BACKGROUND: Topical photodynamic therapy (PDT) using 5-aminolaevulinic acid (ALA) and its methylated ester, methyl aminolevulinate (MAL) is widely used to treat superficial non-melanoma skin cancer (NMSC). It has been proposed that ALA PDT is more painful than MAL PDT. The aim of this paper was to compare pain scores of MAL PDT with ALA PDT in our patients and to analyse the relationship between various parameters and pain during PDT. METHODS: We retrospectively reviewed case notes and electronic records for all patients with superficial NMSC treated with PDT from June 2007 to March 2009. RESULTS: On univariate analysis of patients with single lesions only, we observed no association between pain and lesion diameter or pro-drug or dose or diagnosis. Pre-treatment PpIX fluorescence was significantly associated with pain. However on univariate analysis of all patients (whether single or multiple lesions) treated with PDT, MAL was associated with significantly less pain than ALA. When all the recorded variables were taken into account (multivariate analysis), diagnosis, pre-treatment PpIX fluorescence and lesion diameter were associated with pain. CONCLUSIONS: Our data lends some support to previous published reports suggesting that the MAL PDT regime is less painful than that for ALA PDT. However, PDT pain is multifactorial and choice of photosensitiser is probably not a major pain determining factor. A prospective randomised study, with the same incubation periods for each pro-drug, is needed to definitively answer the question as to whether or not MAL PDT causes less pain than ALA PDT.
BACKGROUND: Topical photodynamic therapy (PDT) using 5-aminolaevulinic acid (ALA) and its methylated ester, methyl aminolevulinate (MAL) is widely used to treat superficial non-melanoma skin cancer (NMSC). It has been proposed that ALA PDT is more painful than MAL PDT. The aim of this paper was to compare pain scores of MAL PDT with ALA PDT in our patients and to analyse the relationship between various parameters and pain during PDT. METHODS: We retrospectively reviewed case notes and electronic records for all patients with superficial NMSC treated with PDT from June 2007 to March 2009. RESULTS: On univariate analysis of patients with single lesions only, we observed no association between pain and lesion diameter or pro-drug or dose or diagnosis. Pre-treatment PpIX fluorescence was significantly associated with pain. However on univariate analysis of all patients (whether single or multiple lesions) treated with PDT, MAL was associated with significantly less pain than ALA. When all the recorded variables were taken into account (multivariate analysis), diagnosis, pre-treatment PpIX fluorescence and lesion diameter were associated with pain. CONCLUSIONS: Our data lends some support to previous published reports suggesting that the MAL PDT regime is less painful than that for ALA PDT. However, PDT pain is multifactorial and choice of photosensitiser is probably not a major pain determining factor. A prospective randomised study, with the same incubation periods for each pro-drug, is needed to definitively answer the question as to whether or not MAL PDT causes less pain than ALA PDT.
Authors: Nathalie C Zeitouni; Ulas Sunar; Daniel J Rohrbach; Anne D Paquette; David A Bellnier; Yi Shi; Gregory Wilding; Thomas H Foster; Barbara W Henderson Journal: Dermatol Surg Date: 2014-12 Impact factor: 3.398
Authors: Ana Luiza Ribeiro de Souza; Ethan LaRochelle; Kayla Marra; Jason Gunn; Scott C Davis; Kimberley S Samkoe; M Shane Chapman; Edward V Maytin; Tayyaba Hasan; Brian W Pogue Journal: Photodiagnosis Photodyn Ther Date: 2017-10-14 Impact factor: 3.631
Authors: Stephen Chad Kanick; Scott C Davis; Yan Zhao; Tayyaba Hasan; Edward V Maytin; Brian W Pogue; M Shane Chapman Journal: J Biomed Opt Date: 2014 Impact factor: 3.170
Authors: Nathalie C Zeitouni; Anne D Paquette; Joseph P Housel; Yi Shi; Gregory E Wilding; Thomas H Foster; Barbara W Henderson Journal: Lasers Surg Med Date: 2013-02-06 Impact factor: 4.025
Authors: S C Kanick; S C Davis; Y Zhao; K L Sheehan; T Hasan; E V Maytin; B W Pogue; M S Chapman Journal: Photodiagnosis Photodyn Ther Date: 2015-10-22 Impact factor: 3.631
Authors: Francesco Borgia; Roberta Giuffrida; Emanuela Caradonna; Mario Vaccaro; Fabrizio Guarneri; Serafinella P Cannavò Journal: Biomedicines Date: 2018-01-29
Authors: Alberto J Ruiz; Ethan Phillip M LaRochelle; Jason R Gunn; Sally M Hull; Tayyaba Hasan; M Shane Chapman; Brian W Pogue Journal: J Biomed Opt Date: 2019-12 Impact factor: 3.170