Photodynamic therapy of actinic keratosis at varying fluence rates:: assessment of photobleaching, pain and primary clinical outcome
Photodynamic therapy of actinic keratosis at varying fluence rates:: assessment of photobleaching, pain and primary clinical outcome
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DOI：
10.1111/j.1365-2133.2004.06211.x
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发表时间：
2004-12-01
影响因子：
10.3
通讯作者：
Rosdahl, I
中科院分区：
文献类型：
--
作者：
Ericson, MB;Sandberg, C;Rosdahl, I
背景虽然光动力疗法（PDT）正在成为光化性角化病（AK）和浅表基底细胞癌等皮肤病变的重要治疗方法，但关于哪种影响率和光剂量更可取仍有讨论。最近对啮齿动物的研究表明，由于在高通量下氧气耗尽，低通量是可取的。然而，这些结果尚未在人体中得到验证。目的探讨影响率和光谱范围对氨基乙酰丙酸PDT治疗AK的初步疗效和漂白率的影响。此外，在治疗过程中对患者所经历的疼痛进行了监测。患者/方法37例（平均年龄71岁）头部、颈部和上胸部AK患者接受PDT治疗，随机分为4组：2组为窄滤光器组（580-650 nm），通量为30或45 mW cm(-2)， 2组为宽滤光器组（580-690 nm），通量为50或75 mW cm（-2）。所有处理的总累积光剂量均为100 J cm（-2）。通过荧光成像监测光漂白，并使用从0（无疼痛）到10（难以忍受的疼痛）的视觉模拟评分来记录患者所经历的疼痛。在7周后的随访中评估主要治疗结果。结果我们的数据显示，通量率与初始治疗结果之间存在显著相关性，较低的通量率导致较好的治疗反应。此外，发现光漂白剂量（1/e）与渗透率有关，范围从30 mW cm（-2）时的4.5 +/- 1.0 J cm（-2）到75 mW cm（-2）时的7.3 +/- 0.7 J cm(-2)，表明在较低的渗透率下组织中的氧含量较高。在累积光剂量达到40 J cm（-2）后，不再发生光漂白，这意味着更高的光剂量是过量的。在30至75 mW cm（-2）的不同影响率下，PDT期间患者所经历的疼痛没有显着差异。然而，在累积光剂量为20 J cm（-2）时，疼痛最为强烈。我们的研究结果表明，光漂白率和初级治疗结果取决于通量，低通量（30 mW cm(-2)）在使用非相干光源对AK进行PDT时似乎更好。
Background Although photodynamic therapy (PDT) is becoming an important treatment method for skin lesions such as actinic keratosis (AK) and superficial basal cell carcinoma, there are still discussions about which fluence rate and light dose are preferable. Recent studies in rodents have shown that a low fluence rate is preferable due to depletion of oxygen at high fluence rates. However, these results have not yet been verified in humans.Objective The objective was to investigate the impact of fluence rate and spectral range on primary treatment outcome and bleaching rate in AK using aminolaevulinic acid PDT. In addition, the pain experienced by the patients has been monitored during treatment.Patients/methods Thirty-seven patients (mean age 71 years) with AK located on the head, neck and upper chest were treated with PDT, randomly allocated to four groups: two groups with narrow filter (580-650 nm) and fluence rates of 30 or 45 mW cm(-2), and two groups with broad filter (580-690 nm) and fluence rates of 50 or 75 mW cm(-2). The total cumulative light dose was 100 J cm(-2) in all treatments. Photobleaching was monitored by fluorescence imaging, and pain experienced by the patients was registered by using a visual analogue scale graded from 0 (no pain) to 10 (unbearable pain). The primary treatment outcome was evaluated at a follow-up visit after 7 weeks.Results Our data showed a significant correlation between fluence rate and initial treatment outcome, where lower fluence rate resulted in favourable treatment response. Moreover, the photobleaching dose (1/e) was found to be related to fluence rate, ranging from 4.5 +/- 1.0 J cm(-2) at 30 mW cm(-2), to 7.3 +/- 0.7 J cm(-2) at 75 mW cm(-2), indicating higher oxygen levels in tissue at lower fluence rates. After a cumulative light dose of 40 J cm(-2) no further photobleaching took place, implying that higher doses are excessive. No significant difference in pain experienced by the patients during PDT was observed in varying the fluence rate from 30 to 75 mW cm(-2). However, the pain was found to be most intense up to a cumulative light dose of 20 J cm(-2).Conclusions Our results imply that the photobleaching rate and primary treatment outcome are dependent on fluence rate, and that a low fluence rate (30 mW cm(-2)) seems preferable when performing PDT of AK using noncoherent light sources.