Paragh Gyorgy, Zeitouni Nathalie C
1 Department of Dermatology, Roswell Park Cancer Institute , Buffalo, New York.
2 Department of Cell Stress Biology, Roswell Park Cancer Institute , Buffalo, New York.
Photomed Laser Surg. 2018 Mar;36(3):174-176. doi: 10.1089/pho.2017.4351. Epub 2017 Dec 11.
To evaluate the ability of two-step irradiance to maintain pain control during red light 5-aminolevulinic acid (ALA) photodynamic therapy (PDT) for actinic keratoses (AK) and assess factors influencing pain.
PDT provides excellent clinical and cosmetic results in the treatment AK and early basal cell carcinomas (BCC). Widespread use of PDT is limited, in part, by pain. A two-step irradiance method for PDT has previously been shown to significantly reduce PDT-associated pain during the treatment of BCC, but the ability of this method to limit pain during the treatment of AKs has not been reported.
We performed a retrospective chart review to assess the level of pain during AK treatment by red light PDT (n = 99). Natural density filter was used to reduce the irradiance of the light source and initially 10 J/cm dose was delivered at 35 mW/cm and then, 65 J/cm dose was delivered at 70 mW/cm. Pain level was measured using a 10-point visual analog scale at three points during the procedure.
Pain was low to moderate in most patients (mean ± standard error of the mean pain score: 2.35 ± 0.19). Higher pain was seen midprocedure versus at the beginning (p < 0.0001) and at the end (p = 0.003) of PDT. There was no significant difference in pain perception between genders and different treatment areas.
Our results provide evidence that red light ALA PDT of AKs is very well tolerated with the two-step irradiance protocol.
评估两步照射法在红光5-氨基酮戊酸（ALA）光动力疗法（PDT）治疗光化性角化病（AK）过程中维持疼痛控制的能力，并评估影响疼痛的因素。
PDT在治疗AK和早期基底细胞癌（BCC）方面具有出色的临床和美容效果。PDT的广泛应用在一定程度上受到疼痛的限制。先前已证明，PDT的两步照射法在治疗BCC期间可显著减轻与PDT相关的疼痛，但该方法在治疗AK期间限制疼痛的能力尚未见报道。
我们进行了一项回顾性病历审查，以评估红光PDT治疗AK期间的疼痛程度（n = 99）。使用自然密度滤光片降低光源的辐照度，最初以35 mW/cm的功率递送10 J/cm²的剂量，然后以70 mW/cm的功率递送65 J/cm²的剂量。在治疗过程中的三个时间点使用10分视觉模拟量表测量疼痛程度。
大多数患者的疼痛程度为轻度至中度（平均疼痛评分±平均标准误差：2.35±0.19）。与PDT开始时（p < 0.0001）和结束时（p = 0.003）相比，治疗过程中疼痛程度更高。不同性别和不同治疗区域之间的疼痛感知没有显著差异。
我们的结果提供了证据，表明采用两步照射方案时，AK的红光ALA PDT耐受性良好。
