M Tarstedt1, M Gillstedt2, A-M Wennberg Larkö2, J Paoli2. 1. Department of Dermatology, Karlskoga Hospital, Karlskoga, Sweden. 2. Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Abstract
BACKGROUND: Topical photodynamic therapy (PDT) is an effective treatment for superficial non-melanoma skin cancers. Two prodrugs, 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL), are available for clinical use. There is, however, a lack of studies comparing the clinical effectiveness of these two prodrugs. OBJECTIVE: The objective of the study was to compare the clinical response between ALA- and MAL-PDT when treating actinic keratosis (AK), Bowen's disease (BD), nodular basal cell carcinoma (nBCC) and superficial basal cell carcinoma (sBCC). METHODS: During the period 2002-2009, patients with AK, BD, nBCC and sBCC were treated with ALA- and MAL-PDT at the Department of Dermatology at Karlskoga Hospital in Sweden using a fixed protocol. All patients were followed up approximately 6 months after treatment to evaluate the clinical results, which were analysed retrospectively. RESULTS: In total, 116 patients with 203 tumours were treated with PDT during the study period. ALA- and MAL-PDT were used for 24 vs. 44 AK fields, 9 vs. 18 BD lesions, 19 vs. 25 nBCCs and 25 vs. 39 sBCCs. Response rates with ALA- and MAL-PDT, respectively, were 63% and 75% for AK, 89% and 78% for BD, 84% and 84% for nBCC and 88% and 87% for sBCC. There were no statistically significant differences in the complete clinical response rates for ALA- and MAL-PDT when used for any of the four lesion types. CONCLUSION: ALA- and MAL-PDT appear to be equally effective in the treatment of AK, BD, nBCC and sBCC. Nevertheless, larger, prospective, randomized and controlled studies should be carried out to confirm these results.
BACKGROUND: Topical photodynamic therapy (PDT) is an effective treatment for superficial non-melanoma skin cancers. Two prodrugs, 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL), are available for clinical use. There is, however, a lack of studies comparing the clinical effectiveness of these two prodrugs. OBJECTIVE: The objective of the study was to compare the clinical response between ALA- and MAL-PDT when treating actinic keratosis (AK), Bowen's disease (BD), nodular basal cell carcinoma (nBCC) and superficial basal cell carcinoma (sBCC). METHODS: During the period 2002-2009, patients with AK, BD, nBCC and sBCC were treated with ALA- and MAL-PDT at the Department of Dermatology at Karlskoga Hospital in Sweden using a fixed protocol. All patients were followed up approximately 6 months after treatment to evaluate the clinical results, which were analysed retrospectively. RESULTS: In total, 116 patients with 203 tumours were treated with PDT during the study period. ALA- and MAL-PDT were used for 24 vs. 44 AK fields, 9 vs. 18 BD lesions, 19 vs. 25 nBCCs and 25 vs. 39 sBCCs. Response rates with ALA- and MAL-PDT, respectively, were 63% and 75% for AK, 89% and 78% for BD, 84% and 84% for nBCC and 88% and 87% for sBCC. There were no statistically significant differences in the complete clinical response rates for ALA- and MAL-PDT when used for any of the four lesion types. CONCLUSION:ALA- and MAL-PDT appear to be equally effective in the treatment of AK, BD, nBCC and sBCC. Nevertheless, larger, prospective, randomized and controlled studies should be carried out to confirm these results.