Quito, Ecuador.
| | - Valeria Ureña
- Postgrado de Dermatología. Facultad de Medicina Eugenio Espejo, Universidad UTE. Quito, Ecuador.
| | - Natalia Inada
- Instituto de Física. Universidade de São Paulo. São Carlos SP-Brasil.
| | - Vanderlei Bagnato
- Instituto de Física. Universidade de São Paulo. São Carlos SP-Brasil.
| | - Franklin Cabrera
- Servicio de Dermatología. Hospital Carlos Andrade Marín. Quito, Ecuador.
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Daylight-PDT: everything under the sun. Biochem Soc Trans 2022; 50:975-985. [PMID: 35385082 PMCID: PMC9162453 DOI: 10.1042/bst20200822] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 12/18/2022]
Abstract
5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) was first implemented over three decades ago and has since been mainly part of clinical practice for the management of pre-cancerous and cancerous skin lesions. Photodynamic therapy relies on the combination of a photosensitizer, light and oxygen to cause photo-oxidative damage of cellular components. 5-Aminolevulinic acid (ALA) is a natural precursor of the heme biosynthetic pathway, which when exogenously administered leads to the accumulation of the photoactivatable protoporphyrin IX. Although, effective and providing excellent cosmetic outcomes, its use has been restricted by the burning, stinging, and prickling sensation associated with treatment, as well as cutaneous adverse reactions that may be induced. Despite intense research in the realm of drug delivery, pain moderation, and light delivery, a novel protocol design using sunlight has led to some of the best results in terms of treatment response and patient satisfaction. Daylight PDT is the protocol of choice for the management of treatment of multiple or confluent actinic keratoses (AK) skin lesions. This review aims to revisit the photophysical, physicochemical and biological characteristics of ALA-PDT, and the underlying mechanisms resulting in daylight PDT efficiency and limitations.
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Liao C, Zhang G, Wang P, Sun X, Wang X. Combination curettage and modified ALA-PDT for multiple basal cell carcinomas of the face and head. Photodiagnosis Photodyn Ther 2021; 35:102393. [PMID: 34116251 DOI: 10.1016/j.pdpdt.2021.102393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Basal cell carcinoma (BCC) is a common non-melanoma skin malignancy arising in sun exposure area. Patients with multiple BCCs have a high-risk factor for recurrence and are very difficult to treat with current methods. 5-aminolaevulinic acid-photodynamic therapy (ALA-PDT) treat superficial type of BCCs with superior efficacy and an excellent cosmetic result, but deep tumor success is limited. Herein, a case of numerous nodular BCCs scattered on the face and head, which was treated with the combination of topical curettage and modified ALA-PDT is reported. Curettage was to rapidly scalp away nodular tumors and contributed to ALA transdermal depth to the tumor base. Modified ALA-PDT as an advanced treatment was nearly painless and can cure multiple BCCs of face and head combing curettage.
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Affiliation(s)
- Caihe Liao
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Xiaofei Sun
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China.
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Abrouk M, Dong J, Waibel JS. Medical and aesthetic improvement of photodamaged skin by the combination of intense pulsed light and photodynamic therapy with 10% aminolevulinic acid hydrochloride gel. Lasers Surg Med 2021; 54:62-65. [PMID: 34324724 DOI: 10.1002/lsm.23460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/11/2021] [Accepted: 07/11/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of photodynamic therapy (PDT) with the novel 10% aminolevulinic acid (ALA) hydrochloride gel (10% ALA gel) and BF-RhodoLED® light (635 nm; 37 J/cm2 ) in combination with intense pulsed light (IPL) to augment the medical and aesthetic improvement of photodamaged skin of the décolleté. METHODS This was a single-site prospective, randomized, intraindividual split chest pilot study with 20 female subjects with moderate to severe photodamage of the décolleté. Subjects were randomized to ALA-PDT + IPL to one split-side of the chest and ALA-PDT only to the contralateral side. Three blinded raters assessed aesthetic improvement using the global aesthetic improvement scale (GAIS). RESULTS Eighteen subjects completed the study. Superior GAIS results were achieved on the ALA-PDT + IPL treatment side than on the ALA-PDT only treatment side (p < 0.001) after 24 weeks of follow-up. CONCLUSIONS ALA-PDT using 10% ALA hydrochloride gel and BF-RhodoLED® light had superior rejuvenation effects on the décolleté when combined with IPL compared to ALA-PDT alone.
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Affiliation(s)
- Michael Abrouk
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joanna Dong
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jill S Waibel
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery (Voluntary Faculty), University of Miami, Miami, Florida, USA
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8
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Hua H, Cheng JW, Bu WB, Liu J, Ma WW, Ni N, Shi J, Zhou BR, Luo D. 5-aminolaevulinic acid-based photodynamic therapy inhibits ultraviolet B-induced skin photodamage. Int J Biol Sci 2019; 15:2100-2109. [PMID: 31592145 PMCID: PMC6775304 DOI: 10.7150/ijbs.31583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 06/21/2019] [Indexed: 12/02/2022] Open
Abstract
To evaluate the photoprotective effect of 5-aminolaevulinic acid-based photodynamic therapy (ALA-PDT) on ultraviolet B (UVB)-induced skin photodamage. In vivo experiments, the dorsal skin of hairless mice were treated with ALA-PDT or saline-PDT, and then exposed to 180 mJ/m2 UVB. Results showed that the number of sunburn cells and apoptotic cells in the epidermis of ALA-PDT-treated groups at 24 h after UVB irradiation were significantly decreased compared with those in the UVB groups. And the removal rate of CPDs was obviously higher in ALA-PDT-treated groups. At 48 h, the number of Ki67 positive nuclei in ALA-PDT-UVB group was significantly fewer than that in UVB group. Further in vitro experiments, human keratinocyte cell line (HaCaT) cells of two groups (one treated with ALA-PDT, the other untreated), were exposed to 60 mJ/m2 UVB irradiation. We found 0.5 mmol/L of ALA and 3 J/cm2 of red light did not affect the vitality of cells, and could reduce UVB induced apoptosis, accelerate the clearance of CPDs, inhibit proliferation and activate p53. Thus, our data demonstrate that ALA-PDT pretreatment can induce a protective DNA damage response that protects skin cells from UVB-induced photodamages.
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Affiliation(s)
- Hui Hua
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-wei Cheng
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen-bo Bu
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
| | - Juan Liu
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-wei Ma
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Na Ni
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Shi
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bing-rong Zhou
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Luo
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Sorbellini E, Rucco M, Rinaldi F. Photodynamic and photobiological effects of light-emitting diode (LED) therapy in dermatological disease: an update. Lasers Med Sci 2018; 33:1431-1439. [PMID: 30006754 PMCID: PMC6133043 DOI: 10.1007/s10103-018-2584-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/05/2018] [Indexed: 12/16/2022]
Abstract
Benefit deriving from the use of light is known since ancient time, but, only in the last decades of twentieth century, we witnessed the rapid expansion of knowledge and techniques. Light-emitted diode (LED)-based devices represent the emerging and safest tool for the treatment of many conditions such as skin inflammatory conditions, aging, and disorders linked to hair growth. The present work reviews the current knowledge about LED-based therapeutic approaches in different skin and hair disorders. LED therapy represents the emerging and safest tool for the treatment of many conditions such as skin inflammatory conditions, aging, and disorders linked to hair growth. The use of LED in the treatment of such conditions has now entered common practice among dermatologists. Additional controlled studies are still needed to corroborate the efficacy of such kind of treatment.
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Affiliation(s)
- Elisabetta Sorbellini
- International Hair Research Foundation (IHRF), Milan, Italy.
- Human Advanced Microbiome Project-HMAP, Milan, Italy.
| | | | - Fabio Rinaldi
- International Hair Research Foundation (IHRF), Milan, Italy
- Human Advanced Microbiome Project-HMAP, Milan, Italy
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10
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Nguyen KP, Knuiman GJ, Blokx WAM, Hoogedoorn L, Smits T, Gerritsen MJP. Is a single day patient friendly methyl aminolevulinate photodynamic therapy illumination scheme for superficial basal cell carcinoma feasible? A randomized multicenter pilot trial. J DERMATOL TREAT 2018; 30:194-199. [PMID: 29862877 DOI: 10.1080/09546634.2018.1484558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Topical methyl aminolevulinate photodynamic therapy (MAL-PDT) is highly effective for the treatment of superficial basal cell carcinoma (sBCC). Current European treatment protocol requires two hospital visits, which is costly and unpractical. The aim of this study was to evaluate the efficacy of fractionated MAL-PDT, using two light fractions at 3 and 4 h compared to illumination at 3 and 5 h after MAL-application. METHODS Thirty patients were randomized into two groups. The first group received illumination at 3 and 4 h (20 + 55 J/cm2) after MAL-application (3/4 group). In the other group, two light fractions were performed at 3 and 5 h (20 + 55 J/cm2) after MAL-application (3/5 group). The lesion response was evaluated at 3 and 12 months posttreatment. RESULTS In the 3/5 group, 70.0% showed a complete response (CR) at 3 months compared to 63.6% in the other group. At 12 months, 100% showed a CR in the 3/5 group compared to 80.0% in the other group. However, most failures/recurrences were eventually due to the presence of a more aggressive BCC subtype, mostly caused by sampling error of the primary punch biopsy. CONCLUSION Single day protocol for MAL-PDT for sBCC is feasible and this study shows promising results.
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Affiliation(s)
- K P Nguyen
- a Department of Dermatology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - G J Knuiman
- b Department of Pathology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - W A M Blokx
- b Department of Pathology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - L Hoogedoorn
- a Department of Dermatology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - T Smits
- c Department of Dermatology , Maxima Medical Center , Eindhoven , The Netherlands
| | - M J P Gerritsen
- a Department of Dermatology , Radboud University Medical Center , Nijmegen , The Netherlands
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11
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Christensen SR. Recent advances in field cancerization and management of multiple cutaneous squamous cell carcinomas. F1000Res 2018; 7. [PMID: 29904586 PMCID: PMC5989149 DOI: 10.12688/f1000research.12837.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 12/31/2022] Open
Abstract
Cutaneous squamous cell carcinoma (SCC) is among the most common cancers in humans, and many patients with SCC will develop multiple tumors within their lifetime. The field cancerization concept, originally proposed over 60 years ago, hypothesized that multiple primary cancers may arise simultaneously and coexist with subclinical precursor lesions within a defined field. Genetic sequencing of SCC and precursor lesions has identified what may be the earliest clonal proliferations in SCC development and confirmed that field cancerization in the skin is mediated by ultraviolet radiation. For patients with multiple SCCs and severe actinic damage, treatment of precursor lesions within a cancerized field can decrease the risk of subsequent cancer development. Sunblock is an effective intervention for field cancerization, even in patients with established disease. There is now direct evidence that field therapy with topical 5-fluorouracil is effective in reducing the incidence of subsequent SCC, and there is indirect evidence suggesting that topical imiquimod, topical ingenol mebutate, and photodynamic therapy are similarly effective. There is limited direct evidence to show that systemic acitretin or nicotinamide can decrease incident SCC in patients with field cancerization. In this review, an approach to the management of patients with multiple SCCs and field cancerization is presented along with the rationale to support field-directed therapy.
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Affiliation(s)
- Sean R Christensen
- Section of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, Yale University, New Haven, CT, USA
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12
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Photodynamic diagnosis with methyl-5-aminolevulinate in squamous intraepithelial lesions of the vulva: Experimental research. PLoS One 2018; 13:e0196753. [PMID: 29742173 PMCID: PMC5942824 DOI: 10.1371/journal.pone.0196753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/18/2018] [Indexed: 11/19/2022] Open
Abstract
The incidence of the High-grade Squamous Intraepithelial Lesion of the vulva, formerly vulvar intra-epithelial neoplasia is progressively increasing. Today, an early detection and a precise localization of vulvar lesions are still problematic issues, due to the lack of accuracy of the available diagnostic tool. A new approach is the photodynamic diagnosis based on the fluorescence detection of protoporphyrin IX (PpIX) in cancer cells after topical application of a cream of methyl amino-levulinic acid. This study aimed to evaluate the effectiveness of photodiagnosis in order to discriminate the intensity of PpIX fluorescence between vulvar tumor and healthy skin. After topical application of the cream, the fluorescence on xenografted A431 tumor and adjacent skin was non-invasively measured with optical fiber. The tumor to skin fluorescence ratios were 1.38 and 1.41 at respectively 3h and 6h after application, which were significantly higher compared to those observed before application. PpIX accumulation at different depths of the tumor was investigated by spectrofluorimetry after PpIX chemical extraction from tumor sections at 3h and 6h post-application. It was noticed at both application times that the concentration of PpIX within the tumor progressively decreased. However PpIX fluorescence was always detectable up to 2.5 mm, a depth equivalent to more than three quarters of the tumor. The tumor to exposed skin ratios of PpIX fluorescence showed a good selectivity up to1mm depth at 3h post-application and up to 1.5mm at 6h post-m-ALA. Thus, the photodynamic diagnosis using in vivo topical methyl amino-levulinic acid appears to be a promising way to detect the intraepithelial lesions of the vulva. Our results open the possibility for implementation of topical methyl amino-levulinic acid in clinical settings for recognition of vulvar high-grade squamous intraepithelial lesions.
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13
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Randomized clinical trial testing the efficacy and safety of 0.5% colchicine cream versus photodynamic therapy with methyl aminolevulinate in the treatment of skin field cancerization: study protocol. BMC Cancer 2018; 18:340. [PMID: 29587662 PMCID: PMC5870300 DOI: 10.1186/s12885-018-4288-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/21/2018] [Indexed: 01/10/2023] Open
Abstract
Background The primary clinical manifestation of skin field cancerization is the presence of actinic keratoses (AKs). Current treatments for AKs related to skin field cancerization include photodynamic therapy (PDT) and colchicine. The objective of this study is to evaluate the efficacy and safety of 0.5% colchicine cream versus PDT with methyl aminolevulinate (MAL-PDT) in the treatment of skin field cancerization. Methods In a randomized controlled and open clinical trial with a blind histopathological and immunohistochemical analysis, 36 patients with up to 10 AKs on their forearms will be included from the outpatient clinic. The forearms will be randomized into two groups, clinically evaluated and biopsied for histopathology and immunohistochemistry (p53 and Ki67). One forearm will be treated with 0.5% colchicine cream for 10 days, and the other forearm will receive one session of MAL-PDT; the forearms will subsequently be reassessed clinically and histologically after 60 days (T60) of treatment. The primary endpoint will be the point of complete clearance of AKs in T60. The sample size will enable a detection in the reduction of over 10% in AK counts between the groups with power of 0.9 and an alpha of 0.05, accounting for an estimated dropout rate of 10%, resulting in 36 patients (72 forearms). All participants included in the randomized study will be part of the analysis, and the final outcomes of any dropouts will be the value of their last visit (LOCF). The statistical analysis will be performed using SPSS 22.0, and a p value < 5% will be considered to be significant. Discussion It is expected that colchicine will be superior to MAL-PDT in reducing AKs and in the skin field cancerization, and there will be good tolerability in both groups. Colchicine intervention is novel in that it provides a new alternative to MAL-PDT. Moreover, this drug is inexpensive that may be a potential treatment of skin field cancerization that can be prescribed in public health systems with good results. Trial registration The trial is registered in Brazilian Registry for Clinical Trials (Registration number: RBR-8y3sj9, date assigned May 4, 2016, retrospectively registered).
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Kessels J, Kreukels H, Nelemans P, Roozeboom M, van Pelt H, Mosterd K, de Haas E, Kelleners-Smeets N. Treatment of superficial basal cell carcinoma by topical photodynamic therapy with fractionated 5-aminolaevulinic acid 20% vs. two-stage topical methyl aminolaevulinate: results of a randomized controlled trial. Br J Dermatol 2018; 178:1056-1063. [DOI: 10.1111/bjd.15967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J.P.H.M. Kessels
- Department of Dermatology; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Dermatology; Zuyderland Medical Centre; Heerlen the Netherlands
- GROW School for Developmental Biology and Oncology
| | - H. Kreukels
- Department of Epidemiology; Maastricht University; Maastricht the Netherlands
| | - P.J. Nelemans
- Department of Dermatology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - M.H. Roozeboom
- Department of Dermatology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - H. van Pelt
- Department of Dermatology; VieCuri Medical Centre; Venlo/Venray the Netherlands
| | - K. Mosterd
- Department of Dermatology; Maastricht University Medical Centre; Maastricht the Netherlands
- GROW School for Developmental Biology and Oncology
| | - E.R.M. de Haas
- Department of Epidemiology; Maastricht University; Maastricht the Netherlands
| | - N.W.J. Kelleners-Smeets
- Department of Dermatology; Maastricht University Medical Centre; Maastricht the Netherlands
- GROW School for Developmental Biology and Oncology
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Clinical Benefits of Preoperative Conventional Fluorescence Diagnosis in Surgical Treatment of Extramammary Paget Disease. Dermatol Surg 2017; 44:375-382. [PMID: 28945622 DOI: 10.1097/dss.0000000000001329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In extramammary Paget disease (EMPD), initial margins of surgical excision are difficult to determine preoperatively. Fluorescence diagnosis (FD) may have utility as a noninvasive method for delineating tumor boundaries. OBJECTIVE The relationship between FD-delineated borders and results of multiple scouting biopsies (MSBs) in EMPD was investigated, evaluating the potential clinical role of FD. MATERIALS AND METHODS A cohort of 21 patients was studied, looking for consistencies between FD and MSB results. Initial surgical margins were determined by FD or FD plus MSB. All margins were subjected to frozen section analysis. RESULTS Paget cells were identified in 88 of 117 (71.8%) biopsies obtained from FD borders. When used preoperatively with MSB in 9 patients, 96.4% of margins proved negative at initial resection stage. Using a 6-mm margin beyond FD borders in another 9 patients, 86.7% of margins were negative at initial stage. The maximum distance of excision beyond FD border was 12 mm. CONCLUSION Fluorescence diagnosis borders (identified visually) correlated well with MSB histopathology. Fluorescence diagnosis is a useful method to delineate initial margins for surgical resection of EMPD.
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Campbell CL, Brown CTA, Wood K, Salvio AG, Inada NM, Bagnato VS, Moseley H. A quantitative study of in vivo protoporphyrin IX fluorescence build up during occlusive treatment phases. Photodiagnosis Photodyn Ther 2017; 18:204-207. [DOI: 10.1016/j.pdpdt.2017.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 01/02/2017] [Accepted: 02/06/2017] [Indexed: 01/06/2023]
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Zhang RR, Schroeder AB, Grudzinski JJ, Rosenthal EL, Warram JM, Pinchuk AN, Eliceiri KW, Kuo JS, Weichert JP. Beyond the margins: real-time detection of cancer using targeted fluorophores. Nat Rev Clin Oncol 2017; 14:347-364. [PMID: 28094261 PMCID: PMC5683405 DOI: 10.1038/nrclinonc.2016.212] [Citation(s) in RCA: 309] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Over the past two decades, synergistic innovations in imaging technology have resulted in a revolution in which a range of biomedical applications are now benefiting from fluorescence imaging. Specifically, advances in fluorophore chemistry and imaging hardware, and the identification of targetable biomarkers have now positioned intraoperative fluorescence as a highly specific real-time detection modality for surgeons in oncology. In particular, the deeper tissue penetration and limited autofluorescence of near-infrared (NIR) fluorescence imaging improves the translational potential of this modality over visible-light fluorescence imaging. Rapid developments in fluorophores with improved characteristics, detection instrumentation, and targeting strategies led to the clinical testing in the early 2010s of the first targeted NIR fluorophores for intraoperative cancer detection. The foundations for the advances that underline this technology continue to be nurtured by the multidisciplinary collaboration of chemists, biologists, engineers, and clinicians. In this Review, we highlight the latest developments in NIR fluorophores, cancer-targeting strategies, and detection instrumentation for intraoperative cancer detection, and consider the unique challenges associated with their effective application in clinical settings.
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Affiliation(s)
- Ray R Zhang
- Department of Radiology, University of Wisconsin-Madison (UW-Madison), 600 Highland Avenue, Madison, Wisconsin 53792, USA
- Department of Neurological Surgery, UW-Madison, 600 Highland Avenue, Madison, Wisconsin 53792, USA
| | - Alexandra B Schroeder
- Medical Engineering, Morgridge Institute for Research, 330 North Orchard Street, Madison, Wisconsin 53715, USA
- Laboratory for Optical and Computational Instrumentation, 1675 Observatory Drive, Madison Wisconsin 53706, USA
- Department of Medical Physics, UW-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
| | - Joseph J Grudzinski
- Department of Medical Physics, UW-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, California 94305, USA
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, Alabama 35294, USA
| | - Anatoly N Pinchuk
- Department of Radiology, University of Wisconsin-Madison (UW-Madison), 600 Highland Avenue, Madison, Wisconsin 53792, USA
| | - Kevin W Eliceiri
- Medical Engineering, Morgridge Institute for Research, 330 North Orchard Street, Madison, Wisconsin 53715, USA
- Laboratory for Optical and Computational Instrumentation, 1675 Observatory Drive, Madison Wisconsin 53706, USA
- Department of Medical Physics, UW-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
- Carbone Cancer Center, UW-Madison, 600 Highland Avenue Madison, Wisconsin 53792, USA
| | - John S Kuo
- Department of Neurological Surgery, UW-Madison, 600 Highland Avenue, Madison, Wisconsin 53792, USA
- Carbone Cancer Center, UW-Madison, 600 Highland Avenue Madison, Wisconsin 53792, USA
| | - Jamey P Weichert
- Department of Radiology, University of Wisconsin-Madison (UW-Madison), 600 Highland Avenue, Madison, Wisconsin 53792, USA
- Department of Medical Physics, UW-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
- Carbone Cancer Center, UW-Madison, 600 Highland Avenue Madison, Wisconsin 53792, USA
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Vignion-Dewalle AS, Baert G, Devos L, Thecua E, Vicentini C, Mortier L, Mordon S. Red light photodynamic therapy for actinic keratosis using 37 J/cm 2 : Fractionated irradiation with 12.3 mW/cm 2 after 30 minutes incubation time compared to standard continuous irradiation with 75 mW/cm 2 after 3 hours incubation time using a mathematical modeling. Lasers Surg Med 2017; 49:686-697. [PMID: 28370134 DOI: 10.1002/lsm.22665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE AND STUDY DESIGN Photodynamic therapy (PDT) is an emerging treatment modality for various diseases, especially for dermatological conditions. Although, the standard PDT protocol for the treatment of actinic keratoses in Europe has shown to be effective, treatment-associated pain is often observed in patients. Different modifications to this protocol attempted to decrease pain have been investigated. The decrease in fluence rate seems to be a promising solution. Moreover, it has been suggested that light fractionation significantly increases the efficacy of PDT. Based on a flexible light-emitting textile, the FLEXITHERALIGHT device specifically provides a fractionated illumination at a fluence rate more than six times lower than that of the standard protocol. In a recently completed clinical trial of PDT for the treatment of actinic keratosis, the non-inferiority of a protocol involving illumination with the FLEXITHERALIGHT device after a short incubation time and referred to as the FLEXITHERALIGHT protocol has been assessed compared to the standard protocol. In this paper, we propose a comparison of the two above mentioned 635 nm red light protocols with 37 J/cm2 in the PDT treatment of actinic keratosis: the standard protocol and the FLEXITHERALIGHT one through a mathematical modeling. METHODS This mathematical modeling, which slightly differs from the one we have already published, enables the local damage induced by the therapy to be estimated. RESULTS The comparison performed in terms of the local damage induced by the therapy demonstrates that the FLEXITHERALIGHT protocol with lower fluence rate, light fractionation and shorter incubation time is somewhat less efficient than the standard protocol. Nevertheless, from the clinical trial results, the FLEXITHERALIGHT protocol results in non-inferior response rates compared to the standard protocol. CONCLUSION This finding raises the question of whether the PDT local damage achieved by the FLEXITHERALIGHT protocol (respectively, the standard protocol) is sufficient (respectively, excessive) to destroy actinic keratosis cells. Lasers Surg. Med. 49:686-697, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Anne-Sophie Vignion-Dewalle
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Gregory Baert
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Laura Devos
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Elise Thecua
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Claire Vicentini
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Laurent Mortier
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Serge Mordon
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
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Lima CA, Goulart VP, Bechara EJH, Correa L, Zezell DM. Optimization and therapeutic effects of PDT mediated by ALA and MAL in the treatment of cutaneous malignant lesions: A comparative study. JOURNAL OF BIOPHOTONICS 2016; 9:1355-1361. [PMID: 27653310 DOI: 10.1002/jbio.201600164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/01/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
5-aminolevulinic acid (ALA) and its methylated ester (MAL) are the most common topical agents used in photodynamic therapy (PDT) as precursors of the photosensitizer protoporphyrin IX (PpIX). The induction of newly PpIX depends on incubation time of each photosensitizer in the tissue and the presence of high intralesional porphyrin levels is an important parameter for the PDT effectiveness. This study used laser-induced fluorescence (LIF) spectroscopy to evaluate the optimum time to light exposure of PDT mediated by ALA (20% w/w) and MAL (10% w/w) to treat malignant lesions precursors of cutaneous squamous cell carcinoma induced in mice. The therapeutic effects obtained by optimized ALA- and MAL-PDT were assessed 10 and 20 days after treatments. Higher PpIX levels were evidenced in the lesions photosensitized by ALA than MAL and according to LIF measurements the PDT irradiation was performed, respectively, at 300 and 330 minutes after ALA and MAL incubation. Histopathological analysis evidenced necrosis and epithelial atrophy after 10 days of PDT using both prodrugs, as well as reepitelization and collagen deposition at 20 days. Thus, despite the distinct concentration of ALA and MAL used in the formulation of each photosensitizing cream, PDT mediated by both photosensitizing agents obtained similar therapeutic outcomes.
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Affiliation(s)
- Cassio Aparecido Lima
- Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Universidade de Sao Paulo, Av. Prof. Lineu Prestes 2242, 05508-000, Sao Paulo-SP, Brazil
| | - Viviane Pereira Goulart
- Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Universidade de Sao Paulo, Av. Prof. Lineu Prestes 2242, 05508-000, Sao Paulo-SP, Brazil
| | | | - Luciana Correa
- Faculdade de Odontologia, Universidade de Sao Paulo, Av. Prof. Lineu Prestes 2227, 05508-000, Sao Paulo-SP, Brazil
| | - Denise Maria Zezell
- Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Universidade de Sao Paulo, Av. Prof. Lineu Prestes 2242, 05508-000, Sao Paulo-SP, Brazil
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Cohen DK, Lee PK. Photodynamic Therapy for Non-Melanoma Skin Cancers. Cancers (Basel) 2016; 8:cancers8100090. [PMID: 27782043 PMCID: PMC5082380 DOI: 10.3390/cancers8100090] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/27/2016] [Indexed: 12/22/2022] Open
Abstract
Non-melanoma skin cancer (NMSC) is traditionally treated with surgical excision. Nonsurgical methods such as cryotherapy and topical chemotherapeutics, amongst other treatments, are other options. Actinic keratosis (AKs) are considered precancerous lesions that eventually may progress to squamous cell carcinoma (SCC). Photodynamic therapy (PDT) offers an effective treatment for AKs, and is also effective for superficial basal cell carcinoma (BCC). Nodular BCC and Bowen's disease (SCC in situ) have shown acceptable response rates with PDT, although recurrence rates are higher for these two NMSC subtypes. Methylaminolevulinate (MAL) PDT is a more effective treatment option than 5-aminolevulinic acid (ALA) PDT for nodular BCC. Several studies have shown that PDT results in superior cosmetic outcomes compared to surgical treatment. PDT is overall well-tolerated, with pain being the most common side effect.
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Affiliation(s)
- Diana K Cohen
- Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Peter K Lee
- Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA.
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21
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Casey S, Best L, Vujovic O, Jordan K, Fisher B, Carey D, Bourdeau D, Yu E. Use of Protoporphyrin Fluorescence to Determine Clinical Target Volume for Non-melanotic Skin Cancers Treated with Primary Radiotherapy. Cureus 2016; 8:e767. [PMID: 27725923 PMCID: PMC5050029 DOI: 10.7759/cureus.767] [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] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Non-melanotic skin cancers remain the most commonly diagnosed cancers. Radiotherapy and surgery are the most common treatment options. Radiotherapy has a recurrence rate of up to 20% for basal or squamous cell cancers. One of the difficulties is to determine the extent of disease for poorly demarcated tumors. This study utilizes protoporphyrin (PpIX) fluorescence to provide information on the extent of subclinical disease for poorly demarcated tumors treated with radiotherapy. MATERIALS AND METHODS For 33 patients, PpIX photo-delineation was used to determine the clinical target volume (CTV2), which was compared to current conventional margins used to account for microscopic disease. RESULTS The use of PpIX photo-delineation demonstrated a significantly larger CTV of 15 mm compared to the conventional 10 mm (p = 0.03) for poorly demarcated lesions. A larger CTV was also demonstrated with PpIX photo-delineation for all basal cell carcinomas (13 mm, p = 0.03) as well as for non-nasal lesions (14 mm, p = 0.04). A trend towards an increased CTV was also noted for squamous cell carcinomas (16 mm, p = 0.19) and nasal primary sites (14 mm, p = 0.11). Nasal primary malignancies had multifocal PpIX uptake in 94% of cases. There was one case of local recurrence and one case of distant recurrence, with an average follow-up time of 22 months. CONCLUSIONS The margins currently used to account for subclinical disease may underestimate the extent of microscopic spread for poorly demarcated tumors. Longer follow-up with larger pools of patients are necessary to determine if using PpIX photo-delineation translates into significantly improved clinical outcomes.
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Affiliation(s)
- Stephanie Casey
- London Regional Cancer Program, London Health Sciences Center
| | - Lara Best
- Department of Radiation Oncology, Nova Scotia Cancer Center
| | - Olga Vujovic
- Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Ontario, CA
| | - Kevin Jordan
- Physics, London Regional Cancer Program, Western University, London, Ontario, CA ; Department of Medical Biophysics, Western University, London, Ontario, CA
| | - Barbara Fisher
- Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Ontario, CA
| | - Deborah Carey
- Department of Physics, London Regional Cancer Program, Western University, London, Ontario, CA
| | - Deborah Bourdeau
- Department of Physics, London Regional Cancer Program, Western University, London, Ontario, CA
| | - Edward Yu
- Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Ontario, CA ; Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA
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Wiegell SR, Lerche CM, Wulf HC. Is the thin layer of methyl aminolevulinate used during photodynamic therapy sufficient? PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 32:88-92. [DOI: 10.1111/phpp.12227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Stine R. Wiegell
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Catharina M. Lerche
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Hans Christian Wulf
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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Kulyk O, Ibbotson SH, Moseley H, Valentine RM, Samuel ID. Development of a handheld fluorescence imaging device to investigate the characteristics of protoporphyrin IX fluorescence in healthy and diseased skin. Photodiagnosis Photodyn Ther 2015; 12:630-9. [DOI: 10.1016/j.pdpdt.2015.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/10/2015] [Accepted: 10/06/2015] [Indexed: 11/30/2022]
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Choi S, Kim K, Song K. Er:YAG ablative fractional laser-primed photodynamic therapy with methyl aminolevulinate as an alternative treatment option for patients with thin nodular basal cell carcinoma: 12-month follow-up results of a randomized, prospective, comparative trial. J Eur Acad Dermatol Venereol 2015; 30:783-8. [DOI: 10.1111/jdv.13453] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/04/2015] [Indexed: 01/30/2023]
Affiliation(s)
- S.H. Choi
- Department of Dermatology; College of Medicine; Dong-A University; Seo-gu Busan South Korea
| | - K.H. Kim
- Department of Dermatology; College of Medicine; Dong-A University; Seo-gu Busan South Korea
| | - K.H. Song
- Department of Dermatology; College of Medicine; Dong-A University; Seo-gu Busan South Korea
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Usefulness of Photodynamic Therapy as a Possible Therapeutic Alternative in the Treatment of Basal Cell Carcinoma. Int J Mol Sci 2015; 16:23300-17. [PMID: 26426005 PMCID: PMC4632699 DOI: 10.3390/ijms161023300] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/18/2015] [Accepted: 09/22/2015] [Indexed: 01/26/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common cancer in individuals with fair skin type (I–II) and steadily increasing in incidence (70% of skin malignancy). It is locally invasive but metastasis is usually very rare, with an estimated incidence of 0.0028%–0.55%. Conventional therapy is surgery, especially for the H region of the face and infiltrative lesions; in case of inoperable tumors, radiotherapy is a valid option. Recently, topical photodynamic therapy (PDT) has become an effective treatment in the management of superficial and small nodular BCC. PDT is a minimally invasive procedure that involves the administration of a photo-sensibilizing agent followed by irradiation at a pre-defined wavelength; this determines the creation of reactive oxygen species that specifically destroy target cells. The only major side effect is pain, reported by some patients during the irradiation. The high cure rate and excellent cosmetic outcome requires considering this possibility for the management of patients with both sporadic and hereditary BCC. In this article, an extensive review of the recent literature was made, in order to clarify the role of PDT as a possible alternative therapeutic option in the treatment of BCC.
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Choi S, Kim K, Song KH. Efficacy of ablative fractional laser-assisted photodynamic therapy for the treatment of actinic cheilitis: 12-month follow-up results of a prospective, randomized, comparative trial. Br J Dermatol 2015; 173:184-91. [DOI: 10.1111/bjd.13542] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 12/23/2022]
Affiliation(s)
- S.H. Choi
- Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong, Seo-gu; Busan 602-715 Korea
| | - K.H. Kim
- Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong, Seo-gu; Busan 602-715 Korea
| | - K.-H. Song
- Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong, Seo-gu; Busan 602-715 Korea
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27
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Choi S, Kim K, Song K. Efficacy of ablative fractional laser-assisted photodynamic therapy with short-incubation time for the treatment of facial and scalp actinic keratosis: 12-month follow-up results of a randomized, prospective, comparative trial. J Eur Acad Dermatol Venereol 2015; 29:1598-605. [DOI: 10.1111/jdv.12953] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/05/2014] [Indexed: 01/03/2023]
Affiliation(s)
- S.H. Choi
- Department of Dermatology; College of Medicine; Dong-A University; Busan South Korea
| | - K.H. Kim
- Department of Dermatology; College of Medicine; Dong-A University; Busan South Korea
| | - K.H. Song
- Department of Dermatology; College of Medicine; Dong-A University; Busan South Korea
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Lerche CM, Fabricius S, Philipsen PA, Wulf HC. Correlation between treatment time, photobleaching, inflammation and pain after photodynamic therapy with methyl aminolevulinate on tape-stripped skin in healthy volunteers. Photochem Photobiol Sci 2015; 14:875-82. [DOI: 10.1039/c5pp00069f] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A shorter incubation time with methyl aminolevulinate in healthy volunteers results in decreased photobleaching and also less inflammation and pain.
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Affiliation(s)
| | - Susanne Fabricius
- Department of Dermatology
- Copenhagen University Hospital
- Copenhagen
- Denmark
| | - Peter A. Philipsen
- Department of Dermatology
- Copenhagen University Hospital
- Copenhagen
- Denmark
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29
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Kim BK, Lee NR, Park SY, Eom M, Choi EH. Efficacy of photodynamic therapy with laser pretreatment for actinic keratosis and photorejuvenation as evaluated by fluorescent imaging. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2014; 31:36-43. [DOI: 10.1111/phpp.12140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Bo-Kyung Kim
- Department of Dermatology; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Noo Ri Lee
- Department of Dermatology; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Sang-Yeon Park
- Department of Dermatology; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Minseob Eom
- Department of Pathology; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Eung Ho Choi
- Department of Dermatology; Yonsei University Wonju College of Medicine; Wonju Korea
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Rubel D, Spelman L, Murrell D, See J, Hewitt D, Foley P, Bosc C, Kerob D, Kerrouche N, Wulf H, Shumack S. Daylight photodynamic therapy with methyl aminolevulinate cream as a convenient, similarly effective, nearly painless alternative to conventional photodynamic therapy in actinic keratosis treatment: a randomized controlled trial. Br J Dermatol 2014; 171:1164-71. [DOI: 10.1111/bjd.13138] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D.M. Rubel
- Woden Dermatology and Probity Medical Research Level 1, 1 Bowes Place Phillip ACT 2606 Australia
- Australian National University Canberra Australia
| | - L. Spelman
- Specialist Connect Woolloongabba Qld Australia
| | - D.F. Murrell
- Premier Specialists Kogarah Sydney NSW Australia
- University of NSW Sydney NSW Australia
| | - J.‐A. See
- Central Sydney Dermatology Sydney NSW Australia
| | - D. Hewitt
- Skin and Cancer Foundation Westmead NSW Australia
| | - P. Foley
- Skin and Cancer Foundation Inc. Carlton Vic. Australia
- The University of Melbourne Parkville Vic. Australia
- St Vincent's Hospital Fitzroy Melbourne Vic. Australia
| | - C. Bosc
- Galderma R&D Sophia Antipolis France
| | - D. Kerob
- Galderma International Paris France
| | | | - H.C. Wulf
- Bispebjerg Hospital Copenhagen University Copenhagen Denmark
| | - S. Shumack
- St George Dermatology and Skin Cancer Centre and Probity Medical Research Kogarah Sydney NSW Australia
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Helgesen ALO, Gjersvik P, Peng Q, Vasovic V, Pripp AH, Jebsen P, Tanbo T, Warloe T. Biodistribution of protoporphyrin IX in female genital erosive lichen planus after topical application of hexaminolevulinate. Photodiagnosis Photodyn Ther 2014; 11:113-7. [DOI: 10.1016/j.pdpdt.2014.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
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Wan MT, Lin JY. Current evidence and applications of photodynamic therapy in dermatology. Clin Cosmet Investig Dermatol 2014; 7:145-63. [PMID: 24899818 PMCID: PMC4038525 DOI: 10.2147/ccid.s35334] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In photodynamic therapy (PDT) a photosensitizer – a molecule that is activated by light – is administered and exposed to a light source. This leads both to destruction of cells targeted by the particular type of photosensitizer, and immunomodulation. Given the ease with which photosensitizers and light can be delivered to the skin, it should come as no surprise that PDT is an increasingly utilized therapeutic in dermatology. PDT is used commonly to treat precancerous cells, sun-damaged skin, and acne. It has reportedly also been used to treat other conditions including inflammatory disorders and cutaneous infections. This review discusses the principles behind how PDT is used in dermatology, as well as evidence for current applications of PDT.
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Affiliation(s)
- Marilyn T Wan
- Melanoma Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Y Lin
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Ko D, Kim K, Song K. A randomized trial comparing methyl aminolaevulinate photodynamic therapy with and without Er:YAG ablative fractional laser treatment in Asian patients with lower extremity Bowen disease: results from a 12-month follow-up. Br J Dermatol 2014; 170:165-72. [DOI: 10.1111/bjd.12627] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- D.Y. Ko
- Skin Cancer Center; Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong Seo-gu Busan 602-715 Korea
| | - K.H. Kim
- Skin Cancer Center; Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong Seo-gu Busan 602-715 Korea
| | - K.H. Song
- Skin Cancer Center; Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong Seo-gu Busan 602-715 Korea
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Ko DY, Jeon SY, Kim KH, Song KH. Fractional erbium: YAG laser-assisted photodynamic therapy for facial actinic keratoses: a randomized, comparative, prospective study. J Eur Acad Dermatol Venereol 2013; 28:1529-39. [DOI: 10.1111/jdv.12334] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- D.-Y. Ko
- Department of Dermatology; Skin Cancer Center; College of Medicine; Dong-A University; Busan Korea
| | - S.-Y. Jeon
- Department of Dermatology; Skin Cancer Center; College of Medicine; Dong-A University; Busan Korea
| | - K.-H. Kim
- Department of Dermatology; Skin Cancer Center; College of Medicine; Dong-A University; Busan Korea
| | - K.-H. Song
- Department of Dermatology; Skin Cancer Center; College of Medicine; Dong-A University; Busan Korea
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Jeon SY, Kim KH, Song KH. Efficacy of photodynamic diagnosis-guided Mohs micrographic surgery in primary squamous cell carcinoma. Dermatol Surg 2013; 39:1774-83. [PMID: 24299572 DOI: 10.1111/dsu.12359] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) usually has ill-defined margins because of its irregular invasive patterns. OBJECTIVE To evaluate the surgical efficacy of photodynamic diagnosis (PDD) in primary cSCC treated using Mohs micrographic surgery (MMS). METHODS & MATERIALS We examined 67 cases of biopsy-proven primary facial cSCC treated with MMS. The 67 SCC were divided into the two groups depending on PDD application: PDD group (n = 38, 56.7%) and non-PDD group (n = 29, 43.3%). We analyzed the differences in surgical features between the PDD and non-PDD groups. RESULTS The PDD group required fewer Mohs stages (1.37 vs 1.83, p = .02) and smaller surgical margins (8.03 vs 11.24 mm, p = .03). PDD showed additional benefits in terms of surgical margin and Mohs stage, especially in low-risk SCC, including thin (≤4 mm), small (≤20 mm), well-differentiated, and nonulcerative tumors (p < .05) but did not show beneficial effects in high-risk SCC (p > .05) during MMS. CONCLUSION PDD can increase surgical efficacy of primary cSCC during MMS. These benefits are more pronounced in low-risk SCC. We recommend PDD as a simple and useful technique for delineating the margins of low-risk SCC before MMS.
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Affiliation(s)
- Su-Young Jeon
- Department of Dermatology, Skin Cancer Center, College of Medicine, Dong-A University, Busan, Korea
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Fabricius S, Lerche CM, Philipsen PA, Wulf HC. The relation between methyl aminolevulinate concentration and inflammation after photodynamic therapy in healthy volunteers. Photochem Photobiol Sci 2013; 12:117-23. [PMID: 22785615 DOI: 10.1039/c2pp25128k] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Inflammation and pain are well known adverse-effects in photodynamic therapy (PDT). There is currently a tendency towards introducing lower concentrations of the photosensitizer than used in the standard treatment for various indications. The aim of this study was to investigate whether reduced concentrations of methyl aminolevulinate (MAL) can reduce inflammation (erythema) during PDT treatment. We measured the formation of protoporphyrin IX (PpIX) using fluorescence and monitored both erythema and pain during and after PDT treatment with conventional 16% MAL and threee reduced concentrations of 2, 0.75, and 0.25% in twenty-four healthy volunteers. We found that lowering the MAL concentration reduced PpIX fluorescence and erythema after PDT treatment. There was a strong correlation (R(2) = 0.70) between the PpIX fluorescence and erythema after treatment. A further increase in erythema after PDT was dependent on pre-treatment skin erythema. PpIX fluorescence could explain 70% of the increase in erythema (P < 0.0005). Pain and post-treatment hyperpigmentation can be reduced but not eliminated by limiting the MAL concentration. An efficacy study of PDT with these three reduced concentrations has not been performed.
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Basset-Seguin N, Bissonnette R, Girard C, Haedersdal M, Lear JT, Paul C, Piaserico S. Consensus recommendations for the treatment of basal cell carcinomas in Gorlin syndrome with topical methylaminolaevulinate-photodynamic therapy. J Eur Acad Dermatol Venereol 2013; 28:626-32. [PMID: 23581795 DOI: 10.1111/jdv.12150] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/06/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with Gorlin syndrome develop multiple basal cell carcinomas (BCC), for which treatment is often difficult. Methylaminolevulinate-photodynamic therapy (MAL-PDT) is approved for the treatment of superficial and nodular BCCs in Canada and several European countries. OBJECTIVES To establish consensus recommendations for the use of MAL-PDT in patients with Gorlin syndrome. METHODS The Gorlin consensus panel was comprised of 7 dermatologists who had treated a total of 83 patients with Gorlin syndrome using MAL-PDT. Consensus was developed based on the personal experience of the expert and results of literature review (on PUBMED using the keywords 'MAL' and 'PDT' and 'Gorlin' or 'naevoid basal cell carcinoma syndrome'). RESULTS Consensus was reached among the experts and the literature review identified 9 relevant reports. The experts considered MAL-PDT a generally effective and safe therapy for treatment of BCC in Gorlin syndrome. For superficial BCC (sBCC), all sizes can be treated, and in nodular BCC (nBCC), better efficacy can be achieved in thinner lesions (<2 mm in thickness). MAL-PDT treatment schedule should be performed according to labelling although in individual cases, it may be adapted and performed on a monthly basis based on clinical assessment. Follow-up should be related to frequency of recurrence, and severity, number and location of lesions. Multiple lesions and large areas may be treated during the same session; however, adequate pain management should be considered. CONCLUSIONS MAL-PDT is safe and effective in patients with Gorlin syndrome. Utilization of these recommendations may improve efficacy and clearance rates in this population.
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Passos SK, de Souza PE, Soares PK, Eid DR, Primo FL, Tedesco AC, Lacava ZG, Morais PC. Quantitative approach to skin field cancerization using a nanoencapsulated photodynamic therapy agent: a pilot study. Clin Cosmet Investig Dermatol 2013; 6:51-9. [PMID: 23450821 PMCID: PMC3581285 DOI: 10.2147/ccid.s36758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background This paper introduces a new nanoformulation of 5-aminolevulinic acid (nano-ALA) as well as a novel quantitative approach towards evaluating field cancerization for actinic keratosis and/or skin photodamage. In this pilot study, we evaluated field cancerization using nano-ALA and methyl aminolevulinate (MAL), the latter being commercialized as Metvix®. Methods and results Photodynamic therapy was used for the treatment of patients with selected skin lesions, whereas the fluorescence of the corresponding photosensitizer was used to evaluate the time evolution of field cancerization in a quantitative way. Field cancerization was quantified using newly developed color image segmentation software. Using photodynamic therapy as the precancer skin treatment and the approach introduced herein for evaluation of fluorescent area, we found that the half-life of field cancerization reduction was 43.3 days and 34.3 days for nano-ALA and MAL, respectively. We also found that nano-ALA targeted about 45% more skin lesion areas than MAL. Further, we found the mean reduction in area of skin field cancerization was about 10% greater for nano-ALA than for MAL. Conclusion Although preliminary, our findings indicate that the efficacy of nano-ALA in treating skin field cancerization is higher than that of MAL.
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Affiliation(s)
- Simone K Passos
- University of Brasília, Institute of Biological Sciences, DF, Brazil ; Foundation for Teaching and Research on Health Sciences, Brasília, DF, Brazil
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Wiegell SR, Skødt V, Wulf HC. Daylight-mediated photodynamic therapy of basal cell carcinomas - an explorative study. J Eur Acad Dermatol Venereol 2013; 28:169-75. [PMID: 23294223 DOI: 10.1111/jdv.12076] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/19/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies have shown that daylight-photodynamic therapy (PDT) is an effective treatment of actinic keratoses, nearly pain free and more convenient for both the clinics and patients. Treatment of basal cell carcinomas (BCCs) is another main indication for PDT. OBJECTIVES The aim of this open, uncontrolled, prospective explorative study was to evaluate the efficacy of daylight-PDT for BCCs. METHODS Twenty-one patients with a total of 32 BCCs located in the face, scalp, chest, back and lower leg received one cycle of daylight-methyl aminolevulinate (MAL)-PDT, consisting of two treatments 1 week apart. After sunscreen application and lesion preparation, MAL was applied and patients exposed themselves to daylight for 2½ h. Daylight exposure was monitored with a wrist-borne dosimeter. RESULTS At 3-month follow-up, complete response was seen in 30 lesions (94%) and in 19 patients (90%). At 12-month follow-up, six lesions had recurred resulting in a total recurrence rate of 21% (6/29) as one lesion was lost to follow-up. Twelve months after daylight-PDT, 74% (23/31) of the treated lesions showed complete response. During each treatment, the mean effective light dose was 10.8 J/cm(2) during an average of 152 min of daylight exposure. Treatment was pain free with good or excellent cosmesis. CONCLUSIONS In conclusion, daylight-PDT proved to be as effective as conventional PDT in the treatment of BCCs in this explorative clinical study. Daylight-PDT was pain free and more convenient for both clinicians and patients. The cosmetic outcome was good or excellent. Larger studies need to confirm the findings of this study.
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Affiliation(s)
- S R Wiegell
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - V Skødt
- Department of Pathology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H C Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Bloom BS, Brauer JA, Geronemus RG. Ablative fractional resurfacing in topical drug delivery: an update and outlook. Dermatol Surg 2013; 39:839-48. [PMID: 23294061 DOI: 10.1111/dsu.12111] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The effective delivery of therapeutic molecules to varied targets in the skin and elsewhere has been an area of ongoing research and development. OBJECTIVE To review the structure of the skin with an emphasis on topical drug delivery and to present the rationale for the use of ablative and nonablative fractional resurfacing in assisted drug delivery. METHODS AND MATERIALS Review of the currently available scientific literature on laser-assisted drug delivery. RESULTS A number of strategies can be employed to enhance topical drug delivery. Ablative fractional resurfacing (AFR) has been demonstrated to be effective in enhancing drug delivery. Further studies are needed to assess the use of nonablative fractional resurfacing in assisted drug delivery. CONCLUSION AFR-assisted drug delivery is a promising tool for the future of dermatology. We expect to see a number of agents to be paired with AFR for enhanced drug delivery. Further investigation is necessary to evaluate appropriate drug specific channel density and depth parameters. Factors that must be considered include the physicochemical properties of the drug, the target tissue, skin wounding, and cost when evaluating the drugs and conditions that will most benefit from this promising new drug delivery system.
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Affiliation(s)
- Bradley S Bloom
- Ronald O. Perelman Department of Dermatology, School of Medicine, New York University, New York, New York 10016, USA.
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Piffaretti F, Zellweger M, Kasraee B, Barge J, Salomon D, van den Bergh H, Wagnières G. Correlation between Protoporphyrin IX Fluorescence Intensity, Photobleaching, Pain and Clinical Outcome of Actinic Keratosis Treated by Photodynamic Therapy. Dermatology 2013; 227:214-25. [DOI: 10.1159/000353775] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/17/2013] [Indexed: 11/19/2022] Open
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Valentine RM, Wood K, Brown CTA, Ibbotson SH, Moseley H. Monte Carlo simulations for optimal light delivery in photodynamic therapy of non-melanoma skin cancer. Phys Med Biol 2012; 57:6327-45. [DOI: 10.1088/0031-9155/57/20/6327] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Gaál M, Kui R, Hunyadi Z, Kemény L, Gyulai R. [Fluorescence diagnosis of non-melanoma skin cancer]. Orv Hetil 2012; 153:1334-40. [PMID: 22913915 DOI: 10.1556/oh.2012.29424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Photodynamic therapy involves - in dermatological practice usually exogenous - application of a photosensitizer then activation of accumulated protoporphyrin IX by light with an appropriate wavelength after a short incubation period. It is an evidence based method to treat certain non-melanoma skin cancers. During treatment when the excited protoporphyrin IX returns to base state, reactive oxygen species are formed leading to cell death in rapidly proliferating cells. Fluorescence of excited protoporphyrin IX can be used in diagnostics as well. In ultraviolet light, the photodamaged or neoplastic areas show coral red fluorescence which can clearly be distinguished from the much lower fluorescence of adjacent normal tissue. This process is suitable for exact determination of tumor margins so it can be used for planning surgical procedures or after photodynamic therapy at a follow up visit for the visualization of the therapeutic result. The present article reviews the literature of photodynamic diagnosis that is also used by the authors.
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Affiliation(s)
- Magdolna Gaál
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Bőrgyógyászati és Allergológiai Klinika Szeged Korányi.
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Differential cytotoxic response in keloid fibroblasts exposed to photodynamic therapy is dependent on photosensitiser precursor, fluence and location of fibroblasts within the lesion. Arch Dermatol Res 2012; 304:549-62. [DOI: 10.1007/s00403-012-1264-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/25/2012] [Accepted: 07/05/2012] [Indexed: 11/25/2022]
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Kamrava SK, Behtaj M, Ghavami Y, Shahabi S, Jalessi M, Afshar EE, Maleki S. Evaluation of diagnostic values of photodynamic diagnosis in identifying the dermal and mucosal squamous cell carcinoma. Photodiagnosis Photodyn Ther 2012. [PMID: 23200008 DOI: 10.1016/j.pdpdt.2012.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We conducted a study to determine and compare the efficacy of pathology and photodynamic studies in establishing diagnosis of malignant dermal and mucosal lesions. METHODS AND PATIENTS This descriptive cross-sectional study was performed on 40 patients suspected of SCC (squamous cell carcinoma). First, in PDD (photodynamic diagnosis) photosensitizing agent was applied to the lesion, and after 4-5h the fluorescence spectrum was detected by laser radiation. Based on fluorescence intensity, normal area was differentiated from malignant area. Also, biopsy samples from these suspected areas were sent to pathology simultaneously. Data were analyzed with SPSS v.16. The distribution of nominal variables was compared using the Chi-square test. Diagnostic index for photodynamic diagnosis were calculated. A two-sided p-value<0.05 was considered to be statistically significant. RESULTS In 27 cases (90%), results of pathology and photodynamic studies similarly showed malignancy. In 8 cases (80%), results of pathology and photodynamic studies similarly showed non-malignant lesion. But in five cases (12.5%) the results of pathology and photodynamic studies were not the same. This difference was not statistically significant showed by the Chi-square test analysis (p-value>0.05). A sensitivity of 90%, specificity of 80%, accuracy of 87.5%, positive predictive value (PPV) of 93%, negative predictive value (NPV) of 72%, positive likelihood ratio (PLR) of 4.5, negative likelihood ratio(NLR) of 0.125 were found in diagnosing SCC for photodynamic studies. CONCLUSION Photodynamic diagnosis is a useful non-invasive initial step in the diagnostic work-up of patients with suspected malignant lesions (SCC). In this work we have studied 40 SCC suspicious patients using PDD method and successfully carried out 27 cases as malignant all of which were matching with pathologic results. This outcome can prove both accuracy and reliability of PDD method for detecting SCC lesions on head and neck regions. Also PDD can fully demarcate the lesion peripheries less invasively as well as preserving much more time and effort. Although PDD method is a bit more expensive that biopsy and pathology but great advantages can easily cover this issue. We recommend PDD as a useful easy technique to visualize and detect the extension of the tumor preoperatively.
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Affiliation(s)
- Seyed Kamran Kamrava
- ENT Research Center, Rasoul-e-Akram Hospital, Tehran University of Medical Sciences and Health Services, Tehran, Iran
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Bozzini G, Colin P, Betrouni N, Nevoux P, Ouzzane A, Puech P, Villers A, Mordon S. Photodynamic therapy in urology: what can we do now and where are we heading? Photodiagnosis Photodyn Ther 2012; 9:261-73. [PMID: 22959806 DOI: 10.1016/j.pdpdt.2012.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an innovative technique in oncologic urology. Its application appears increasingly realistic to all kind of cancers with technological progress made in treatment planning and light delivery associated with the emergence of novel photosensitizers. The aim of this study is to review applications of this technique in urology. MATERIALS AND METHODS We reviewed the literature on PDT for urological malignancies with the following key words: photodynamic therapy, prostate cancer, kidney cancer, urothelial cancer, penile cancer and then by cross-referencing from previously identified studies. RESULTS Focal therapy of prostate cancer is an application of PDT. Clinical studies are ongoing to determine PDT efficacy and safety. PDT as salvage treatment after radiotherapy has been tested. Oncologic results were promising but important side effects were reported. Individual dosimetric planning is necessary to avoid toxicity. PDT was tested to treat superficial bladder carcinoma with promising oncologic results. Serious side effects have limited use of first photosensitizers generation. Second generation of photosensitizer allowed reducing morbidity. For upper urinary tract carcinoma and urethra, data are limited. Few studies described PDT application in penile oncology for conservative management of carcinoma in situ and premalignant lesions. For renal cancer, PDT was only tested on preclinical model despite of its potential application. No data is available concerning PDT application for testicular cancer. CONCLUSION PDT clinical applications in urology have proved a kind of efficiency balanced with an important morbidity. Development of new photosensitizer generations and improvement in illumination protocols should permit to decrease side effects.
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Affiliation(s)
- G Bozzini
- Department of Urology, Centre Hospitalier Regional Universitaire de Lille, avenue oscar lambret, Lille, France. bozzini
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Wiegell S, Wulf H, Szeimies RM, Basset-Seguin N, Bissonnette R, Gerritsen MJ, Gilaberte Y, Calzavara-Pinton P, Morton C, Sidoroff A, Braathen L. Daylight photodynamic therapy for actinic keratosis: an international consensus. J Eur Acad Dermatol Venereol 2011; 26:673-9. [DOI: 10.1111/j.1468-3083.2011.04386.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Haedersdal M, Katsnelson J, Sakamoto F, Farinelli W, Doukas A, Tam J, Anderson R. Enhanced uptake and photoactivation of topical methyl aminolevulinate after fractional CO2 laser pretreatment. Lasers Surg Med 2011; 43:804-13. [DOI: 10.1002/lsm.21096] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The ever-increasing incidence of primary cutaneous malignancies has heralded the need for multiple treatment options. Surgical modalities remain the mainstay of treatment of nonmelanoma skin cancer. However, it is important for the dermatologic surgeon to have an understanding of all treatment options to assist the patient in making the most informed decision possible, ultimately leading to the most favorable outcome. This article explores the available nonsurgical treatment options, their indications, and their efficacy.
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Affiliation(s)
- Edward M Galiczynski
- Department of Dermatology, A-61, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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50
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Tierney E, Petersen J, Hanke CW. Photodynamic diagnosis of tumor margins using methyl aminolevulinate before Mohs micrographic surgery. J Am Acad Dermatol 2011; 64:911-8. [DOI: 10.1016/j.jaad.2010.03.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 02/28/2010] [Accepted: 03/15/2010] [Indexed: 10/18/2022]
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