Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON.
J Otolaryngol Head Neck Surg. 2011 Feb;40 Suppl 1:S82-9.
Topical photodynamic therapy (PDT) is a successful treatment for nonmelanotic skin cancers (NMSCs). Nevertheless, surgical excision continues to be the gold standard treatment. Cervicofacial excision often results in functional and aesthetic impairment. We hypothesize that topical PDT as a neoadjuvant therapy to surgical excision may reduce tumour size and subsequently decrease local morbidity.
To determine the utility of PDT in reducing the NMSC area for the purpose of surgical excision.
A prospective cohort study.
Thirty-three basal cell carcinomas with a mean area of 523.11 ± 120.93 mm² and 26 squamous cell carcinomas with a mean area of 357.53 ± 61.96 mm² were included. Of these lesions, 22 demonstrated a complete curative response after an average of two PDT treatments, which were then confirmed with histologically negative biopsies. The remaining lesions demonstrated a partial response to topical PDT with a maximum reduction in lesion area following an average of three PDT treatments of at least 88% (p < .05). These lesions were then excised with clear histologic margins. Follow-up at 1 year for all lesions demonstrated no locoregional recurrence.
This is the first study to investigate the efficacy of neoadjuvant topical PDT in the management of NMSC. The results suggest that for NMSC not demonstrating a complete curative response to PDT, neoadjuvant PDT can substantially reduce tumour burden, allowing for less morbid surgical excisions with histologically clear margins.
局部光动力疗法（PDT）是治疗非黑素瘤皮肤癌（NMSC）的成功方法。然而，手术切除仍然是金标准治疗。颈面部切除常常导致功能和美容损伤。我们假设局部 PDT 作为手术切除的辅助治疗可以减少肿瘤大小，从而降低局部发病率。
确定 PDT 在减少 NMSC 手术切除面积方面的作用。
前瞻性队列研究。
纳入 33 例基底细胞癌，平均面积为 523.11 ± 120.93mm²，26 例鳞状细胞癌，平均面积为 357.53 ± 61.96mm²。这些病变中，22 例在平均 2 次 PDT 治疗后表现出完全治愈反应，随后活检证实为阴性。其余病变对局部 PDT 有部分反应，在平均 3 次 PDT 治疗后，病变面积最大减少至少 88%（p <.05）。然后用切缘无肿瘤的组织学边缘切除这些病变。所有病变在 1 年的随访中均无局部区域复发。
这是第一项研究局部 PDT 在 NMSC 管理中的疗效的研究。结果表明，对于 PDT 治疗未完全治愈的 NMSC，辅助性 PDT 可以显著降低肿瘤负担，使组织学上切缘无肿瘤的手术切除范围更小，发病率更低。
