Development of an alternative light source to lasers for photodynamic therapy: 3. Clinical evaluation in the treatment of pre-malignant non-melanoma skin cancer

Abstract

The efficacy of a prototype non-laser light source for photodynamic therapy was assessed in clinical practice in the treatment of Bowen's disease and actinic keratoses. The light source, incorporating a 300 W short arc plasma discharge, was adjusted by appropriate filters to produce a bandwidth of 630±15 nm. Topical 5-aminolaevulinic acid was applied 4 h before irradiation to permit production within the lesion of the active photosensitizer, protoporphyrin IX. Individual lesions received 94–156 J cm−2. Twenty lesions of Bowen's disease and four actinic keratoses were treated in 12 patients. Patients were reviewed at monthly intervals and treatment repeated if residual disease was present. Clearance was achieved with a single treatment in 15 lesions and in all of the remaining nine lesions after a second treatment. The treatment was well tolerated, with pain absent or mild during treatment in 22 lesions, with only one lesion requiring local anaesthesia. Over the 10 days following treatment, no pain was associated with 21 treated lesions. During a 12 month follow-up period, two Bowen's disease lesions recurred. The overall complete response rate was 92%. Scarring was evident following PDT in only three lesions. Photodynamic therapy using this portable non-laser light source appears to be an effective and well-tolerated treatment for Bowen's disease and actinic keratoses.

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References

  1. 1

    Dougherty TJ, Marcus SL. Photodynamic therapy.Eur J Cancer 1992,28A:1734–42

    PubMed  Google Scholar 

  2. 2

    Pass HI. Photodynamic therapy in oncology: Mechanisms and clinical use.J Nat Cancer Inst 1993,85:443–56

    PubMed  Google Scholar 

  3. 3

    Lui H, Anderson RR. Photodynamic therapy in dermatology.Arch Dermatol 1992,128:1631–6

    PubMed  Google Scholar 

  4. 4

    Wolf P, Kerl H. Photodynamic therapy with 5-aminolaevulinic acid: A promising concept for the treatment of cutaneous tumours.Dermatology 1995,190:183–5

    PubMed  Google Scholar 

  5. 5

    Henderson BW, Dougherty TJ. How does photodynamic therapy work?Photochem Photobiol 1992,55:145–57

    PubMed  Google Scholar 

  6. 6

    Whitehurst C, Byrne K, Moore JV. Development of an alternative light source to lasers for photodynamic therapy: 1. Comparative in vitro dose response characteristics.Lasers Med Sci 1993,8:259–67

    Google Scholar 

  7. 7

    Whitehurst C, Humphries JD, Moore JV. Development of an alternative light source to lasers for photodynamic therapy: 2. Comparative in vivo tumour response characteristics.Lasers Med Sci 1995,10:121–6

    Google Scholar 

  8. 8

    Cairnduff F, Stringer MR, Hudson EJ et al. Superficial photodynamic therapy with topical 5-aminolaevulinic acid for superfical primary and secondary skin cancer.Br J Cancer 1994,69:605–8

    PubMed  Google Scholar 

  9. 9

    Svanberg K, Anderson T, Killander D et al. Photodynamic therapy of non-melanoma malignant tumours of the skin using topical 5-aminolaevulinic acid sensitisation and laser irradiation.Br J Dermatol 1994,130:743–51

    PubMed  Google Scholar 

  10. 10

    Wilson BC, Patterson MS. The physics of photodynamic therapy.Phys Med Biol 1986,31:327–60

    PubMed  Google Scholar 

  11. 11

    Kennedy JC, Pottier RH. Photodynamic therapy with endogenous protoporphyrin IX: Basic principles and present clinical experience.J Photochem Photobiol B 1990,6:143–8

    PubMed  Google Scholar 

  12. 12

    Wolf P, Rieger E, Kerl H. Topical photodynamic therapy with endogenous porphyrins after application of 5-aminolaevulinic acid.J Am Acad Dermatol 1993,28:17–21

    PubMed  Google Scholar 

  13. 13

    Pottier RH, Chow YFA, LaPlante JP et al. Noninvasive technique for obtaining fluorescence excitation and emission spectra in vivo.Photochem Photobiol 1986,44:679–87

    PubMed  Google Scholar 

  14. 14

    Karrer S, Szeimies RM, Hohenleutner U et al. Unilateral localised basaliomatosis: Treatment with topical photodynamic therapy after application of 5-aminolaevulinic acid.Dermatology 1995,190:218–22

    PubMed  Google Scholar 

  15. 15

    Dougherty TJ, Cooper MT, Mang TS. Cutaneous phototoxic occurrences in patients receiving photofrin.Lasers Surg Med 1990,10:485–8

    PubMed  Google Scholar 

  16. 16

    Mullooly VM, Abramson AL, Shikowitz MJ. Dihematoporphyrin ether-induced photosensitivity in laryngeal papilloma patients.Lasers Surg Med 1990,10:349–56

    PubMed  Google Scholar 

  17. 17

    Warloe T, Peng Q, Heyerdahl H et al. Photodynamic therapy with 5-aminolaevulinic acid induced porphyrins and DMSO/EDTA for basal cell carcinoma.SPIE 1994,2371:226–35

    Google Scholar 

  18. 18

    Szeimies RM, Sassy T, Landthaler M. Penetration potency of topical applied 5-aminolaevulinic acid for photodynamic therapy of basal cell carcinoma.Photochem Photobiol 1994,59:73–6

    PubMed  Google Scholar 

  19. 19

    Martin A, Tope WD, Grevelink JM et al. Lack of sensitivity of protoporphyrin IX fluorescence for basal cell carcinoma after topical application of 5-aminolaevulinic acid: implications for PDT.Arch Dermatol Res 1995,287:665–74

    PubMed  Google Scholar 

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Correspondence to C. A. Morton.

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Morton, C.A., Whitehurst, C., Moseley, H. et al. Development of an alternative light source to lasers for photodynamic therapy: 3. Clinical evaluation in the treatment of pre-malignant non-melanoma skin cancer. Laser Med Sci 10, 165–171 (1995). https://doi.org/10.1007/BF02133327

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Key words

  • Photodynamic therapy
  • Non-laser light source
  • 5-Aminolaevulinic acid
  • Non-melanoma skin cancer