Marcus LindaSusan
Dermatol Surg. 2003 Oct;29(10):1061-4; discussion 1064-5. doi: 10.1046/j.1524-4725.2003.29303.x.
Actinic or solar keratoses are the earliest form of cancerous lesions that are found in sun-exposed areas of the body. Treatment involves eliminating the lesions before they have a chance to progress. Mainstay therapies include curettage, cryosurgery, and topical 5-fluorouracil. A recently Food and Drug Administration-approved regime using photodynamic therapy has also been employed since 2000.
To inform physicians of the efficacy and potential inefficiency of this procedure, enabling the assessment of proper placement in the armamentarium.
This patient underwent photodynamic therapy. She was challenged with 5-fluorouracil 5 weeks after photodynamic treatment.
The patient responded well to the photodynamic therapy and also to the challenge with the 5-fluorouracil.
Did the photodynamic treatment really destroy lesions significantly? What is the mechanism for the response to 5-fluorouracil after such a short period between treatment modalities? If 33% of patients treated with photodynamic therapy require retreatment in 8 weeks, is this modality cost-effective, and what is its place in treating patients? How should this new treatment be implemented in practice? These questions must be seriously assessed.
光化性或日光性角化病是在身体暴露于阳光的部位发现的最早的癌前病变形式。治疗包括在病变有机会进展之前将其消除。主要治疗方法包括刮除术、冷冻手术和外用5-氟尿嘧啶。自2000年以来，一种最近获得美国食品药品监督管理局批准的使用光动力疗法的方案也已被采用。
告知医生该治疗方法的疗效和潜在的无效性，以便评估其在治疗手段中的合理地位。
该患者接受了光动力治疗。在光动力治疗5周后，她接受了5-氟尿嘧啶的激发试验。
患者对光动力治疗以及5-氟尿嘧啶激发试验反应良好。
光动力治疗真的能显著破坏病变吗？在两种治疗方式间隔如此短的时间后，对5-氟尿嘧啶产生反应的机制是什么？如果接受光动力治疗的患者中有33%在8周内需要再次治疗，这种治疗方式是否具有成本效益，其在治疗患者中的地位如何？在实践中应如何实施这种新治疗方法？这些问题必须得到认真评估。
