Doffoel-Hantz V, Sparsa A, Marin B, Durox H, Bonnetblanc J-M, Bédane C
Service de dermatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
Ann Dermatol Venereol. 2008 Dec;135(12):822-7. doi: 10.1016/j.annder.2008.09.014. Epub 2008 Nov 21.
While the standard treatments for Bowen's disease (BD) (surgery, cryotherapy and antimitotic agents) are efficient, they are associated with extensive scarring. In this paper we confirm that photodynamic therapy using topical aminolevulinic acid provides effective treatment for this disease.
Twenty-two patients with a total of 38 cases of BD were included in this retrospective single-centre study between 2001 and 2006. They were treated with photodynamic therapy using topical aminolevulinic acid (Metvix. The study criteria consisted of patient age and gender, site and area of lesions, number of patients with multiple patches of BD and/or large lesions, tolerance of the treatment, clinical response and quality of wound healing at 3, 6 and 12 months. Annual follow-up was conducted for five years. The probability of remission up to 60 months after treatment was determined by means of survival analysis based on the variable-interval actuarial method.
Seven men and 15 women of median age: 76 years (interquartile range: [69-82]) with 38 cases of Bowen's diseases were treated with photodynamic therapy. In terms of frequency, lesions were seen predominantly on the lower limbs (N=24) and face (N=10). Other lesions were seen on the trunk or back (N=4). The mean surface area of lesions was 8.62 cm2 (1-96 cm2). Eight patients were presenting multiple patches of BD (> or = three lesions), and large lesions were noted in 11 cases. The most common adverse effect was an immediate burning sensation, described by 32% of patients (n=7). Treatment was effective, with remission being achieved in all patients at 3 months of follow-up. Wound healing was optimal and without atrophy or cosmetic sequelae. The remission rate was 100% at 6 months, 95% at 12 months and 85% at 24 months.
This open retrospective study confirmed the good efficacy of photodynamic therapy in the treatment of BD in terms of both clinical remission and cosmetic results. It enables easier treatment of large and/or multiple lesions than surgery. It is more suitable for elderly patients than either topical anticancer drugs, which require prolonged compliance, or surgery and cryotherapy, both of which result in slow-healing postoperative wounds.
Since photodynamic therapy is a very costly therapeutic method, we feel that dynamic phototherapy should be used only for large and/or multifocal lesions or for lesions of the lower limbs in patients with chronic venous insufficiency.
虽然 Bowen 病（BD）的标准治疗方法（手术、冷冻疗法和抗有丝分裂药物）有效，但它们会导致广泛的瘢痕形成。在本文中，我们证实使用外用氨基乙酰丙酸的光动力疗法可为这种疾病提供有效的治疗。
本回顾性单中心研究纳入了 2001 年至 2006 年间的 22 例患者，共 38 例 BD 病例。他们接受了使用外用氨基乙酰丙酸（Metvix）的光动力疗法。研究标准包括患者的年龄和性别、病变部位和面积、患有多个 BD 斑块和/或大病变的患者数量、治疗耐受性、临床反应以及 3、6 和 12 个月时伤口愈合的质量。进行了为期五年的年度随访。通过基于可变间隔精算方法的生存分析确定治疗后长达 60 个月的缓解概率。
7 名男性和 15 名女性，中位年龄为 76 岁（四分位间距：[69 - 82]），共 38 例 Bowen 病患者接受了光动力疗法治疗。从发生频率来看，病变主要见于下肢（n = 24）和面部（n = 10）。其他病变见于躯干或背部（n = 4）。病变的平均表面积为 8.62 cm²（1 - 96 cm²）。8 例患者有多个 BD 斑块（≥3 个病变），11 例有大病变。最常见的不良反应是即时烧灼感，32%的患者（n = 7）有此描述。治疗有效，所有患者在随访 3 个月时均实现缓解。伤口愈合情况最佳，无萎缩或美容后遗症。6 个月时缓解率为 100%，12 个月时为 95%，24 个月时为 85%。
这项开放性回顾性研究证实了光动力疗法在 BD 治疗中在临床缓解和美容效果方面都具有良好的疗效。与手术相比，它能更轻松地治疗大的和/或多个病变。对于老年患者，它比需要长期依从性的外用抗癌药物，以及会导致术后伤口愈合缓慢的手术和冷冻疗法更合适。
由于光动力疗法是一种非常昂贵的治疗方法，我们认为光动力疗法仅应用于大的和/或多灶性病变，或用于患有慢性静脉功能不全患者的下肢病变。
