Efficacy of topical ALA-PDT combined with excision in the treatment of skin malignant tumor

https://doi.org/10.1016/j.pdpdt.2014.02.006Get rights and content

Summary

Background

Photodynamic therapy (PDT) is a successful treatment for non-melanoma skin cancers in clinical practice. In China, more and more doctors use PDT to cure the patients with skin cancer, especially in the elder. The purpose of this study was to evaluate the efficacy of topical PDT using aminolevulinic acid (5-ALA) combined with excision in the treatment of skin malignant tumor and its role in surgical improvements.

Methods

A total of 58 cases including 32 cases of BCC, 13 cases of Bowen's disease, 8 cases of Paget's disease and 5 cases of SCC were included in this study. All cases were treated with topical ALA-PDT after surgery. Each tumor region was irradiated with 120 J/cm2 using a 635-nm laser for 15 min. A total of 3 times of assisted ALA-PDT was applied after surgery.

Results

There was no recurrence in 6 months after treatment. Only 5 cases of Paget's disease and 2 cases of SCC experienced disease recurrence in 1 year. All patients were able to complete the treatment protocol, with well cosmetic results and no moderate adverse reactions.

Conclusions

As an assistive therapy after tumor resection, ALA-PDT can reduce the excision range of the tumor lesions. However, its role in the reduction of recurrence rate remains to be further investigated.

Introduction

Skin cancer, particularly nonmelanoma skin tumor, frequently occurs in the exposed parts of the body, e.g., head, face, neck and arms. Invasive growth of the tumors results in the local tissue destruction, leading to the disfigurement due to the displacement of surface organs. Traditional surgery, freezing, radiation and chemotherapy have good therapeutic efficacy to the primary malignant tumor of the skin. However, they are traumatic and are prone to scar formation. In addition, these therapies have very limited effect in beauty [1]. With the economic and social development, the pursuit for good appearance becomes higher and higher. People are looking for the tumor therapies that have less recurrence rate, less pain, less side effects, and do not cause resistance after multiple treatments. How to meet the therapeutic requirement of patients with skin malignancies is one of the clinical challenges. Topical photodynamic therapy (PDT) is a treatment in which 5-ALA is distributed to the lesions and then a light source with specific wavelength enters the lesions to selectively destroy these lesions. As a novel therapy, PDT has good selectivity for tumor tissues, does not destroy normal cells and is not limited by the location or size of the skin lesions. In addition, PDT can be used for multiple times without resistance, and scar formation. Thus, PDT has been more and more applied in the treatment of nonmelanoma skin cancers, and even becomes one of the standard treatments [2], [3]. Our department admitted a total of 58 cases with malignant skin tumors from January 2009 to December 2011. We used topical PDT combined with excision to treat these patients and reported the results below.

Section snippets

Patients and methods

A total of 58 patients (male: 42; female: 16) were diagnosed as skin cancer from January 2009 to December 2011. These patients had an age of 45–81 years old and a disease course of 9 months to 6 years. Lesions were located in the face, the inner canthus, head and tempus, mouth, neck, limbs, abdomen, penis and vulva, etc. Single lesion occurred in 41 cases and multiple lesions occurred in 17 cases. Eighteen cases had a lesion of less than 2 cm in diameter, 25 cases had a lesion between 3 and 4 cm

Results

In the group with combination of surgery and PDT, visible lesions were completed removed in 40 patients (Fig. 1a–c), while tumors were partially removed in 18 patients due to the special position (in the inner canthus, scrotum, penis, etc.). After three times of PDT, skin lesions were completely receded (Fig. 2a–d).

There was no recurrence after 6 months of treatment. In the one-year follow-up, recurrence was observed in 5 cases of Paget's disease, 2 cases of squamous cell carcinoma. Recurrence

Discussion

With the aging of Chinese population, environmental pollution, lifestyle changes and China's huge population base, the incidence of skin cancer is getting higher and higher. Skin cancer often occurs at the surface, which may result in the disfigurement due to the rapid growth of the tumor and the shift or destruction of the body surface organs. The skin cancer patients are currently not only looking for the extension of life but also the recovery of normal appearance and function. In the

Conflicts of interest

The authors have no conflict of interest to report.

Acknowledgment

This work was supported by the National Natural Science Foundation of China (No. 81172211).

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1

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