Vignion-Dewalle Anne-Sophie, Baert Gregory, Devos Laura, Thecua Elise, Vicentini Claire, Mortier Laurent, Mordon Serge
Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.
Lasers Surg Med. 2017 Sep;49(7):686-697. doi: 10.1002/lsm.22665. Epub 2017 Apr 2.
Photodynamic therapy (PDT) is an emerging treatment modality for various diseases, especially for dermatological conditions. Although, the standard PDT protocol for the treatment of actinic keratoses in Europe has shown to be effective, treatment-associated pain is often observed in patients. Different modifications to this protocol attempted to decrease pain have been investigated. The decrease in fluence rate seems to be a promising solution. Moreover, it has been suggested that light fractionation significantly increases the efficacy of PDT. Based on a flexible light-emitting textile, the FLEXITHERALIGHT device specifically provides a fractionated illumination at a fluence rate more than six times lower than that of the standard protocol. In a recently completed clinical trial of PDT for the treatment of actinic keratosis, the non-inferiority of a protocol involving illumination with the FLEXITHERALIGHT device after a short incubation time and referred to as the FLEXITHERALIGHT protocol has been assessed compared to the standard protocol. In this paper, we propose a comparison of the two above mentioned 635 nm red light protocols with 37 J/cm in the PDT treatment of actinic keratosis: the standard protocol and the FLEXITHERALIGHT one through a mathematical modeling.
This mathematical modeling, which slightly differs from the one we have already published, enables the local damage induced by the therapy to be estimated.
The comparison performed in terms of the local damage induced by the therapy demonstrates that the FLEXITHERALIGHT protocol with lower fluence rate, light fractionation and shorter incubation time is somewhat less efficient than the standard protocol. Nevertheless, from the clinical trial results, the FLEXITHERALIGHT protocol results in non-inferior response rates compared to the standard protocol.
This finding raises the question of whether the PDT local damage achieved by the FLEXITHERALIGHT protocol (respectively, the standard protocol) is sufficient (respectively, excessive) to destroy actinic keratosis cells. Lasers Surg. Med. 49:686-697, 2017. © 2017 Wiley Periodicals, Inc.
光动力疗法（PDT）是一种针对多种疾病，尤其是皮肤病的新兴治疗方式。尽管欧洲治疗光化性角化病的标准PDT方案已证明有效，但患者常出现与治疗相关的疼痛。人们对该方案进行了不同的改进以试图减轻疼痛。降低光通量率似乎是一个有前景的解决方案。此外，有人提出光分割显著提高了PDT的疗效。基于一种柔性发光纺织品的FLEXITHERALIGHT设备特别提供了一种光分割照明，其光通量率比标准方案低六倍以上。在最近完成的一项PDT治疗光化性角化病的临床试验中，已评估了一种在短孵育时间后使用FLEXITHERALIGHT设备照明的方案（称为FLEXITHERALIGHT方案）与标准方案相比的非劣效性。在本文中，我们通过数学建模对上述两种在PDT治疗光化性角化病中光通量为37 J/cm²的635 nm红光方案进行比较：标准方案和FLEXITHERALIGHT方案。
这种数学建模与我们已发表的模型略有不同，能够估计该疗法引起的局部损伤。
根据该疗法引起的局部损伤进行的比较表明，光通量率较低、光分割且孵育时间较短的FLEXITHERALIGHT方案在效率上略低于标准方案。然而，从临床试验结果来看，FLEXITHERALIGHT方案与标准方案相比，应答率具有非劣效性。
这一发现提出了一个问题，即FLEXITHERALIGHT方案（分别为标准方案）实现的PDT局部损伤是否足以（分别为过度）破坏光化性角化病细胞。《激光外科与医学》49:686 - 697, 2017。© 2017威利期刊公司
