应用分幅 CO2 激光强化光动力疗法治疗光化性角化病：一项随机临床试验。
Intensified photodynamic therapy of actinic keratoses with fractional CO2 laser: a randomized clinical trial.
机构信息
Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen 2400, Denmark.
出版信息
Br J Dermatol. 2012 Jun;166(6):1262-9. doi: 10.1111/j.1365-2133.2012.10893.x.
BACKGROUND
Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is effective for thin actinic keratoses (AKs) in field-cancerized skin. Ablative fractional laser resurfacing (AFXL) creates vertical channels that facilitate MAL uptake and may improve PDT efficacy.
OBJECTIVES
To evaluate efficacy and safety of AFXL-assisted PDT (AFXL-PDT) compared with conventional PDT in field-directed treatment of AK.
METHODS
Fifteen patients with a total of 212 AKs (severity grade I-III) in field-cancerized skin of the face and scalp were randomized to one treatment with PDT and one treatment with AFXL-PDT in two symmetrical areas. Following curettage of both treatment areas, AFXL was applied to one area using 10 mJ per pulse, 0·12 mm spot, 5% density, single pulse (UltraPulse(®), DeepFx handpiece; Lumenis Inc., Santa Clara, CA, U.S.A.). MAL cream was then applied under occlusion for 3 h and illuminated with red light-emitting diode light at 37 J cm(-2). Fluorescence photography quantified protoporphyrin IX (PpIX) before and after illumination.
RESULTS
At 3-month follow-up, AFXL-PDT was significantly more effective than PDT for all AK grades. Complete lesion response of grade II-III AK was 88% after AFXL-PDT compared with 59% after PDT (P = 0·02). In grade I AK, 100% of lesions cleared after AFXL-PDT compared with 80% after PDT (P = 0·04). AFXL-PDT-treated skin responded with significantly fewer new AK lesions (AFXL-PDT n = 3, PDT n = 11; P = 0·04) and more improved photoageing (moderate vs. minor improvement, P = 0·007) than PDT-treated skin. Pain scores during illumination (6·5 vs. 5·4; P = 0·02), erythema and crusting were more intense, and long-term pigmentary changes more frequent from AFXL-PDT than PDT (P = not significant). PpIX fluorescence was higher in AFXL-pretreated skin [7528 vs. 12,816 arbitrary units (AU); P = 0·003] and photobleached to equal intensities after illumination (AFXL-PDT 595 AU, PDT 454 AU; P = 0·59).
CONCLUSIONS
AFXL-PDT is more effective than conventional PDT for treatment of AK in field-cancerized skin.
背景
采用 5-氨基酮戊酸（MAL）进行光动力疗法（PDT）对皮肤癌前病变的表浅光化性角化病（AK）有效。消融性点阵激光换肤术（AFXL）可产生有利于 MAL 吸收的垂直通道，并可能提高 PDT 疗效。
目的
评估与传统 PDT 相比，AFXL 辅助 PDT（AFXL-PDT）在 AK 的定向区域治疗中的疗效和安全性。
方法
15 例患者，共 212 个 AK（面部和头皮癌前病变皮肤 I-III 级）随机分为 PDT 治疗组和 AFXL-PDT 治疗组，在两个对称区域各进行一次治疗。在对两个治疗区域进行刮除后，在一个区域应用 10 mJ 脉冲、0·12mm 光斑、5%密度、单次脉冲（UltraPulse®，DeepFx 手柄；Lumenis Inc.，美国圣克拉拉）进行 AFXL 治疗。然后，MAL 乳膏在避光下敷用 3 小时，并用红色发光二极管光以 37 J cm(-2) 进行光照。荧光摄影术在光照前后定量测定原卟啉 IX（PpIX）。
结果
在 3 个月的随访中，AFXL-PDT 对所有 AK 分级的疗效均明显优于 PDT。II-III 级 AK 的完全病变反应率，AFXL-PDT 组为 88%，而 PDT 组为 59%（P = 0·02）。I 级 AK 中，AFXL-PDT 组的病灶清除率为 100%，而 PDT 组为 80%（P = 0·04）。与 PDT 治疗皮肤相比，AFXL-PDT 治疗皮肤出现的新发 AK 病变明显更少（AFXL-PDT 组 n = 3，PDT 组 n = 11；P = 0·04），光老化改善程度更明显（中度改善 vs. 轻度改善，P = 0·007）。与 PDT 相比，AFXL-PDT 治疗皮肤的光照期间疼痛评分更高（6·5 分 vs. 5·4 分；P = 0·02）、红斑和结痂更严重，且长期色素沉着改变更频繁（P = 非显著）。经 AFXL 预处理的皮肤 PpIX 荧光强度更高[7528 个 AU 与 12816 个 AU（P = 0·003）]，且光照后荧光强度相等（AFXL-PDT 组为 595 AU，PDT 组为 454 AU；P = 0·59）。
结论
与传统 PDT 相比，AFXL-PDT 治疗皮肤癌前病变的 AK 更有效。
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