Combination of Er:YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma
Combination of Er:YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma
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DOI：
10.1002/lsm.20606
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发表时间：
2008-02-01
影响因子：
2.4
通讯作者：
Vlk, Marek
中科院分区：
文献类型：
--
作者：
Smucler, Roman;Vlk, Marek
背景和目的：通过局部氨基乙酰丙酸（ALA）进行光动力治疗（PDT）是治疗深度不超过2mm的基底细胞癌的有效方法。这将基底细胞癌（非黑色素瘤皮肤癌）的治疗限制在表面形式和结节治疗（仅在美观的位置）。本文讨论了通过初始Er:YAG激光消融减少肿瘤质量的有效性，该深度对ALA PDT治疗有反应。研究设计/材料和方法：本研究比较了三种治疗复发性结节性基底细胞癌（r nBCC）的方法。方法A采用局部应用ALA甲酯的PDT，方法B采用Er:YAG单用激光消融，方法C采用Er:YAG激光消融将肿瘤缩小到2 mm以下（方法B），随后采用ALA甲酯PDT（方法A）。所有三种方法都用于治疗每个患者，所有受试者都有三个或更多的基底细胞癌，以消除患者对治疗反应性的差异。每隔3个月、6个月和12个月对患者进行监测和访谈，以检查肿瘤消除进展、美学结果以及患者对治疗方法的偏好。总共有286名患者接受了治疗，其中194人在规定的时间间隔内接受了检查，然后进行了评估。结果：统计学上，联合治疗在所有时间间隔内均表现出最有效的治疗效果，最终疗效为98.97%，而PDT治疗为94.85%，Er:YAG激光治疗为91.75%。联合方法还提供了最佳的美学结果（评分：1-最佳；4-最差），为1.23 +/- 1.23，而仅PDT的结果为1.67 +/- 0.76，仅Er:YAG激光的结果为1.83 +/- 0.95。结论：尽管67%的患者更倾向于单独Er:YAG激光治疗，而不是PDT方法（20%）和联合治疗（13%），但由于治疗简单，联合治疗已被证明在临床和美学上都更优越。然而，对于表现简单的浅表性基底细胞癌，单发Er:YAG激光消融仍将是一种快速、有效和经济的治疗选择，并已取代PDT治疗无并发症的病例。Er:YAG激光消融联合ALA-PDT有望成为BCC的治疗选择。
Backgrounds and Objectives: Photodynamic therapy (PDT), via topical aminolevulinic acid (ALA) is an effective treatment for basal cell carcinomas not exceeding a depth of 2 mm. This limits the treatment of basal cell carcinoma (non-melanoma skin cancer) to superficial forms and nodular therapy (only in aesthetically desired locations). This paper addresses the effectiveness of reducing tumor mass via initial Er:YAG laser ablation to depths that are therapeutically responsive to PDT with ALA.Study Design/Materials and Methods: This study compared three methods for the treatment of recurring nodular basal cell carcinomas (r nBCC). Method A utilized PDT with topical application of ALA methyl ester, method B with solitary Er:YAG laser ablation, and method C combined Er:YAG laser ablation reducing tumor size below 2 mm (method B) with subsequent ALA methyl ester PDT (method A). All three methods were used to treat to each patient, all subjects presenting with three or more basal cell carcinomas in order to eliminate differences in patient responsiveness to treatment. Patients were monitored and interviewed at 3, 6, and 12 month intervals to examine the progress of tumor elimination, aesthetic results as well as the patient's preference of treatment method. In all, 286 patients were treated, of whom 194 were checked at the prescribed intervals and then evaluated.Results: Statistically, the combination therapy demonstrated the most effective treatment at all time intervals, with a final efficacy of 98.97% versus 94.85% (PDT only) and 91.75% (Er:YAG laser only). The combined method also provided the best aesthetic results (scale: 1-best; 4-worst) of 1.23 +/- 1.23, compared to 1.67 +/- 0.76 (PDT only) and 1.83 +/- 0.95 (Er:YAG laser only).Conclusions: Although 67% patients preferred solitary Er:YAG laser treatment over the PDT method (20%) and the combined treatment (13%, because of the simplicity of the treatment, the combination therapy has proven to be both clinically and aesthetically superior. Solitary Er:YAG laser ablation will remain however a fast, effective, and economical treatment alternative for simple manifestations of superficial basal cell carcinoma and has replaced PDT for uncomplicated cases at our facility. The combination of Er:YAG laser ablation and ALA-PDT aspires to be therapy of choice for BCC.