Cai Hong, Wang Yi-xia, Zheng Ji-Chun, Sun Ping, Yang Zhi-yong, Li Yuan-li, Liu Xiao-yong, Li Qiang, Liu Wei
Department of Dermatology, Air Force General Hospital, PLA, Beijing, 100142, People's Republic of China.
Lasers Med Sci. 2015 Jul;30(5):1505-10. doi: 10.1007/s10103-015-1754-1. Epub 2015 Apr 22.
Photodynamic therapy (PDT) involves the activation of a previously administered photosensitizing agent by visible light to induce tumor necrosis. Photosensitizers are topically applied in the treatment of skin tumors to avoid systemic side effects. In this study, we evaluated the feasibility and efficacy of aminolevulinic acid (ALA) as a photosensitizer (ALA-PDT) in combination with CO2 laser in the treatment of Bowen's disease (BD; intraepithelial squamous cell carcinoma). Twenty-two lesions from 18 patients were randomized into two groups: 11 lesions were treated with topical ALA-PDT (180 J/cm(2) at 100 mW/cm(2)) + CO2 laser for one to three sessions. The remaining 11 lesions were treated with CO2 laser alone, serving as control group. All patients were reviewed at ≤1-week intervals. Biopsies were taken from BD lesions prior to treatment. The initial evaluation was undertaken 1 month after treatment, and biopsies were harvested for histological evaluation. Patients who did not respond to the three sessions of treatment were referred to surgical treatment. In the ALA-PDT + CO2 laser group, 72.73 % (8/11) of BD lesions showed complete remission, with an overall clearance of 90.91 %, and only one recurred (9 %) during follow-up. Local side effects included mild erythema, edema, erosion, and burning and/or stinging sensation. No systemic side effects were observed. In the control group, 63.63 % (7/11) of lesions had complete remission and the overall clearance was 54.55 %. However, five lesions (45.45 %) had recurrence. Local side effects included mild to moderate edema, erosion, ulceration, delayed healing, prolonged pain, and scarring. There existed a significant difference in recurrence rate between the two groups (P < 0.05). Moreover, after ALA-PDT plus CO2 laser treatment, complete necrosis was observed in responsive lesions, and 3 months later, the atypical BD cells were replaced by normal keratinocytes. Topical ALA-PDT in combination with CO2 laser is safe, effective, and is associated with low recurrence and reduced side effects.
光动力疗法（PDT）是通过可见光激活预先给予的光敏剂来诱导肿瘤坏死。光敏剂通过局部应用于皮肤肿瘤治疗，以避免全身副作用。在本研究中，我们评估了氨基乙酰丙酸（ALA）作为光敏剂（ALA-PDT）联合二氧化碳激光治疗鲍恩病（BD；上皮内鳞状细胞癌）的可行性和疗效。将18例患者的22个病灶随机分为两组：11个病灶采用局部ALA-PDT（100 mW/cm²下180 J/cm²）联合二氧化碳激光治疗1至3个疗程。其余11个病灶仅采用二氧化碳激光治疗作为对照组。所有患者每隔≤1周接受复查。在治疗前从BD病灶处取活检组织。治疗1个月后进行初步评估，并采集活检组织进行组织学评估。对三个疗程治疗无反应的患者转至手术治疗。在ALA-PDT联合二氧化碳激光组中，72.73%（8/11）的BD病灶完全缓解，总体清除率为90.91%，随访期间仅1例复发（9%）。局部副作用包括轻度红斑、水肿、糜烂、灼痛和/或刺痛感。未观察到全身副作用。在对照组中，63.63%（7/11）的病灶完全缓解，总体清除率为54.55%。然而，有5个病灶（45.45%）复发。局部副作用包括轻度至中度水肿、糜烂、溃疡、愈合延迟、疼痛持续时间延长和瘢痕形成。两组之间的复发率存在显著差异（P＜0.05）。此外，ALA-PDT加二氧化碳激光治疗后，在有反应的病灶中观察到完全坏死，3个月后，非典型BD细胞被正常角质形成细胞取代。局部ALA-PDT联合二氧化碳激光治疗安全、有效，复发率低且副作用减少。
