Fractional laser-mediated photodynamic therapy of high-risk basal cell carcinomas: a randomized clinical trial
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Fractional laser-mediated photodynamic therapy of high-risk basal cell carcinomas : a randomized clinical trial. / Haak, C S; Togsverd-Bo, K; Thaysen-Petersen, D; Wulf, H C; Paasch, U; Anderson, R R; Haedersdal, M.
I: British Journal of Dermatology, Bind 172, Nr. 1, 01.2015, s. 215-222.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Fractional laser-mediated photodynamic therapy of high-risk basal cell carcinomas
T2 - a randomized clinical trial
AU - Haak, C S
AU - Togsverd-Bo, K
AU - Thaysen-Petersen, D
AU - Wulf, H C
AU - Paasch, U
AU - Anderson, R R
AU - Haedersdal, M
N1 - © 2014 British Association of Dermatologists.
PY - 2015/1
Y1 - 2015/1
N2 - BACKGROUND: Photodynamic therapy (PDT) is approved for selected nodular basal cell carcinomas (nBCC) but efficacy is reduced for large and thick tumours. Ablative fractional lasers (AFXL) facilitate uptake of methyl aminolaevulinate (MAL) and may thus improve PDT outcome.OBJECTIVES: To evaluate efficacy and safety of AFXL-mediated PDT (AFXL-PDT) compared with conventional PDT of high-risk nBCC.METHODS: Patients with histologically verified facial nBCC (n = 32) defined as high-risk tumours were included; diameter > 15 mm, tumours located in high-risk zones, or on severely sun-damaged skin. Tumours were debulked and patients randomized to either AFXL-PDT (n = 16) or PDT (n = 16). Fractional CO2 laser treatment was applied at 5% density and 1000 μm (80 mJ) ablation depth. MAL was applied under occlusion for 3 h and illuminated with a 633-nm light-emitting diode source, 37 J cm(-2) . Clinical assessments were performed at 3, 6, 9 and 12 months and biopsies were taken at 12 months.RESULTS: Clinical cure rates at 3 months were 100% (16 of 16 AFXL-PDT) and 88% (14 of 16 PDT, P = 0·484). Recurrences tended to occur later and in lower numbers after AFXL-PDT at 6, 9 and 12 months (6%, 19%, 19%) than PDT (25%, 38%, 44%) (P = 0·114). Histology at 12 months documented equal tumour clearance after AFXL-PDT (63%, 10 of 16) and PDT (56%, 9 of 16). Cosmetic outcomes were highly satisfactory after both treatments (P > 0·090).CONCLUSIONS: Long-term efficacy was similar after PDT and AFXL-PDT with a trend for a favourable short-term cure rate after AFXL-PDT. AFXL-PDT needs further refinement for nBCC and at present is not recommended over PDT.
AB - BACKGROUND: Photodynamic therapy (PDT) is approved for selected nodular basal cell carcinomas (nBCC) but efficacy is reduced for large and thick tumours. Ablative fractional lasers (AFXL) facilitate uptake of methyl aminolaevulinate (MAL) and may thus improve PDT outcome.OBJECTIVES: To evaluate efficacy and safety of AFXL-mediated PDT (AFXL-PDT) compared with conventional PDT of high-risk nBCC.METHODS: Patients with histologically verified facial nBCC (n = 32) defined as high-risk tumours were included; diameter > 15 mm, tumours located in high-risk zones, or on severely sun-damaged skin. Tumours were debulked and patients randomized to either AFXL-PDT (n = 16) or PDT (n = 16). Fractional CO2 laser treatment was applied at 5% density and 1000 μm (80 mJ) ablation depth. MAL was applied under occlusion for 3 h and illuminated with a 633-nm light-emitting diode source, 37 J cm(-2) . Clinical assessments were performed at 3, 6, 9 and 12 months and biopsies were taken at 12 months.RESULTS: Clinical cure rates at 3 months were 100% (16 of 16 AFXL-PDT) and 88% (14 of 16 PDT, P = 0·484). Recurrences tended to occur later and in lower numbers after AFXL-PDT at 6, 9 and 12 months (6%, 19%, 19%) than PDT (25%, 38%, 44%) (P = 0·114). Histology at 12 months documented equal tumour clearance after AFXL-PDT (63%, 10 of 16) and PDT (56%, 9 of 16). Cosmetic outcomes were highly satisfactory after both treatments (P > 0·090).CONCLUSIONS: Long-term efficacy was similar after PDT and AFXL-PDT with a trend for a favourable short-term cure rate after AFXL-PDT. AFXL-PDT needs further refinement for nBCC and at present is not recommended over PDT.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Aminolevulinic Acid
KW - Carcinoma, Basal Cell
KW - Combined Modality Therapy
KW - Facial Neoplasms
KW - Female
KW - Fluorescence
KW - Humans
KW - Laser Therapy
KW - Lasers, Gas
KW - Male
KW - Middle Aged
KW - Neoplasm Recurrence, Local
KW - Photochemotherapy
KW - Photosensitizing Agents
KW - Risk Factors
KW - Skin Neoplasms
KW - Treatment Outcome
U2 - 10.1111/bjd.13166
DO - 10.1111/bjd.13166
M3 - Journal article
C2 - 24903544
VL - 172
SP - 215
EP - 222
JO - British Journal of Dermatology
JF - British Journal of Dermatology
SN - 0007-0963
IS - 1
ER -
ID: 152245016