Tanew Adrian, Ristl Robin, Trattner Hannes, Hacker Valentin, Kroyer Bettina, Radakovic Sonja
Private Practice, Vienna, Austria.
Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
J Eur Acad Dermatol Venereol. 2025 Aug;39(8):1460-1467. doi: 10.1111/jdv.20527. Epub 2024 Dec 31.
Conventional photodynamic therapy (cPDT) is an effective treatment option for field cancerization and multiple actinic keratoses (AK). The main side effect of cPDT is pain during illumination which in severe cases might necessitate early termination of treatment. Modification of treatment parameters such as light dose and fluence rate is a promising approach to mitigate PDT-associated pain.
The aim of this study was to compare the efficacy and tolerability of four different cPDT illumination protocols in the treatment of AK in the head region.
Prospective, investigator-blinded, within-patient study on 67 patients with multiple AK in the head region. PDT treatment was performed on comparable target areas with four different settings of illumination: (A) standard light dose and standard fluence rate, (B) standard light dose and halved fluence rate, (C) halved standard light dose and standard fluence rate and (D) halved standard light dose and halved fluence rate. Pain and the intensity of the phototoxic skin reaction was recorded during and after illumination. The clearance rate of the target areas and target lesions was assessed at 12 weeks after PDT. Target areas with incomplete clearance were retreated, those with complete clearance were reassessed at 24 weeks after PDT.
The mean and maximum pain level during illumination was significantly decreased at the lower fluence rates. The phototoxic skin reaction was most pronounced with the standard illumination setting. The overall clearance rate of AK and the clearance rate of the target lesions at 3 months after PDT as well as the number of recurrent or new AK at 6 months after PDT did not differ between four treatment protocols.
Reduction of the fluence rate and/or light dose was associated with less PDT-induced pain and/or shorter exposures times without compromising the therapeutic efficacy of cPDT for AK in the head region.
传统光动力疗法（cPDT）是治疗场癌化和多发性光化性角化病（AK）的有效方法。cPDT的主要副作用是光照期间的疼痛，严重时可能需要提前终止治疗。改变治疗参数，如光剂量和能量密度率，是减轻光动力疗法相关疼痛的一种有前景的方法。
本研究旨在比较四种不同的cPDT光照方案治疗头部区域AK的疗效和耐受性。
对67例头部区域有多发性AK的患者进行前瞻性、研究者盲法、患者内研究。在可比的靶区域采用四种不同的光照设置进行光动力疗法治疗：（A）标准光剂量和标准能量密度率，（B）标准光剂量和减半的能量密度率，（C）减半的标准光剂量和标准能量密度率，以及（D）减半的标准光剂量和减半的能量密度率。在光照期间和之后记录疼痛和光毒性皮肤反应的强度。在光动力疗法后12周评估靶区域和靶病变的清除率。清除不完全的靶区域进行再次治疗，清除完全的在光动力疗法后24周重新评估。
在较低能量密度率下，光照期间的平均和最大疼痛水平显著降低。标准光照设置下光毒性皮肤反应最为明显。四种治疗方案之间，光动力疗法后3个月时AK的总体清除率、靶病变的清除率以及光动力疗法后6个月时复发或新发AK的数量没有差异。
降低能量密度率和/或光剂量与光动力疗法引起的疼痛减轻和/或照射时间缩短相关，且不影响cPDT治疗头部区域AK的疗效。
