Department of Dermatology, Aichi Medical University, Aichi, Japan.
Photodermatol Photoimmunol Photomed. 2012 Jun;28(3):142-6. doi: 10.1111/j.1600-0781.2012.00658.x.
BACKGROUND/PURPOSE: Topical 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) is an effective treatment for Bowen's disease (BD). In order to compare the efficacy of two different light sources, using either an excimer-dye laser (EDL) (630 nm) or a metal-halide lamp (MHL) (600 to 740 nm) a protocol for topical ALA-PDT for treatment of BD of the extremities was established, and responses during 12 months follow-up were assessed.
From 25 patients a total of 26 lesions that had been histopathologically diagnosed as BD from 2005 to 2010 in the Department of Dermatology at the Aichi Medical University Hospital were randomly selected. The light source used for the topical ALA-PDT was EDL in 17 lesions and MHL in 9 lesions. The photosensitizing protoporphyrin IX that is produced within BD lesions 4 h after application of 20% ALA cream was mostly consumed after exposure to 100 J/cm(2) irradiation using 630 nm EDL. Each lesion was irradiated once a week for 3 weeks, for a total dosage of 300 J/cm(2) (100 mW/cm(2)). Patients were followed up clinically every 3 months for 12 months, and at 1 month after the final treatment lesions were evaluated histopathologically.
Histologically, the complete response (CR) rate at 1-month follow-up was 82% (14/17 lesions) in the EDL treatment group and 100% (9/9 lesions) in the MHL treatment group (P > 0.05). The recurrence rate at 12 months after PDT was 46% (6/13 lesions, one patient lost to follow-up) in the EDL group and 0% in the MHL group (P < 0.05) (χ(2) test with Fisher's exact test). The average period before recurrence after EDL treatment was 6.5 months.
A novel protocol for topical ALA-PDT in Japanese in Asian patients with BD was developed and implemented. The protocol improved the CR rate compared with previous studies. Moreover, the present results indicate that the efficacy of topical ALA-PDT using MHL was superior to that using EDL for BD patients.
背景/目的：局部 5-氨基酮戊酸光动力疗法（ALA-PDT）是治疗 Bowen 病（BD）的有效方法。为了比较两种不同光源的疗效，采用准分子染料激光（EDL）（630nm）或金属卤化物灯（MHL）（600 至 740nm）治疗肢端 BD，建立了局部 ALA-PDT 方案，并在 12 个月的随访中评估了疗效。
从 2005 年至 2010 年在爱知医科大学医院皮肤科被组织病理学诊断为 BD 的 25 例患者中随机选择了总共 26 个病变。局部 ALA-PDT 使用的光源在 17 个病变中为 EDL，在 9 个病变中为 MHL。在应用 20%ALA 乳膏后 4 小时内，BD 病变内产生的光敏原卟啉 IX 在暴露于 630nm EDL 照射 100J/cm²后大部分被消耗。每个病变每周照射一次，共 3 周，总剂量为 300J/cm²（100mW/cm²）。患者每 3 个月进行临床随访 12 个月，并在最后一次治疗后 1 个月进行组织病理学评估。
组织学上，在 EDL 治疗组，1 个月随访时的完全缓解（CR）率为 82%（17 个病变中的 14 个），在 MHL 治疗组为 100%（9 个病变中的 9 个）（P>0.05）。在 PDT 后 12 个月时，EDL 组的复发率为 46%（13 个病变中的 6 个，1 个患者失访），MHL 组为 0%（P<0.05）（χ²检验与 Fisher 确切检验）。EDL 治疗后复发的平均时间为 6.5 个月。
为日本和亚洲的 BD 患者制定并实施了一种新的局部 ALA-PDT 方案。该方案与以前的研究相比，提高了 CR 率。此外，本研究结果表明，与 EDL 相比，MHL 治疗 BD 的疗效更好。
