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

详细信息    查看全文

• 作者：Fink-Puches ; Regina ; Hofer ; Angelika ; Smolle ; Josef ; Kerl ; Helmut ; Wolf ; Peter
• 关键词：Photodynamic therapy ; Aminolevulinic acid ; Epicutaneous application ; Primary response ; Follow-up
• 刊名：Journal of Photochemistry and Photobiology B: Biology
• 出版年：1997
• 出版时间：November, 1997
• 年：1997
• 卷：41
• 期：1-2
• 页码：145-151
• 全文大小：635 K

文摘

Photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is based on photosensitization by endogenous synthesis of protoporphyrin 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 study 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 study. Standard treatment involved the topical application of 20 % ALA, under occlusive and light-shielding dressing for 4 hours before exposure to 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 treatments together, the complete response rate for 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, 91 % 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 51 % for full-spectrum visible light and 33 % for the combination 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 (χ²; p = 0.0001). However, due to the treatment protocol the mean light dose applied to lesions on the face, scalp and neck (50 J cm⁻²) was substantially higher than that for lesions on forearms and hands (35 J cm⁻²). In the long term follow-up of SK on face scalp and neck, the 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 full-spectrum visible light at higher light doses may be the most effective and promising form of light exposure in ALA-PDT of SK.