Kacerovská Denisa, Pizinger Karel, Majer Filip, Smíd Frantisek
Department of Dermatology and Venereology, Medical School and Teaching Hospital Pilsen, Charles University, Pilsen, Czech Republic.
Photochem Photobiol. 2008 May-Jun;84(3):779-85. doi: 10.1111/j.1751-1097.2007.00260.x. Epub 2008 Jan 7.
Hypericin, the photoactive compound of Hypericum perforatum, is probably the most powerful photosensitizer found in nature. This compound has shown high potency in the photodynamic treatment of tumor cells. However, there is only limited knowledge regarding the photodynamic effect of hypericin on nonmelanoma skin cancer cells. The aim of this prospective study was to investigate the efficacy of photodynamic therapy with topical application of an extract of H. perforatum in actinic keratosis, basal cell carcinoma (BCC) and morbus Bowen (carcinoma in situ). The study was carried out on 34 patients--eight with actinic keratoses (AKs), 21 with BCC and five with Bowen's disease. The extract of H. perforatum was applied on the skin lesions under occlusion and that was followed by irradiation with 75 J cm(-2) of red light 2 h later. The treatment was performed weekly for 6 weeks on average. The percentage of complete clinical response was 50% for AKs, 28% in patients with superficial BCC and 40% in patients with Bowen's disease. There was only a partial remission seen in patients with nodular BCCs. A complete disappearance of tumor cells was found in the histologic preparation of 11% of patients with superficial BCCs and 80% in the patients with Bowen's disease. All patients complained of burning and pain sensations during irradiation. Although the results of this first clinical trial could be regarded as disappointing, there are still possibilities for improvement. Better preparation of the lesions, enhancement of hypericin delivery and other types of light exposure procedures could significantly improve the clinical outcomes of this relatively inexpensive treatment modality.
金丝桃素是贯叶连翘中的光活性化合物，可能是自然界中发现的最强大的光敏剂。这种化合物在肿瘤细胞的光动力治疗中显示出高效能。然而，关于金丝桃素对非黑素瘤皮肤癌细胞的光动力效应的了解仍然有限。这项前瞻性研究的目的是调查外用贯叶连翘提取物在光动力治疗光化性角化病、基底细胞癌（BCC）和鲍温病（原位癌）中的疗效。该研究对34例患者进行——8例患有光化性角化病（AK），21例患有基底细胞癌，5例患有鲍温病。将贯叶连翘提取物敷于皮肤病变处并封闭，2小时后用75 J/cm²的红光照射。平均每周进行一次治疗，共6周。光化性角化病的完全临床缓解率为50%，浅表性基底细胞癌患者为28%，鲍温病患者为40%。结节性基底细胞癌患者仅出现部分缓解。在浅表性基底细胞癌患者的组织学标本中，11%的患者肿瘤细胞完全消失，鲍温病患者中这一比例为80%。所有患者在照射过程中均抱怨有烧灼感和疼痛感。尽管这项首次临床试验的结果可能令人失望，但仍有改进的可能性。更好地准备病变、增强金丝桃素的递送以及其他类型的光照程序可能会显著改善这种相对廉价的治疗方式的临床效果。
