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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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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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Photodynamic Therapy with 5-Aminolevulinic Acid Patch for the Treatment of Actinic Keratosis. J Clin Med 2022; 11:jcm11113164. [PMID: 35683551 PMCID: PMC9181164 DOI: 10.3390/jcm11113164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 01/09/2023] Open
Abstract
Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) is an emerging treatment option in the care of actinic keratosis (AK). A self-adhesive 5-ALA patch was recently developed that allows a precise PDT procedure. Here, we review the current literature and report the findings of our case series that observed the outcomes and safety of 5-ALA patch PDT. Ten patients with a total of 40 AKs were treated with a single session of conventional or daylight PDT using 5-ALA patch at the Department of Dermatology and Venereology, Sapienza University of Rome or at the European Institute of Oncology, Milan, Italy. Complete response was observed in three patients, while partial response was seen in seven patients. Overall tolerability was good or excellent, with local adverse events observed in four patients. This is the first case series reported where the 5-ALA patch was applied using daylight PDT, and its efficacy and tolerability in the treatment of AK were demonstrated. In conclusion, the self-adhesive 5-ALA patch is a convenient application of PDT that provides a well-tolerated and effective treatment option with satisfactory cosmetic outcomes.
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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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Bohne AS, Kähler KC. Update aktinische Keratosen – Neuigkeiten und Relevanz für den Alltag. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1487-3992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Ziel der Arbeit Die im März 2020 zuletzt überarbeitete Leitlinie „Aktinische Keratosen und Plattenepithelkarzinome der Haut“ hat aufgrund der Zunahme der klinischen Studien zum Thema aktinische Keratosen den höchsten Grad für Methodik (S3) erreicht, da diese nicht nur konsensbasiert sondern auch evidenzbasiert verfasst wurde. Diesen Entwicklungen gerecht zu werden und den klinisch relevanten Teil des aktuellen Stands des Wissens zu vermitteln, ist Ziel dieses Artikels.
Methodik Anhand der aktuellen epidemiologischen Lage wird der dramatisch wachsende Bedarf für das bessere Verständnis der Ätiologie aktinischer Keratosen deutlich. Ebenso gilt es, Patienten mit aktinischen Keratosen und therapiebedürftigen Ko-Morbiditäten vor einem therapiebedingten, erhöhten Risiko für die Entwicklung weiterer aktinischer Keratosen oder Plattenepithelkarzinomen zu bewahren. Die Möglichkeit der Spontanremission aktinischer Keratosen sollte ebenso wenig vernachlässigt werden wie eine mögliche Progredienz in ein Plattenepithelkarzinom. Die kontroverse Diskussion der fortwährend postulierten, sequenziellen Abfolge der histologischen Grade aktinischer Keratosen zum Plattenepithelkarzinom beinhaltet klinische und histologische Fallstricke. Diese sollten bei der Therapieentscheidung ebenso bedacht werden wie die Wünsche und Erwartungen der Patienten an ein Therapieregime. Eine bleibende Schwierigkeit ist die fehlende Standardisierung erhobener Daten zu den zahlreichen zur Verfügung stehenden Therapieoptionen. Das Potenzial dieses Forschungsgebietes für neue Therapiealternativen und präventive Maßnahmen lässt nach wie vor auf weitere, interessante Entwicklungen hoffen.
Ergebnisse Der gut etablierte kausale Zusammenhang zwischen kumulativer UV-Strahlung in der Entwicklung von Plattenepithelkarzinomen und aktinischer Keratosen hat zur Anerkennung berufsbedingter UV-Exposition als Berufserkrankung geführt, die auch die Anerkennung multipler aktinischer Keratosen als Berufserkrankung beinhaltet. Das therapeutische Handeln sollte durch die Gesamtanzahl der aktinischen Keratosen, das Ausmaß der betroffenen Fläche, die Dynamik des Krankheitsgeschehens und den Wunsch des Patienten bestimmt werden. Ein besonderes Augenmerk sollte auf den Patienten liegen, denen die Krankheitseinsicht fehlt oder die nur wenig motiviert zur Therapie sind. Es könnte der Schlüssel zur Verbesserung der Therapieadhärenz und Akzeptanz sein, diese Patienten zu erkennen und ihre Bedürfnisse in das Arzt-Patienten-Gespräch zu integrieren. Die Differenzierung zwischen lokalisierten aktinischen Keratosen und einer Feldkanzerisierung stellt ein wichtiges Entscheidungskriterium für die Wahl der empfohlenen Therapie dar. Die Rücknahme der Zulassung von Ingenolmebutat in der EU durch die EMA im Jahr 2020 hat das Spektrum der lokaltherapeutischen Optionen eingeschränkt. Der periinterventionelle Schmerz ist nach wie vor der limitierende Faktor für die konventionelle photodynamische Therapie, jedoch schreitet die Entwicklung für schmerzärmere Varianten weiter voran. Es ist zu erwarten, dass sich in den kommenden Jahren durch eine bessere Evidenzlage für weitere systemische oder lokaltherapeutische Optionen neue Behandlungsstrategien ergeben werden. Besonders im Fokus wird sicherlich nach wie vor die Präventionsforschung stehen, die v. a. den Erhalt einer erzielten Remission beinhaltet.
Schlussfolgerung Die aktuellen Forschungsergebnisse und -bestrebungen zur Thematik der aktinischen Keratosen sind aufgrund des zukünftig gesteigerten Bedarfes zum einen notwendig und zum anderen sehr ermutigend. Das Ende des therapeutischen Horizonts ist gegenwärtig noch nicht erreicht.
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Affiliation(s)
- Ann-Sophie Bohne
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Katharina C. Kähler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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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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Treatment Options and Post-Treatment Malignant Transformation Rate of Actinic Cheilitis: A Systematic Review. Cancers (Basel) 2021; 13:cancers13133354. [PMID: 34283099 PMCID: PMC8268797 DOI: 10.3390/cancers13133354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Actinic cheilitis is a precancerous condition that may evolve to a more aggressive type of skin cancer. Therefore, its therapy is crucial for the disease prognosis. In this systematic review, we tried to identify the best therapies of actinic cheilitis regarding safety, efficacy, recurrences, and the potential to progress to skin cancer. The therapeutic approach comprised invasive and topical treatments. The invasive therapies, such as partial surgery and laser treatments, had the best cosmetic and therapeutic results with few recurrences. Photodynamic therapy demonstrated satisfactory outcomes, while topical treatments were the least beneficial. Notably, the efficacy of photodynamic therapy was improved when combined with 5% imiquimod. However, except from photodynamic therapy, the other modalities were assessed in a limited number of patients. Finally, when actinic cheilitis is treated, no risk of cancer progression exists. Larger studies are necessary to confirm these results. Abstract Actinic cheilitis is a premalignant condition that may evolve to squamous cell carcinoma. A consensus on its management has not been established, and large clinical trials are lacking. We aimed to review the existing data regarding the treatment of actinic cheilitis with various modalities regarding safety, efficacy, recursions, and post-treatment malignant transformation. A systematic review was conducted through Pubmed, Ovid and the Cochrane library for studies in English language and the references of included papers from inception to January 2021. Case series were considered if ≥6 patients were included. Of the 698 articles, 36 studies and, overall, 699 patients were eventually reviewed. Laser ablation and vermilionectomy provided the best clinical and aesthetic outcomes with few recurrences, while photodynamic therapy was linked to more relapses. Generally, the adverse events were minor and there was no risk of post-treatment malignant transformation. The limitations of our review include the heterogeneity and the small number of patients across studies. Conclusively, invasive treatments demonstrated superior therapeutic and safety profile. Nevertheless, high-quality head-to-head studies that assess different modalities for actinic cheilitis and report patient preferences are lacking.
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Willis JA, Cheburkanov V, Kassab G, Soares JM, Blanco KC, Bagnato VS, Yakovlev VV. Photodynamic viral inactivation: Recent advances and potential applications. APPLIED PHYSICS REVIEWS 2021; 8:021315. [PMID: 34084253 PMCID: PMC8132927 DOI: 10.1063/5.0044713] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/13/2021] [Indexed: 05/04/2023]
Abstract
Antibiotic-resistant bacteria, which are growing at a frightening rate worldwide, has put the world on a long-standing alert. The COVID-19 health crisis reinforced the pressing need to address a fast-developing pandemic. To mitigate these health emergencies and prevent economic collapse, cheap, practical, and easily applicable infection control techniques are essential worldwide. Application of light in the form of photodynamic action on microorganisms and viruses has been growing and is now successfully applied in several areas. The efficacy of this approach has been demonstrated in the fight against viruses, prompting additional efforts to advance the technique, including safety use protocols. In particular, its application to suppress respiratory tract infections and to provide decontamination of fluids, such as blood plasma and others, can become an inexpensive alternative strategy in the fight against viral and bacterial infections. Diverse early treatment methods based on photodynamic action enable an accelerated response to emerging threats prior to the availability of preventative drugs. In this review, we evaluate a vast number of photodynamic demonstrations and first-principle proofs carried out on viral control, revealing its potential and encouraging its rapid development toward safe clinical practice. This review highlights the main research trends and, as a futuristic exercise, anticipates potential situations where photodynamic treatment can provide a readily available solution.
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Affiliation(s)
- Jace A. Willis
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Vsevolod Cheburkanov
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Giulia Kassab
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, Brazil
| | - Jennifer M. Soares
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, Brazil
| | - Kate C. Blanco
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, Brazil
| | | | - Vladislav V. Yakovlev
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
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Dattola A, Gutiérrez Garcìa-Rodrigo C, Tambone S, Garofalo V, Lappi A, De Luca EV, Peris K, Bianchi L, Campione E, Fargnoli MC. 5-Aminolaevulinic acid patch photodynamic therapy for the treatment of actinic keratoses: preliminary results from an Italian study in the real-life setting. GIORN ITAL DERMAT V 2020; 155:636-641. [PMID: 33026214 DOI: 10.23736/s0392-0488.20.06598-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is recommended for both lesion and field therapy of actinic keratoses (AKs). The 5-aminolaevulinic acid (5-ALA) patch PDT is indicated for the treatment of isolated mild AKs (≤1.8 cm) on the face and bald scalp. It was demonstrated to be effective and safe in clinical trials with a good tolerability profile. METHODS In this retrospective multicenter real-life study, 33 patients with a total of 99 AKs of the scalp, face, ears, and/or hands and 2 actinic cheilitis were treated with one treatment session of 5-ALA patch PDT with a red light source (total dose of 37 J/cm2). RESULTS Overall, 12 weeks after treatment, 68/99 (69%) lesions were completely cleared. Complete response was obtained in 82% of AKs on the ears, 78% on the face, 57% on the hands, and 56% on the scalp and in the two actinic cheilitis. The treatment was very effective on grade I AKs, cleared in 87% of the cases and less efficient on grade II-III lesions, cleared in 47% of the cases. 5-ALA patch PDT was well tolerated with a good to excellent cosmetic outcome in 97% of the patients and with 94% of the patients being satisfied or very satisfied with the treatment. CONCLUSIONS Our results confirm that 5-ALA patch PDT is a good option for AK treatment in clinical practice, it is easy to use, effective and well tolerated even in difficult-to-treat-areas. Moreover, it has an excellent cosmetic outcome.
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Affiliation(s)
| | | | - Sara Tambone
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | - Astrid Lappi
- Unit of Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Erika V De Luca
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, Tor Vergata University, Rome, Italy
| | - Elena Campione
- Department of Dermatology, Tor Vergata University, Rome, Italy
| | - Maria C Fargnoli
- Unit of Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy -
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Zhang G, Cao Z, Wang P, Zhu L, Zhang L, Zho Z, Shi L, Wang X. Comparison of efficacy, adverse effects and costs between 20 % ALA-PDT and 10 % ALA-PDT for the treatment of actinic keratosis in Chinese patients. Photodiagnosis Photodyn Ther 2020; 31:101605. [DOI: 10.1016/j.pdpdt.2019.101605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 01/10/2023]
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Treatments of actinic cheilitis: A systematic review of the literature. J Am Acad Dermatol 2020; 83:876-887. [DOI: 10.1016/j.jaad.2019.07.106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/16/2019] [Accepted: 07/30/2019] [Indexed: 01/27/2023]
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Andreadis D, Pavlou AM, Vakirlis E, Anagnostou E, Vrani F, Poulopoulos A, Kolokotronis A, Ioannidis D, Sotiriou E. Daylight photodynamic therapy for the management of actinic cheilitis. Arch Dermatol Res 2020; 312:731-737. [PMID: 32266532 DOI: 10.1007/s00403-020-02069-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/30/2020] [Indexed: 12/20/2022]
Abstract
Early identification and adequate treatment of actinic cheilitis (AC), which affects the lower lip vermillion and is considered a precursor of squamous cell carcinoma, is mandatory. Photodynamic therapy (PDT) has been successfully used in AC. PDT with the use of daylight (DLPDT) is equally effective and more convenient than the conventional PDT. Data on short and long-term efficacy of DLPDT in AC are limited. Our primary purpose was to assess efficacy of DLPDT in AC as well as safety and tolerance. Twenty-two individuals with histologically confirmed AC received 2 MAL (5-aminolevulinic acid)-DLPDT sessions 1 week apart. Patients were evaluated clinically 3, 6, and 12 months after treatment. Non-complete responders were biopsied and excluded from the study if histological alterations were indicative of AC. Adverse events were recorded from baseline to the end of the 12-month follow-up period. Twenty patients completed the study. Overall, complete clinical response 12 months after treatment was 80% (16/20), while an association between treatment response and grade of dysplasia was observed (p = 0.016). With respect to response by grade, complete clinical response achieved in grade I AC was 100% (12/12) and 50% (4/8) in grade II AC. Main adverse events included mild erythema, oedema, and scaling, with no pain associated with DLPDT. According to our results, DLPDT seems to be of significant benefit for the treatment of grade I AC. Combination with the other treatment modalities could improve the efficacy in grade II AC. Further studies are needed for the assessment of late recurrences.
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Affiliation(s)
- Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Achilleia -Maria Pavlou
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, 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, Thessaloniki, 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, Thessaloniki, Greece
| | - Alexandros Kolokotronis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, 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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13
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Radakovic S, Dangl M, Tanew A. 5-Aminolevulinic acid patch (Alacare) photodynamic therapy for actinic cheilitis: data from a prospective 12-month follow-up study on 21 patients. J Eur Acad Dermatol Venereol 2020; 34:2011-2015. [PMID: 31999856 PMCID: PMC7496675 DOI: 10.1111/jdv.16247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
Abstract
Background Actinic cheilitis (AC) is a variant of actinic keratosis (AK) affecting the lips and caused by chronic ultraviolet exposure. Objective Alacare is a self‐adhesive, skin‐coloured 5‐aminolaevulinic acid patch that has been developed for use in photodynamic therapy (PDT) of mild‐to‐moderate AK. Based on promising preliminary results in the treatment of AC with Alacare patch PDT, we decided to extend our previous investigation to gain more data on the efficacy, tolerability, safety and cosmetic outcome of Alacare patch PDT for AC. Methods Twenty‐one patients with a clinical diagnosis of mild‐to‐moderate AC were included in the study and subjected to one single session of PDT. After occlusion with the Alacare patch for 4 h, the AC lesions were illuminated for 10 min with red light at a dose of 37 J/cm2. All patients received local anaesthesia prior to illumination. Additionally, all lesions were cooled during PDT with a cold air blower. PDT‐induced pain and skin phototoxicity were monitored during and up to 7 days after PDT. Clinical assessment of efficacy, cosmetic outcome and global patient satisfaction was performed at 3, 6 and 12 months after treatment. Results Nineteen patients completed the study. Three months after PDT, 17 patients (89.5%) had achieved complete remission. Of these, one patient presented with recurrence of AC at the 6‐month follow‐up, whereas all other patients remained in remission until the end of the observation period. The complete clinical cure rate at 1 year after a single Alacare patch PDT thus was 84.2%. Pain during illumination and the phototoxic skin reaction were in general mild to moderate. The cosmetic outcome was excellent. Conclusion The present prospective study on Alacare patch PDT for AC confirms its high clinical efficacy, good tolerability and favourable cosmetic effects. Alacare patch PDT should be considered as a valid treatment option for patients with AC.
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Affiliation(s)
- S Radakovic
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - M Dangl
- Landesklinikum Gmünd, Gmünd, Austria
| | - A Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Nguyen K, Khachemoune A. An update on topical photodynamic therapy for clinical dermatologists. J DERMATOL TREAT 2019; 30:732-744. [DOI: 10.1080/09546634.2019.1569752] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Khoa Nguyen
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA
- Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
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15
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Tampa M, Sarbu MI, Matei C, Mitran CI, Mitran MI, Caruntu C, Constantin C, Neagu M, Georgescu SR. Photodynamic therapy: A hot topic in dermato-oncology. Oncol Lett 2019; 17:4085-4093. [PMID: 30944601 PMCID: PMC6444307 DOI: 10.3892/ol.2019.9939] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
Photodynamic therapy (PDT) is a modern, non-invasive therapeutic method used for the destruction of various cells and tissues. It requires the simultaneous presence of three components: a photosensitizer (PS), a light source and oxygen. Precancerous skin lesions are conditions associated with a high likelihood of malignant transformation to squamous cell carcinoma. Data available so far indicate that PDT is a promising treatment method which can be successfully employed in several medical fields including dermatology, urology, ophthalmology, pneumology, cardiology, dentistry and immunology. Numerous authors therefore have studied this technique in order to improve its efficacy. As a result, significant advancement has been achieved with regard to PSs and drug delivery systems. Substantial progress was also obtained with respect to PDT for the treatment of precancerous skin lesions, several authors focusing their efforts on the study of daylight-PDT and on identifying methods of decreasing technique-related pain. This review reports on the most recent findings in PDT, with emphasis on cutaneous precancerous lesions.
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Affiliation(s)
- Mircea Tampa
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maria-Isabela Sarbu
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Clara Matei
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | | | | | - Constantin Caruntu
- Department of Physiology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Carolina Constantin
- Department of Immunology, ‘Victor Babes’, National Institute of Pathology, 050096 Bucharest, Romania
| | - Monica Neagu
- Department of Immunology, ‘Victor Babes’, National Institute of Pathology, 050096 Bucharest, Romania
| | - Simona-Roxana Georgescu
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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