预处理采用消融性分段二氧化碳激光可提高光动力疗法协议对头面部光化性角化病的协同治疗效果。

Pretreatment with ablative fractional carbon dioxide laser improves treatment efficacy in a synergistic PDT protocol for actinic keratoses on the head.

机构信息

CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany.

Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany; Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany.

出版信息

Photodiagnosis Photodyn Ther. 2021 Jun;34:102249. doi: 10.1016/j.pdpdt.2021.102249. Epub 2021 Mar 9.

DOI:10.1016/j.pdpdt.2021.102249

PMID:33711530

Abstract

BACKGROUND

A recently proposed synergistic photodynamic therapy protocol (s-PDT) combining advantages of both conventional- and daylight-PDT proved to be an effective and almost painless treatment for patients with actinic keratoses (AKs). This study investigated the safety and efficacy of an additional ablative fractional CO2-laser (AFXL) pretreatment.

METHODS

28 patients with AKs on the head received s-PDT using 5-aminolevulinic acid. AFXL pretreatment was conducted using the following parameters: pulse energy 8 mJ, spot density 50 spots/cm, power 30 W, beam size 4-18 mm. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) before and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements. Intensity of pain was determined by use of a visual analog scale (VAS).

RESULTS

Most patients (96.4 %) showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (median AKASI 1.6 [0-2.4]) compared to baseline (5.3 [4-7.75]). Median reduction rate was 75.5 % (61.3 %-100 %). Eleven patients (39.3 %) achieved AKASI 100, three (10.7 %) AKASI 75 and ten (35.7 %) AKASI 50. Blood pressure and pulse did not change significantly throughout treatment. Median VAS for pain during irradiation was 0 (0-0), 0 (0-2) and 0 (0-2) at the beginning, in the meantime and at the end, respectively. Compared to data without AFXL pretreatment, this study showed significantly higher AKASI and LC reduction rates (75.5 % vs. 63.7 % [P = 0.023] and 91.3 % vs. 80.4 % [P = 0.043]).

CONCLUSIONS

S-PDT with AFXL pretreatment represents a safe and almost painless treatment for patients with AKs on the head and improves treatment efficacy.

摘要

背景

最近提出的协同光动力疗法方案（s-PDT）结合了常规光动力疗法和日光光动力疗法的优势，已被证明是治疗光化性角化病（AK）患者的有效且几乎无痛的治疗方法。本研究调查了额外的消融性分数 CO2 激光（AFXL）预处理的安全性和有效性。

方法

28 例头部 AK 患者接受 5-氨基酮戊酸 s-PDT。AFXL 预处理采用以下参数：脉冲能量 8mJ，光斑密度 50 个/cm，功率 30W，光束尺寸 4-18mm。通过 AK 面积和严重程度指数（AKASI）和病变计数（LC）在治疗前和治疗后 3 个月进行评估。通过血压和脉搏测量监测安全性。通过使用视觉模拟量表（VAS）确定疼痛强度。

结果

大多数患者（96.4%）在 PDT 后 3 个月（中位数 AKASI 1.6[0-2.4]）与基线（5.3[4-7.75]）相比，AKASI 显著降低（P<0.0001）。中位数降低率为 75.5%（61.3%-100%）。11 例患者（39.3%）达到 AKASI 100，3 例（10.7%）达到 AKASI 75，10 例（35.7%）达到 AKASI 50。治疗过程中血压和脉搏无明显变化。照射过程中疼痛的中位数 VAS 分别为 0（0-0）、0（0-2）和 0（0-2）。与无 AFXL 预处理的数据相比，本研究显示 AKASI 和 LC 降低率显著更高（75.5%比 63.7%[P=0.023]和 91.3%比 80.4%[P=0.043]）。