Photodynamic therapy in combination with CO2 laser for the treatment of Bowen’s disease
Photodynamic therapy in combination with CO2 laser for the treatment of Bowen’s disease
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光动力疗法联合CO2激光治疗鲍文氏病
DOI：
10.1007/s10103-015-1754-1
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发表时间：
2015
影响因子：
2.1
通讯作者：
Wei Liu
中科院分区：
文献类型：
--
作者：
H. Cai;Yi;Jinwang Zheng;P. Sun;Zhi;Yuanlong Li;Xiao;Qiang Li;Wei Liu
光动力疗法（PDT）涉及通过可见光激活先前施用的光敏剂以诱导肿瘤坏死。光敏剂局部应用于皮肤肿瘤的治疗以避免全身副作用。在这项研究中，我们评估了氨基乙酰丙酸（ALA）作为光敏剂（ALA-PDT）联合CO2激光治疗Bowen病（BD;上皮内鳞状细胞癌）的可行性和有效性。将18例患者的22个病灶随机分为两组：11个病灶局部ALA-PDT（180 J/cm 2，100 mW/cm 2）+CO2激光治疗1 ~ 3次。其余11个病灶采用单纯CO2激光治疗，作为对照组。所有患者均以≤1周的间隔进行审查。在治疗前从BD病变中进行活检。治疗后1个月进行初步评估，并收获活检组织学评价。对三次治疗无反应的患者被转介手术治疗。ALA-PDT + CO2激光治疗组中，72.73%（8/11）的BD病灶完全缓解，总清除率为90.91%，随访期间仅1例复发（9%）。局部副作用包括轻度红斑、水肿、糜烂、烧灼感和/或刺痛感。未观察到全身副作用。对照组63.63%（7/11）的病灶完全缓解，总清除率为54.55%。但有5个病灶（45.45%）复发.局部副作用包括轻度至中度水肿、糜烂、溃疡、延迟愈合、持续疼痛和瘢痕形成。两组复发率差异有统计学意义（P< 0.05）。此外，ALA-PDT加CO2激光治疗后，反应性病变中观察到完全坏死，3个月后，非典型BD细胞被正常角质形成细胞取代。局部ALA-PDT联合CO2激光安全、有效，复发率低，副作用少。
Photodynamic therapy (PDT) involves the activation of a previously administered photosensitizing agent by visible light to induce tumor necrosis. Photosensitizers are topically applied in the treatment of skin tumors to avoid systemic side effects. In this study, we evaluated the feasibility and efficacy of aminolevulinic acid (ALA) as a photosensitizer (ALA-PDT) in combination with CO2laser in the treatment of Bowen’s disease (BD; intraepithelial squamous cell carcinoma). Twenty-two lesions from 18 patients were randomized into two groups: 11 lesions were treated with topical ALA-PDT (180 J/cm2at 100 mW/cm2) + CO2laser for one to three sessions. The remaining 11 lesions were treated with CO2laser alone, serving as control group. All patients were reviewed at ≤1-week intervals. Biopsies were taken from BD lesions prior to treatment. The initial evaluation was undertaken 1 month after treatment, and biopsies were harvested for histological evaluation. Patients who did not respond to the three sessions of treatment were referred to surgical treatment. In the ALA-PDT + CO2laser group, 72.73 % (8/11) of BD lesions showed complete remission, with an overall clearance of 90.91 %, and only one recurred (9 %) during follow-up. Local side effects included mild erythema, edema, erosion, and burning and/or stinging sensation. No systemic side effects were observed. In the control group, 63.63 % (7/11) of lesions had complete remission and the overall clearance was 54.55 %. However, five lesions (45.45 %) had recurrence. Local side effects included mild to moderate edema, erosion, ulceration, delayed healing, prolonged pain, and scarring. There existed a significant difference in recurrence rate between the two groups (P< 0.05). Moreover, after ALA-PDT plus CO2laser treatment, complete necrosis was observed in responsive lesions, and 3 months later, the atypical BD cells were replaced by normal keratinocytes. Topical ALA-PDT in combination with CO2laser is safe, effective, and is associated with low recurrence and reduced side effects.