Primary clinical response and long-term follow-up of solar keratoses treated with topically applied 5-aminolevulinic acid and irradiation by different wave bands of light
✍ Scribed by Regina Fink-Puches; Angelika Hofer; Josef Smolle; Helmut Kerl; Peter Wolf
- Publisher
- Elsevier Science
- Year
- 1997
- Tongue
- English
- Weight
- 581 KB
- Volume
- 41
- Category
- Article
- ISSN
- 1011-1344
No coin nor oath required. For personal study only.
✦ Synopsis
Photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is based on photosensitization by endogenous synthesis of protoporphyfin IX and its transient accumulation especially in malignant epithelially derived tissues. Recent studies have indicated that ALA-PDT is effective for the treatment of solar keratoses (SK), but there has been a lack of long-term clinical follow-up. The goal of the present ~udy was to investigate the immediate and long-term effect of ALA-PDT on SK. Twenty-eight patients with a total of 251 SK were enrolled in the s~udy. Standard treatment involved the topical application of 20% ALA, under occlusive and light-shielding dressing for 4 hours before exposure Eo UVA and/or different wave bands or wave band combinations of polychromatic visible light ( full-spectrum visible light, and/or different wave bands of filtered visible light > 515, > 530, > 570, or > 610 nm ) in one or two treatment sessions. The primary complete response rate of SK to ALA-PDT was 64% after one treatment, but 85% when the responses to a second treatment were included. Taken all treamaents together, the complete response rate |br lesions on face, scalp and neck was 93% for full-spectrum visible light, 96% for the combination of full-spectrum visible light and filtered light. 9 ! % for different wave bands of filtered visible light, and 100% for the combination of long wave UVA and full-spectrum visible light, respectively. The complete response rate for lesions on forearms and hands was 5 !% for full-speca'um visible light and 33% for the combinatiot~ of full-spectrum visible light and filtered light. The greater response rate for SK on the face, scalp, and neck was associated with a higher surface fluorescence and immediate response rate after ALA photosensitization at these sites (X~; p =0.0001 ). However, due to the treatment protocol the mean light dose applied to lesions on the face, ~alp and neck (50 J cm--') was substantially higher than that for lesions on forearms and hands (35 J cm--'). In the long term follow-up of SK on face scalp and neck. projected disease-free rate at 36 months after therapy was 71% for lesions treated with full-spectrum visible light versus 23% for lesions treated with different wave bands of filtered light (Log rank -Mantel Cox; p=0.0001 ). These results indicate that treatment with fullspectrum visible light at higher light dt, ses alay b~ ,~,c ino~i ~A|'ct, ti ve and promising form of light exposure in ALA-PDT of SK.