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Regression Analysis of Protoporphyrin IX Measurements Obtained During Dermatological Photodynamic Therapy
摘要： Photodynamic therapy (PDT) is a light activated drug therapy that can be used to treat a number of dermatological cancers and precancers. Improvement of efficacy is required to widen its application. Clinical protoporphyrin IX (PpIX) fluorescence data were obtained using a pre-validated, non-invasive imaging system during routine methyl aminolevulinate (MAL)-PDT treatment of 172 patients with licensed dermatological indications (37.2% actinic keratosis, 27.3% superficial basal cell carcinoma and 35.5% Bowen’s disease). Linear and logistic regressions were employed to model any relationships between variables that may have affected PpIX accumulation and/or PpIX photobleaching during irradiation and thus clinical outcome at three months. Patient age was found to be associated with lower PpIX accumulation/photobleaching, however only a reduction in PpIX photobleaching appeared to consistently adversely affect treatment efficacy. Clinical clearance was reduced in lesions located on the limbs, hands and feet with lower PpIX accumulation and subsequent photobleaching adversely affecting the outcome achieved. If air cooling pain relief was employed during light irradiation, PpIX photobleaching was lower and this resulted in an approximate three-fold reduction in the likelihood of achieving clinical clearance. PpIX photobleaching during the first treatment was concluded to be an excellent predictor of clinical outcome across all lesion types.
关键词： photobleaching,aminolevulinic acid (ALA; Ameluz),dermatology,protoporphyrin IX (PpIX),imaging,methyl aminolevulinate (MAL; Metvix),photodynamic therapy (PDT),fluorescence,non-melanoma skin cancer (NMSC)
更新于2025-09-23 15:22:29
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Daylight photodynamic therapy for prevention of new actinic keratosis and keratinocyte carcinomas in organ transplants. A cryotherapy‐controlled randomized clinical trial.
摘要： Background: Organ transplant recipients (OTR) have a higher risk of actinic keratosis (AK) and keratinocyte carcinomas (KC). There are no clinical trials assessing the effectiveness of daylight photodynamic therapy (DPDT) to prevent new AK and KC in OTR. Objectives: To determine whether repeated treatments of field cancerization with DPDT are effective in preventing new AK and KC in OTR. Methods: A randomized, intra-subject controlled, evaluator-blind, split-face and/or scalp trial, from April 2016 to October 2018. Participants were OTR older than 18 years, 1 year post-transplant, with at least 5 AK on each hemi-face/hemi-scalp. One side received 6 field-treatments with DPDT: two sessions 15 days apart at baseline, two at 3 months, and two at 9 months after baseline. Control side received lesion-directed treatment with cryotherapy (double freeze-thaw) at baseline, 3 and 9 months. Total number of lesions (AK and KC) at 21 months, number of new AK and KC at 3, 9, 15 and 21 months and treatment preferences were analysed. Results: Of 24 men included, 23 were analysed at 3 months; and 21, at 9, 15 and 21 months. Mean (SD) age was 69.8 years (9.2). Total number of lesions at 21 months were 4.7 (4.3) for DPDT and 5.8 (5.0) for control side; P= 0.09. DPDT showed significantly lower means [SD] of new lesions compared to control side at 3 months (4.2 [3.4] vs 6.8 [4.8]; P< 0.001), 9 months (3.0 [3.3] vs 4.3 [3.4]; P= 0.04) and 15 months (3.0 [4.6] vs 4.8 [5.0]; P= 0.02), and nonsignificant at 21 months (3.7 [3.5] vs 5.0 [4.5]; P= 0.06). Most participants preferred DPDT. Conclusion: DPDT showed potential effectiveness in preventing new AK and KC in OTR by consecutive treatments of field cancerization. The preference for DPDT could facilitate adherence to the long-term treatment necessary in these patients.
关键词： methyl aminolevulinate,daylight photodynamic therapy,keratinocyte carcinomas,actinic keratosis,organ transplant recipients
更新于2025-09-11 14:15:04
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Daylight-Mediated Photodynamic Therapy for Actinic Keratosis
摘要： Actinic (solar) keratoses are premalignant lesions caused by prolonged exposure to ultraviolet radiation, with the potential to progress into squamous cell carcinoma. Hence, use of appropriate therapies is critical for effective treatment. Daylight-mediated photodynamic therapy with methyl aminolevulinate cream is a convenient new option for the safe and effective treatment of actinic (solar) keratosis lesions, offering similar efficacy to conventional photodynamic therapy, nearly painless treatment, and reduced in-clinic times. Use of appropriate therapies and optimization of clinical practice are critical for safe and effective treatment. Nurses play a key role in ensuring best clinical practice and effective treatment. This article explains the practicalities and principles of daylight-mediated photodynamic therapy to ensure best practice by treating nurses.
关键词： methyl aminolevulinate,Daylight-Mediated Photodynamic Therapy,Actinic (Solar) Keratosis,Clinical Practice Guidelines
更新于2025-09-10 09:29:36