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Photodynamic therapy with ablative carbon dioxide fractional laser for treating Bowen disease.

Kim SK, Park JY, Song HS, Kim YS, Kim YC - Ann Dermatol (2013)

Bottom Line: The average number of treatments to CR was 3.70±1.70.The treatments showed favorable cosmetic outcomes and no serious adverse events.The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Background: Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT.

Objective: We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO2 fractional laser pretreatment for treating Bowen disease.

Methods: Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO2 fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded.

Results: Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70±1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events.

Conclusion: The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.

No MeSH data available.


Related in: MedlinePlus

Fluorescence assessment of the lesion (arrows). (A) Before application of photosensitizer, (B) after 70 minutes as incubation time.
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Figure 3: Fluorescence assessment of the lesion (arrows). (A) Before application of photosensitizer, (B) after 70 minutes as incubation time.

Mentions: A fluorescence photograph was taken after applying MAL to evaluate MAL penetration. The fluorescence of the penetrated photosensitizer applied with a shorter incubation time was similar to that of the conventional method (Fig. 3). Several limitations should be noted. Because of the small sample sizes, further larger studies will be needed to confirm the results. It is obvious that adding the ablative fractional CO2 laser pretreatment contributed to the reduction of incubation time; however, a comparative study with various incubation times will be necessary to determine the most suitable time. In this study, we have fixed the incubation time as 70 minutes (38.9% of conventional 3-hour incubation time). In the preliminary study, we have performed the 5-aminolevulinic acid (ALA)-PDT with ablative carbon dioxide fractional laser of 90 minutes as 37.5% of 4 hours for incubation time in actinic keratosis (AK), and the CR was up to 90% (unpublished data). The CR was similar to the previously published data of AK, ranging from 71 to 100%1. It is well known that the efficacy of MAL-PDT is prior to that of ALA-PDT in the case of BD2. Therefore, we have chosen MAL instead of ALA with similar percentages of incubation time as 33.3% (70 minutes) for 3 hour (the conventional incubation time of MAL is 3 hour). The parameter that we have chosen was based on the published data21. We expect that further study should be performed for accurate incubations and laser parameters with maximal efficacy and minimal adverse event.


Photodynamic therapy with ablative carbon dioxide fractional laser for treating Bowen disease.

Kim SK, Park JY, Song HS, Kim YS, Kim YC - Ann Dermatol (2013)

Fluorescence assessment of the lesion (arrows). (A) Before application of photosensitizer, (B) after 70 minutes as incubation time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756199&req=5

Figure 3: Fluorescence assessment of the lesion (arrows). (A) Before application of photosensitizer, (B) after 70 minutes as incubation time.
Mentions: A fluorescence photograph was taken after applying MAL to evaluate MAL penetration. The fluorescence of the penetrated photosensitizer applied with a shorter incubation time was similar to that of the conventional method (Fig. 3). Several limitations should be noted. Because of the small sample sizes, further larger studies will be needed to confirm the results. It is obvious that adding the ablative fractional CO2 laser pretreatment contributed to the reduction of incubation time; however, a comparative study with various incubation times will be necessary to determine the most suitable time. In this study, we have fixed the incubation time as 70 minutes (38.9% of conventional 3-hour incubation time). In the preliminary study, we have performed the 5-aminolevulinic acid (ALA)-PDT with ablative carbon dioxide fractional laser of 90 minutes as 37.5% of 4 hours for incubation time in actinic keratosis (AK), and the CR was up to 90% (unpublished data). The CR was similar to the previously published data of AK, ranging from 71 to 100%1. It is well known that the efficacy of MAL-PDT is prior to that of ALA-PDT in the case of BD2. Therefore, we have chosen MAL instead of ALA with similar percentages of incubation time as 33.3% (70 minutes) for 3 hour (the conventional incubation time of MAL is 3 hour). The parameter that we have chosen was based on the published data21. We expect that further study should be performed for accurate incubations and laser parameters with maximal efficacy and minimal adverse event.

Bottom Line: The average number of treatments to CR was 3.70±1.70.The treatments showed favorable cosmetic outcomes and no serious adverse events.The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Background: Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT.

Objective: We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO2 fractional laser pretreatment for treating Bowen disease.

Methods: Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO2 fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded.

Results: Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70±1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events.

Conclusion: The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.

No MeSH data available.


Related in: MedlinePlus