Varma S, Wilson H, Kurwa H A, Gambles B, Charman C, Pearse A D, Taylor D, Anstey A V
Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
Br J Dermatol. 2001 Mar;144(3):567-74. doi: 10.1046/j.1365-2133.2001.04085.x.
Photodynamic therapy (PDT) has not yet been demonstrated to be superior to conventional treatment in the treatment of superficial skin cancers and premalignant skin conditions. A limitation for PDT is the absence to date of a light source suitable for the treatment of larger lesions or 'field changes' where several lesions are present on one anatomical site.
To investigate the safety and efficacy of a large field light source, the Waldmann PDT 1200, in the treatment of Bowen's disease (BD), superficial basal cell carcinomas (BCCs) and solar keratoses (SKs).
After application of 5-aminolaevulinic acid for 4-6 h, each lesion was irradiated with 105 J cm-2 of incoherent red light centred on 640 nm. Eighty-eight patients with 239 lesions were recruited.
Within two treatments, 88% of BD lesions, 95% of BCCs and 99% of SKs showed complete clinical clearance. At 12 months the complete response rates were 69% for BD, 82% for BCC and 72% for SK.
This study confirms that PDT is a useful treatment and that selected superficial BCCs and SKs respond well to PDT. The PDT 1200 light source proved capable of treating multiple lesions amounting to a 'field change' and also lesions up to 10 cm in diameter within an acceptable treatment time. Thus far, PDT has failed to become established as a routine treatment for small premalignant and malignant skin lesions as it has not proved superior to simple cheaper conventional therapies such as cryotherapy, curettage and cautery, topical chemotherapy with 5-fluorouracil, or surgery. However, PDT has become established as a treatment for selected cases in some centres. This study suggests a role for PDT in the treatment of large premalignancies, superficial BCCs and field change where existing treatments may be problematic.
在浅表皮肤癌和癌前皮肤病变的治疗中，光动力疗法（PDT）尚未被证明优于传统治疗方法。PDT的一个局限性是，迄今为止缺乏一种适用于治疗较大病变或“区域改变”（即一个解剖部位存在多个病变）的光源。
研究一种大光斑光源——瓦尔德曼PDT 1200在治疗鲍恩病（BD）、浅表基底细胞癌（BCC）和日光性角化病（SK）中的安全性和有效性。
在涂抹5-氨基酮戊酸4 - 6小时后，以640nm为中心波长，用105J/cm²的非相干红光对每个病变进行照射。招募了88例患有239个病变的患者。
经过两次治疗，88%的BD病变、95%的BCC病变和99%的SK病变实现了临床完全清除。在12个月时，BD的完全缓解率为69%，BCC为82%，SK为72%。
本研究证实PDT是一种有效的治疗方法，特定的浅表BCC和SK对PDT反应良好。PDT 1200光源被证明能够在可接受的治疗时间内治疗相当于“区域改变”的多个病变以及直径达10cm的病变。迄今为止，PDT未能成为小的癌前和恶性皮肤病变的常规治疗方法，因为它尚未被证明优于简单廉价的传统疗法，如冷冻疗法、刮除术和烧灼术、5-氟尿嘧啶局部化疗或手术。然而，在一些中心，PDT已成为特定病例的治疗方法。本研究表明PDT在治疗大型癌前病变、浅表BCC和现有治疗可能存在问题的区域改变方面具有作用。
