Abstract
Between January 1991 and December 1992 a phase I trial of superficial photodynamic therapy (PDT) using topical application of 5-aminolaevulinic acid (ALA) was undertaken to treat Bowen's disease, superficial basal cell carcinomas (BCCs) and metastatic skin secondaries from breast (adenocarcinoma) or pinna (squamous cell carcinoma). Promising results were obtained with 36 areas of Bowen's disease, with a complete response rate of 89% at a median follow-up of 18 months. The treatment of BCCs was less successful, with 50% complete responses in 16 lesions at a median follow-up of 17 months. Metastatic nodules responded poorly. The treatment was well tolerated and discomfort during light irradiation could be reduced by prior application of 'Emla' cream. Lesions wept for 1-2 weeks following treatment and healed over a period of approximately 2 months. For large areas of Bowen's disease, particularly in anatomically difficult areas and in elderly patients, PDT using ALA may constitute a single simple alternative outpatient treatment to existing therapies. Further work is required to improve the results with BCCs.
Full text
PDFImages in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bedwell J., MacRobert A. J., Phillips D., Bown S. G. Fluorescence distribution and photodynamic effect of ALA-induced PP IX in the DMH rat colonic tumour model. Br J Cancer. 1992 Jun;65(6):818–824. doi: 10.1038/bjc.1992.175. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Blank A. A., Schnyder U. W. Soft-X-ray therapy in Bowen's disease and erythroplasia of Queyrat. Dermatologica. 1985;171(2):89–94. doi: 10.1159/000249398. [DOI] [PubMed] [Google Scholar]
- Charlesworth P., Truscott T. G. The use of 5-aminolevulinic acid (ALA) in photodynamic therapy (PDT). J Photochem Photobiol B. 1993 Apr;18(1):99–100. doi: 10.1016/1011-1344(93)80048-e. [DOI] [PubMed] [Google Scholar]
- Divaris D. X., Kennedy J. C., Pottier R. H. Phototoxic damage to sebaceous glands and hair follicles of mice after systemic administration of 5-aminolevulinic acid correlates with localized protoporphyrin IX fluorescence. Am J Pathol. 1990 Apr;136(4):891–897. [PMC free article] [PubMed] [Google Scholar]
- Dougherty T. J., Kaufman J. E., Goldfarb A., Weishaupt K. R., Boyle D., Mittleman A. Photoradiation therapy for the treatment of malignant tumors. Cancer Res. 1978 Aug;38(8):2628–2635. [PubMed] [Google Scholar]
- GRAHAM J. H., HELWIG E. B. Bowen's disease and its relationship to systemic cancer. AMA Arch Derm. 1959 Aug;80(2):133–159. doi: 10.1001/archderm.1959.01560200001001. [DOI] [PubMed] [Google Scholar]
- Gilson D., Ash D., Driver I., Feather J. W., Brown S. Therapeutic ratio of photodynamic therapy in the treatment of superficial tumours of skin and subcutaneous tissues in man. Br J Cancer. 1988 Nov;58(5):665–667. doi: 10.1038/bjc.1988.282. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jones C. M., Mang T., Cooper M., Wilson B. D., Stoll H. L., Jr Photodynamic therapy in the treatment of Bowen's disease. J Am Acad Dermatol. 1992 Dec;27(6 Pt 1):979–982. doi: 10.1016/0190-9622(92)70298-t. [DOI] [PubMed] [Google Scholar]
- Kennedy J. C., Pottier R. H. Endogenous protoporphyrin IX, a clinically useful photosensitizer for photodynamic therapy. J Photochem Photobiol B. 1992 Jul 30;14(4):275–292. doi: 10.1016/1011-1344(92)85108-7. [DOI] [PubMed] [Google Scholar]
- Kennedy J. C., Pottier R. H., Pross D. C. Photodynamic therapy with endogenous protoporphyrin IX: basic principles and present clinical experience. J Photochem Photobiol B. 1990 Jun;6(1-2):143–148. doi: 10.1016/1011-1344(90)85083-9. [DOI] [PubMed] [Google Scholar]
- Kennedy J. HPD photoradiation therapy for cancer at Kingston and Hamilton. Adv Exp Med Biol. 1983;160:53–62. doi: 10.1007/978-1-4684-4406-3_7. [DOI] [PubMed] [Google Scholar]
- Loh C. S., Bedwell J., MacRobert A. J., Krasner N., Phillips D., Bown S. G. Photodynamic therapy of the normal rat stomach: a comparative study between di-sulphonated aluminium phthalocyanine and 5-aminolaevulinic acid. Br J Cancer. 1992 Sep;66(3):452–462. doi: 10.1038/bjc.1992.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moan J., Berg K. Photochemotherapy of cancer: experimental research. Photochem Photobiol. 1992 Jun;55(6):931–948. doi: 10.1111/j.1751-1097.1992.tb08541.x. [DOI] [PubMed] [Google Scholar]
- Pottier R. H., Chow Y. F., LaPlante J. P., Truscott T. G., Kennedy J. C., Beiner L. A. Non-invasive technique for obtaining fluorescence excitation and emission spectra in vivo. Photochem Photobiol. 1986 Nov;44(5):679–687. doi: 10.1111/j.1751-1097.1986.tb04726.x. [DOI] [PubMed] [Google Scholar]
- Rowe D. E., Carroll R. J., Day C. L., Jr Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol. 1989 Mar;15(3):315–328. doi: 10.1111/j.1524-4725.1989.tb03166.x. [DOI] [PubMed] [Google Scholar]
- Sturm H. M. Bowen's disease and 5-fluorouracil. J Am Acad Dermatol. 1979 Dec;1(6):513–522. doi: 10.1016/s0190-9622(79)80095-x. [DOI] [PubMed] [Google Scholar]
- Wilson B. D., Mang T. S., Stoll H., Jones C., Cooper M., Dougherty T. J. Photodynamic therapy for the treatment of basal cell carcinoma. Arch Dermatol. 1992 Dec;128(12):1597–1601. [PubMed] [Google Scholar]
- Wolf P., Rieger E., Kerl H. Topical photodynamic therapy with endogenous porphyrins after application of 5-aminolevulinic acid. An alternative treatment modality for solar keratoses, superficial squamous cell carcinomas, and basal cell carcinomas? J Am Acad Dermatol. 1993 Jan;28(1):17–21. doi: 10.1016/0190-9622(93)70002-b. [DOI] [PubMed] [Google Scholar]