Dragieva Galya, Hafner Jürg, Dummer Reinhard, Schmid-Grendelmeier Peter, Roos Malgorzata, Prinz Bettina M, Burg Günter, Binswanger Ulrich, Kempf Werner
Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
Transplantation. 2004 Jan 15;77(1):115-21. doi: 10.1097/01.TP.0000107284.04969.5C.
Transplant recipients (TR) have a dramatically increased risk for widespread epithelial neoplasms of the skin. Thus, there is a need to treat initial stages of these neoplasms such as actinic keratoses (AK) and Bowen's disease (BD) to prevent progression to invasive and potentially fatal squamous cell carcinoma. Topical photodynamic therapy (PDT) has been proven to be an effective treatment for AK and BD in immunocompetent patients, but no prospective trials in immunocompromised TR have been performed so far.
Twenty TR and 20 controls with histologically confirmed AK or BD underwent either a single or two consecutive treatments of topical PDT in an open trial. The application of 20% 5-aminolevulinic acid (ALA) for 5 hours was followed by illumination with 75 J/cm2 of visible light delivered at 80 mW/cm2 by an incoherent light source.
The overall complete response rates in TR at 4, 12, and 48 weeks were 0.86, 0.68, and 0.48, respectively. The cure rates in both patient groups were comparable at 4 weeks but were significantly lower in TR than in controls at 12 and 48 weeks (P<0.05). Side effects included erythema, edema, and crust formation after illumination. Cosmetic results were excellent without scar formation or alterations in pigmentation.
Topical PDT with 20% 5-ALA is an effective and safe treatment for AK and BD in immunosuppressed TR, with initial response rates comparable with those in immunocompetent patients. It is particularly useful in TR because of the possibility for repeated treatment of large lesional areas.
移植受者患皮肤广泛性上皮肿瘤的风险显著增加。因此，有必要治疗这些肿瘤的初始阶段，如光化性角化病（AK）和鲍恩病（BD），以防止进展为侵袭性且可能致命的鳞状细胞癌。局部光动力疗法（PDT）已被证明是免疫功能正常患者治疗AK和BD的有效方法，但迄今为止尚未在免疫受损的移植受者中进行前瞻性试验。
在一项开放试验中，20名移植受者和20名经组织学确诊为AK或BD的对照者接受了单次或连续两次局部PDT治疗。涂抹20%的5-氨基酮戊酸（ALA）5小时后，用非相干光源以80 mW/cm²的功率照射75 J/cm²的可见光。
移植受者在4周、12周和48周时的总体完全缓解率分别为0.86、0.68和0.48。两组患者在4周时的治愈率相当，但移植受者在12周和48周时的治愈率显著低于对照组（P<0.05）。副作用包括照射后出现红斑、水肿和结痂。美容效果极佳，无瘢痕形成或色素沉着改变。
20% 5-ALA局部PDT是免疫抑制移植受者治疗AK和BD的有效且安全的方法，初始反应率与免疫功能正常患者相当。由于可以对大面积病变区域进行重复治疗，因此对移植受者特别有用。
