Puizina-Ivić Neira, Zorc Hrvoje, Vanjaka-Rogosić Lucija, Mirić Lina, Persin Antun
Clinic of Dermatovenerology, University Hospital Split, Split, Croatia.
Coll Antropol. 2008 Oct;32 Suppl 2:67-73.
Photodynamic therapy (PDT) is a noninvasive therapy for non-melanoma skin cancer. The aim of this study was comparison of efficacy between fractioned versus single dose illumination in photodynamic therapy (PDT) of actinic keratosis (AK) and Bowen's disease (BD). Fifty-one patients (36 AK and 15 BD) were treated with PDT They were randomly arranged in two treatment groups. Group one included 26 patients (20 AK and 6 BD) that, after five hours of incubation with 20% 5-ALA, were treated with a single illumination of 100 Jcm(-2) at fluence rate of 30 mWcm(-2). Group two included 25 patients (16 AK and 9 BD) that, after 16 hours of incubation with 20% 5-ALA, were treated with two light fractions (50 plus 50 Jcm(-2)) at same fluence rate with dark interval of two hours between fractions. Twenty-four weeks later, a treated area was incubated for four hours again with 5-ALA in order to detect occult areas of abnormal skin with possible remaining tumor tissue. In case of fluorescence, histological examination was performed. In the group one, fluorescence at the end of the session was absent in 19 (73%) or very weak in 7 (27%). Residual tumor was found in 15 (75%) AK and in 4 (66.6%) BD. In the group two, fluorescence at the end of second session was more intense; in one patient (4%) was absent, very weak in 5 (20%) and weak in 19 (76%) of patients. In this group histology revealed remaining tumor tissue in only 2 (12.5%) AK and 2 (22.2%) BD. Among the patients in the first group, the remaining tumor tissue was significantly bigger (p=0.005). The treatment response with clearing of tumor tissue was significantly higher in fractionated illumination than in a single dose illumination group. Fractionated illumination scheme with 16 hours of incubation separated by two hours dark interval significantly improves the therapeutic outcome in tumor eradication.
光动力疗法（PDT）是一种用于非黑色素瘤皮肤癌的非侵入性治疗方法。本研究的目的是比较分次照射与单次照射在光化性角化病（AK）和鲍恩病（BD）的光动力疗法（PDT）中的疗效。51例患者（36例AK和15例BD）接受了PDT治疗。他们被随机分为两个治疗组。第一组包括26例患者（20例AK和6例BD），在与20% 5-氨基酮戊酸（5-ALA）孵育5小时后，以30 mW/cm²的光通量率接受100 J/cm²的单次照射。第二组包括25例患者（16例AK和9例BD），在与20% 5-ALA孵育16小时后，以相同的光通量率接受两次光照射（50 + 50 J/cm²），两次照射之间有两小时的暗间隔。24周后，将治疗区域再次与5-ALA孵育4小时，以检测可能残留肿瘤组织的异常皮肤隐匿区域。如有荧光，则进行组织学检查。在第一组中，治疗结束时19例（73%）无荧光，7例（27%）荧光非常微弱。在15例（75%）AK和4例（66.6%）BD中发现残留肿瘤。在第二组中，第二次治疗结束时荧光更强；1例患者（4%）无荧光，5例（20%）荧光非常微弱，19例（76%）患者荧光微弱。在该组中，组织学检查仅在2例（12.5%）AK和2例（22.2%）BD中发现残留肿瘤组织。在第一组患者中，残留肿瘤组织明显更大（p = 0.005）。分次照射组肿瘤组织清除的治疗反应明显高于单次照射组。16小时孵育、间隔两小时暗间隔的分次照射方案显著改善了肿瘤根除的治疗效果。
