A retrospective review of pain control by a two‐step irradiance schedule during topical ALA‐photodynamic therapy of non‐melanoma skin cancer1. Issue 2 (6th February 2013)

• Record Type: Journal Article
• Authors: Zeitouni, Nathalie C.; Paquette, Anne D.; Housel, Joseph P.; Shi, Yi; Wilding, Gregory E.; Foster, Thomas H.; Henderson, Barbara W.; Weiss, Robert A.; Geronemus, Roy G.
• Is Part Of: Lasers in surgery and medicine. Volume 45:Issue 2(2013)
• Page Start: 89
• Page End: 94
• Publication Date: 2013-02-06
• Subjects: Lasers in medicine -- Periodicals; Lasers in surgery -- Periodicals; 617
• DOI: 10.1002/lsm.22118
• Languages: English
• ISSNs: 0196-8092

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Background and Objective</title> <p>Photodynamic therapy (PDT) with topical δ‐aminolevulinic acid (ALA) of non‐melanoma skin cancers is often associated with treatment‐limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two‐step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here, we present a retrospective review of recent clinical experience in a broad patient population.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Study Design/Materials and Methods</title> <p>This was a retrospective review of an existing dermatology database. Fourteen caucasion patients—nine men and five women, ages 18–80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions—were included. ALA was applied to each lesion for approximately 4 hours. Lesions received an initial irradiance of 30–50 mW/cm<sup>2</sup> for 20 J/cm<sup>2</sup>, followed by 150 mW/cm<sup>2</sup> for a total fluence of 200–300 J/cm<sup>2</sup>. Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6–12 months.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results</title> <p>Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA‐PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Conclusions</title> <p>A two‐step irradiance protocol in ALA‐PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time. Lasers Surg. Med. 45: 89–94, 2013. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>