Fluminense Federal University, Professor, Faculdade de Medicina Souza Marques, Niterói, Rio de Janeiro, Brazil.
Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
Photodiagnosis Photodyn Ther. 2019 Dec;28:216-220. doi: 10.1016/j.pdpdt.2019.08.034. Epub 2019 Aug 31.
Laser-assisted MAL-PDT has been reported to increase the effectiveness of conventional PDT. Nonetheless, clinical effects of this association when reducing MAL incubation time is poorly discussed. Furthermore, the association of acoustic pressure wave ultrasound with laser-assisted MAL-PDT with short incubation time for field cancerization had not been reported before.
To compare clinical effects of ablative fractional laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound (IMPACT US) with 1-hour incubation time and conventional MAL-PDT for skin field cancerization on the forearms, as well as the impact on safety and tolerability.
Fifteen patients with 638 AK (grade I-III) with field cancerized-skin on the forearms were enrolled in this left-right trial. Two protocols were randomly chosen. One side was treated with conventional MAL-PDT, whereas the other with laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound with 1-hour incubation time. Actinic keratoses were quantitively measured, and the other signs of sun-damaged skin, like pigmentation and texture, in field cancerized skin were qualitatively evaluated before and after six months. Side effects were assessed subjectively during the procedure and one week after.
All patients completed the study. At six months after treatment, both protocols reduced the number of AK (72%; CO2 + PDT, and 65%; MAL-PDT). The difference between these two protocols was not statistically significant (p = 0.77). The improvement of pigmentation and texture of field cancerized skin was more significant on the side treated with laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound. Both protocols were well tolerated and without significant difference in adverse events.
Laser-assisted MAL-PDT using CO2 laser and acoustic pressure wave ultrasound with short incubation time of 1 h was as effective as conventional MAL-PDT for field-cancerized skin with actinic keratosis in forearms with better cosmetic outcome.
激光辅助 MAL-PDT 已被报道可提高常规 PDT 的疗效。然而，当减少 MAL 孵育时间时，这种联合治疗的临床效果讨论甚少。此外，以前没有报道过短孵育时间的声压波超声联合激光辅助 MAL-PDT 用于皮肤癌前病变的情况。
比较前臂皮肤癌前病变 1 小时 MAL-PDT 孵育时间的激光辅助 MAL-PDT 与传统 MAL-PDT 的临床疗效，以及对安全性和耐受性的影响。
本研究纳入了 15 例前臂有 638 个 AK（I-III 级）的患者，这些患者均有皮肤癌前病变。这些患者被分为两组，进行左右侧对照研究。一侧采用传统 MAL-PDT 治疗，另一侧采用激光辅助 MAL-PDT 联合声压波超声，孵育时间为 1 小时。在治疗前后 6 个月，定量测量光化性角化病的数量，并定性评估癌前病变皮肤的其他光老化迹象，如色素沉着和纹理。在治疗过程中和治疗后一周，主观评估不良反应。
所有患者均完成了研究。治疗 6 个月后，两种方案均减少了 AK 的数量（CO2+PDT 组为 72%，MAL-PDT 组为 65%）。这两种方案之间的差异无统计学意义（p=0.77）。激光辅助 MAL-PDT 联合声压波超声治疗组癌前病变皮肤的色素沉着和纹理改善更明显。两种方案均耐受良好，不良反应无显著差异。
激光辅助 MAL-PDT 联合 CO2 激光和声压波超声，孵育时间短至 1 小时，对前臂有光化性角化病的皮肤癌前病变与传统 MAL-PDT 同样有效，且美容效果更好。
