S C Kanick1, S C Davis2, Y Zhao3, K L Sheehan4, T Hasan5, E V Maytin6, B W Pogue7, M S Chapman4. 1. Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA. Electronic address: stephen.c.kanick@dartmouth.edu. 2. Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA. 3. Thayer School of Engineering, Dartmouth College, Hanover, USA. 4. Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, USA. 5. Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA. 6. Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA; Biomedical Engineering, Cleveland Clinic, Cleveland, USA. 7. Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA; Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA.
Abstract
BACKGROUND: Although aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy (PDT) is an effective FDA-approved therapy for actinic keratosis (AK), a substantial fraction of patients (up to 25%) do not respond to treatment. This study examined the feasibility of using pre-treatment measurements of PpIX concentration in AK lesions to predict response of ALA-PpIX PDT. METHODS: A non-invasive fiber-optic fluorescence spectroscopy system was used to measure PpIX concentration in patients undergoing standard-of-care ALA-PDT for AK. All patients provided assessments of pain at the time of treatment (n=70), and a subset reported pain and erythema 48-76 h after treatment (n=13). RESULTS: PpIX concentration was significantly higher in lesions of patients reporting high levels of pain (VAS score ≥5) immediately after treatment vs. patients reporting pain scores below VAS=5 (p<0.022) (n=70). However, pain was not an exclusive indicator of PpIX concentration as many patients with low PpIX concentration reported high pain. In a subpopulation of patients surveyed in the days after treatment (n=13), PpIX concentration measured on the day of treatment was uncorrelated with pain-reported immediately after treatment (r=0.17, p<0.57), but positive correlations were found between PpIX concentration and patient-reported pain (r=0.55, p<0.051) and erythema (r=0.58, p<0.039) in the 48-72 h following treatment. CONCLUSIONS: These data suggest that in vivo optical measurements of PpIX concentration acquired before light delivery may be an objective predictor of response to ALA-PpIX PDT. Identification of non-responding patients on the day of treatment could facilitate the use of interventions that may improve outcomes.
BACKGROUND: Although aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy (PDT) is an effective FDA-approved therapy for actinic keratosis (AK), a substantial fraction of patients (up to 25%) do not respond to treatment. This study examined the feasibility of using pre-treatment measurements of PpIX concentration in AK lesions to predict response of ALA-PpIX PDT. METHODS: A non-invasive fiber-optic fluorescence spectroscopy system was used to measure PpIX concentration in patients undergoing standard-of-care ALA-PDT for AK. All patients provided assessments of pain at the time of treatment (n=70), and a subset reported pain and erythema 48-76 h after treatment (n=13). RESULTS: PpIX concentration was significantly higher in lesions of patients reporting high levels of pain (VAS score ≥5) immediately after treatment vs. patients reporting pain scores below VAS=5 (p<0.022) (n=70). However, pain was not an exclusive indicator of PpIX concentration as many patients with low PpIX concentration reported high pain. In a subpopulation of patients surveyed in the days after treatment (n=13), PpIX concentration measured on the day of treatment was uncorrelated with pain-reported immediately after treatment (r=0.17, p<0.57), but positive correlations were found between PpIX concentration and patient-reported pain (r=0.55, p<0.051) and erythema (r=0.58, p<0.039) in the 48-72 h following treatment. CONCLUSIONS: These data suggest that in vivo optical measurements of PpIX concentration acquired before light delivery may be an objective predictor of response to ALA-PpIX PDT. Identification of non-responding patients on the day of treatment could facilitate the use of interventions that may improve outcomes.
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