Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA.
G Ital Dermatol Venereol. 2011 Dec;146(6):431-44.
Topical photodynamic therapy (PDT) has been demonstrated to be an effective and safe treatment option for pre-malignancies such as actinic keratoses (AK) and Bowen's disease (BD), with an increasing amount of evidence indicating good long term outcomes. Studies comparing PDT to other options such as cryotherapy and 5-fluorouracil generally demonstrate that PDT is equal to or better than these therapies with respect to patient satisfaction, cosmesis, and efficacy for AK and BD. While there are studies using squamous cell carcinoma (SCC) cells to elucidate the cellular and molecular mechanisms of PDT, this therapy is currently not indicated for treating SCC and surgery is still the first line of therapy. There has been special interest in using PDT to prevent warts, basal cell carcinoma, AK, and BD in solid organ transplant recipients, as these skin lesions are more common in immunosuppressed patients, and trials have been somewhat successful and very promising. Pain remains an obstacle for some patients and techniques such as nerve blocks, cooling packs, and hydration have been attempted to mitigate pain with an overall reduction in pain scores. Optimizing PDT is still a priority and the delivery of pro-drug as well as induction of cellular differentiation are being explored as ways to improve the efficacy of PDT. Perhaps the most interesting use of PDT in treating SCC is the potential for a tumor-specific vaccine, which is currently being developed.
局部光动力疗法（PDT）已被证明是治疗光化性角化病（AK）和 Bowen 病（BD）等癌前病变的有效且安全的选择，越来越多的证据表明其具有良好的长期疗效。与冷冻疗法和 5-氟尿嘧啶等其他疗法相比，比较 PDT 的研究通常表明，PDT 在患者满意度、美容效果和 AK 及 BD 的疗效方面与这些疗法相当或更好。虽然有使用鳞状细胞癌（SCC）细胞来阐明 PDT 的细胞和分子机制的研究，但该疗法目前不适用于治疗 SCC，手术仍然是一线治疗方法。人们对使用 PDT 预防实体器官移植受者的疣、基底细胞癌、AK 和 BD 特别感兴趣，因为这些皮肤病变在免疫抑制患者中更为常见，并且试验已经取得了一定的成功，前景非常广阔。疼痛仍然是一些患者的障碍，已经尝试了神经阻滞、冷敷包和补液等技术来减轻疼痛，总体上降低了疼痛评分。优化 PDT 仍然是当务之急，正在探索将前药递送至细胞以及诱导细胞分化作为提高 PDT 疗效的方法。也许 PDT 在治疗 SCC 方面最有趣的用途是作为肿瘤特异性疫苗的潜力，目前正在开发中。
