1
|
Ong FLL, Loh CH, Oh CC. Wearable devices for photodynamic therapy - A systematic review. JAAD Int 2023; 11:59-62. [PMID: 36865616 PMCID: PMC9972365 DOI: 10.1016/j.jdin.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Chee Hoou Loh
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Correspondence to: Choon Chiat Oh, MBBS, FRCP, MSc, Department of Dermatology, Level 4, Academia, Singapore General Hospital, 20 College Rd, Singapore 169856
| |
Collapse
|
2
|
Gálvez END, Aguilera J, Fonda-Pascual P, de Gálvez MV, de Andrés-Díaz JR, Vidal-Asensi S, Herrera-Acosta E, Gago-Calderon A. Analysis and evaluation of the operational characteristics of a new photodynamic therapy device. Photodiagnosis Photodyn Ther 2022; 37:102719. [PMID: 35021108 DOI: 10.1016/j.pdpdt.2022.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/19/2021] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
One of the key aspects of photodynamic therapy is the light source that is used to irradiate the lesion to be treated. The devices used must ensure that their emission spectrum matches the absorption spectrum of the photosensitizer, so that treatment radiation is delivered only on the injured area, without irradiating healthy tissue at superficial or deep levels. Irradiance values must be adequate in order to avoid thermal damage, exceed the oxygen replenishment rate and avoid long treatment times. Furthermore, the device should be user-friendly, inexpensive, and able to be adapted to different photosensitizers. We have developed an easy-to-use and highly customizable device based on LED technology. Its innovative geometric design allows radiation to be delivered to a small treatment surface, since the LEDs are arranged in three arms, the configuration of which directs their radiation on the treatment point. Different high-power color LEDs are disposed on the arms, and can be independently selected based on the most effective wavelengths for exciting the different photodynamic therapy photosensitizers. We have tested the prototype in 5 different patients (1 actinic keratose, 1 actinic cheilitis, 1 superficial basal cell carcinoma and 2 Bowen's disease) and after 1-2 sessions of total cumulative dose of 25-50 J / cm2, 100% clearance of lesions were obtained. Our device can be used by any professional in the field, whether for medical or research purposes. It facilitates the development of treatment protocols and trials with different photosensitizers.
Collapse
Affiliation(s)
- Enrique Navarrete-de Gálvez
- Project Engineering Area, Department of Graphic Expression Design and Projects, University of Málaga, Málaga, Spain
| | - José Aguilera
- Photobiological Dermatology Laboratory Medical Research Centre, Department of Dermatology and Medicine, School of Medicine, University of Málaga, Málaga, Spain.
| | | | - María Victoria de Gálvez
- Photobiological Dermatology Laboratory Medical Research Centre, Department of Dermatology and Medicine, School of Medicine, University of Málaga, Málaga, Spain
| | - José Ramón de Andrés-Díaz
- Project Engineering Area, Department of Graphic Expression Design and Projects, University of Málaga, Málaga, Spain
| | | | - Enrique Herrera-Acosta
- Photobiological Dermatology Laboratory Medical Research Centre, Department of Dermatology and Medicine, School of Medicine, University of Málaga, Málaga, Spain; Dermatology Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Alfonso Gago-Calderon
- Project Engineering Area, Department of Graphic Expression Design and Projects, University of Málaga, Málaga, Spain
| |
Collapse
|
3
|
Ibbotson SH, Ferguson J, Moseley H, Samuel IDW, Lesar A, Dawe RS. A Randomised Assessor Blinded Comparison of Low Irradiance and Conventional Irradiance Photodynamic Therapy for Superficial Basal Cell Carcinoma and Bowen's Disease. Br J Dermatol 2021; 186:577-579. [PMID: 34545565 DOI: 10.1111/bjd.20762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/26/2022]
Abstract
The inconvenience and pain of hospital-based photodynamic therapy (PDT) is sometimes limiting.1 We developed very low irradiance LEDs for ambulatory PDT. Preliminary studies showed this to be convenient and relatively painless.1-4 Here we evaluate the Ambulight® device (Ambicare Health Ltd) in a randomised controlled assessor-blinded study comparing low irradiance ambulatory PDT (APDT) with conventional PDT (CPDT) for superficial basal cell carcinoma (SBCC) and Bowen's disease (BD) (lesions ≤2cm).
Collapse
Affiliation(s)
- S H Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - J Ferguson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - H Moseley
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - I D W Samuel
- School of Physics and Astronomy, SUPA, University of St Andrews, St Andrews, Fife, UK
| | - A Lesar
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - R S Dawe
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| |
Collapse
|
4
|
Prosa M, Bolognesi M, Fornasari L, Grasso G, Lopez-Sanchez L, Marabelli F, Toffanin S. Nanostructured Organic/Hybrid Materials and Components in Miniaturized Optical and Chemical Sensors. Nanomaterials (Basel) 2020; 10:E480. [PMID: 32155993 PMCID: PMC7153587 DOI: 10.3390/nano10030480] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 01/16/2023]
Abstract
In the last decade, biochemical sensors have brought a disruptive breakthrough in analytical chemistry and microbiology due the advent of technologically advanced systems conceived to respond to specific applications. From the design of a multitude of different detection modalities, several classes of sensor have been developed over the years. However, to date they have been hardly used in point-of-care or in-field applications, where cost and portability are of primary concern. In the present review we report on the use of nanostructured organic and hybrid compounds in optoelectronic, electrochemical and plasmonic components as constituting elements of miniaturized and easy-to-integrate biochemical sensors. We show how the targeted design, synthesis and nanostructuring of organic and hybrid materials have enabled enormous progress not only in terms of modulation and optimization of the sensor capabilities and performance when used as active materials, but also in the architecture of the detection schemes when used as structural/packing components. With a particular focus on optoelectronic, chemical and plasmonic components for sensing, we highlight that the new concept of having highly-integrated architectures through a system-engineering approach may enable the full expression of the potential of the sensing systems in real-setting applications in terms of fast-response, high sensitivity and multiplexity at low-cost and ease of portability.
Collapse
Affiliation(s)
- Mario Prosa
- Institute of Nanostructured Materials (ISMN), National Research Council (CNR), via P. Gobetti 101, 40129 Bologna, Italy; (M.P.); (M.B.)
| | - Margherita Bolognesi
- Institute of Nanostructured Materials (ISMN), National Research Council (CNR), via P. Gobetti 101, 40129 Bologna, Italy; (M.P.); (M.B.)
| | - Lucia Fornasari
- Plasmore s.r.l., viale Vittorio Emanuele II 4, 27100 Pavia, Italy; (L.F.); (L.L.-S.)
| | - Gerardo Grasso
- Institute of Nanostructured Materials (ISMN), National Research Council (CNR) c/o Department of Chemistry, ‘Sapienza’ University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Laura Lopez-Sanchez
- Plasmore s.r.l., viale Vittorio Emanuele II 4, 27100 Pavia, Italy; (L.F.); (L.L.-S.)
| | - Franco Marabelli
- Physics Department, University of Pavia, via A. Bassi 6, 27100 Pavia, Italy;
| | - Stefano Toffanin
- Institute of Nanostructured Materials (ISMN), National Research Council (CNR), via P. Gobetti 101, 40129 Bologna, Italy; (M.P.); (M.B.)
| |
Collapse
|
5
|
Vicentini C, Vignion-Dewalle AS, Thecua E, Lecomte F, Béhal H, Maire C, Tylcz JB, Abi-Rached H, Mortier L, Mordon S. Photodynamic therapy for actinic keratosis of the forehead and scalp with the Aktilite CL 128: Is there a cut-off value for PpIX-weighted irradiance for effective treatment? Photodermatol Photoimmunol Photomed 2019; 35:232-237. [DOI: 10.1111/phpp.12457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/22/2019] [Accepted: 02/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Claire Vicentini
- Univ. Lille, INSERM, CHU Lille; U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology; Lille France
- Department of Dermatology; CHU Lille; Lille France
| | | | - Elise Thecua
- Univ. Lille, INSERM, CHU Lille; U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology; Lille France
| | - Fabienne Lecomte
- Univ. Lille, INSERM, CHU Lille; U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology; Lille France
| | - Hélène Béhal
- Univ. Lille, CHU Lille; EA 2694 - Santé Publique: épidémiologie et qualité des soins; Unité de Biostatistiques; Lille France
| | - Cyril Maire
- Univ. Lille, INSERM, CHU Lille; U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology; Lille France
- Department of Dermatology; CHU Lille; Lille France
| | - Jean-Baptiste Tylcz
- Univ. Lille, INSERM, CHU Lille; U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology; Lille France
| | - Henry Abi-Rached
- Univ. Lille, INSERM, CHU Lille; U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology; Lille France
- Department of Dermatology; CHU Lille; Lille France
| | - Laurent Mortier
- Univ. Lille, INSERM, CHU Lille; U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology; Lille France
- Department of Dermatology; CHU Lille; Lille France
| | - Serge Mordon
- Univ. Lille, INSERM, CHU Lille; U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology; Lille France
| |
Collapse
|
6
|
Fonda-Pascual P, Alegre-Sánchez A, Harto-Castaño A, Moreno-Arrones OM, Pérez-García B, González-Morales ML, Pindado-Ortega C, Gilaberte-Calzada Y, Aguilera J, Jaen-Olasolo P, Fernández-Guarino M. Low-level light-assisted photodynamic therapy using a wearable cap-like device for the treatment of actinic keratosis of the scalp. Photodiagnosis Photodyn Ther 2018; 25:136-141. [PMID: 30508663 DOI: 10.1016/j.pdpdt.2018.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/16/2018] [Accepted: 11/02/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation, minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent. METHODS In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test. RESULTS In all patients we observed a global reduction in the number of AK lesions (71%; p < 0.0001) and AKQoL score (from 5.6 to 4.4; p = 0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment. CONCLUSION PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - José Aguilera
- Dermal Photobiology Laboratory, Medical Research Center, School of Medicine, University of Malaga, E-29071, Málaga, Spain.
| | | | | |
Collapse
|
7
|
Wong TH, Morton CA, Collier N, Haylett A, Ibbotson S, McKenna KE, Mallipeddi R, Moseley H, Seukeran DC, Rhodes LE, Ward KA, Mohd Mustapa MF, Exton LS. British Association of Dermatologists and British Photodermatology Group guidelines for topical photodynamic therapy 2018. Br J Dermatol 2018; 180:730-739. [PMID: 30506819 DOI: 10.1111/bjd.17309] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
Affiliation(s)
- T H Wong
- Stirling Community Hospital, Stirling, FK8 2AU, U.K
| | - C A Morton
- Stirling Community Hospital, Stirling, FK8 2AU, U.K
| | - N Collier
- Photobiology Unit, Dermatology Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, M6 8HD, U.K
| | - A Haylett
- Photobiology Unit, Dermatology Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, M6 8HD, U.K
| | - S Ibbotson
- Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - K E McKenna
- Department of Dermatology, Belfast City Hospital, Belfast, BT9 7AB, U.K
| | - R Mallipeddi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - H Moseley
- Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - D C Seukeran
- The James Cook University Hospital, Middleborough, TS4 3BW, U.K
| | - L E Rhodes
- Photobiology Unit, Dermatology Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, M6 8HD, U.K
| | - K A Ward
- Cannock Chase Hospital, Cannock, WS11 5XY, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| |
Collapse
|
8
|
|
9
|
Ibbotson S, Wong T, Morton C, Collier N, Haylett A, McKenna K, Mallipeddi R, Moseley H, Rhodes L, Seukeran D, Ward K, Mohd Mustapa M, Exton L. Adverse effects of topical photodynamic therapy: a consensus review and approach to management. Br J Dermatol 2018; 180:715-729. [DOI: 10.1111/bjd.17131] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 12/21/2022]
Affiliation(s)
- S.H. Ibbotson
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital and Medical School Dundee U.K
| | - T.H. Wong
- Stirling Community Hospital StirlingU.K
| | | | - N.J. Collier
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | - A. Haylett
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | - K.E. McKenna
- Department of Dermatology Belfast City Hospital BelfastU.K
| | - R. Mallipeddi
- St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
| | - H. Moseley
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital and Medical School Dundee U.K
| | - L.E. Rhodes
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | | | | | | | - L.S. Exton
- British Association of Dermatologists London U.K
| |
Collapse
|
10
|
Collier NJ, Haylett AK, Wong TH, Morton CA, Ibbotson SH, McKenna KE, Mallipeddi R, Moseley H, Seukeran D, Ward KA, Mohd Mustapa MF, Exton LS, Green AC, Rhodes LE. Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis. Br J Dermatol 2018; 179:1277-1296. [PMID: 29889302 DOI: 10.1111/bjd.16838] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is an established treatment option for low-risk basal cell carcinoma (BCC). OBJECTIVES To compare efficacy, cosmesis and tolerability of PDT for BCC with alternative treatments. METHODS MEDLINE, PubMed, Embase and CENTRAL databases were searched from inception until 1 September 2017. Included studies were randomized controlled trials (RCTs) of PDT for nodular (n) and superficial (s) BCC reporting at least one of the following outcomes: clearance at 3 months and sustained at 1 or 5 years; recurrence at ≥ 1 year; cosmesis; adverse events; tolerability. RESULTS From 2331 search results, 15 RCTs (2327 patients; 3509 BCCs) were included. PDT efficacy (5-year sustained clearance) was high but inferior to excisional surgery [nBCC pooled risk ratio (RR) 0·76; 95% confidence interval (CI) 0·63-0·91], and without re-treatment of partially responding lesions, was modestly inferior to imiquimod (sBCC: RR 0·81; 95% CI 0·70-0·95) and similar to fluorouracil (sBCC: RR 0·88; 95% CI 0·75-1·04). Five-year sustained clearance was inferior with conventional vs. fractionated PDT (sBCC: RR 0·76; 95% CI 0·68-0·84). PDT cosmesis was superior to surgery (sBCC: RR 1·68, 95% CI 1·32-2·14; nBCC: RR 1·82, 95% CI 1·19-2·80) and cryosurgery (BCC: RR 3·73, 95% CI 1·96-7·07), and without re-treatment of partially responding lesions was similar to imiquimod (sBCC: RR 1·01, 95% CI 0·85-1·19) and fluorouracil (sBCC: RR 1·04, 95% CI 0·88-1·24). Peak pain was higher but of shorter duration with PDT than topical treatments. Serious adverse reactions were rarer with PDT than imiquimod (sBCC: RR 0·05, 95% CI 0·00-0·84) and fluorouracil (sBCC: RR 0·11, 95% CI 0·01-2·04). Combination PDT regimens demonstrated reduced recurrence and improved cosmesis; however, results from these small studies were often nonsignificant. CONCLUSIONS PDT is an effective treatment for low-risk BCC, with excellent cosmesis and safety. Imiquimod has higher efficacy than single-cycle PDT but more adverse effects. Highest efficacy is with excisional surgery. Fractionated and combination PDT options warrant further study.
Collapse
Affiliation(s)
- N J Collier
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - A K Haylett
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - T H Wong
- Stirling Community Hospital, Stirling, U.K
| | - C A Morton
- Stirling Community Hospital, Stirling, U.K
| | - S H Ibbotson
- The Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital & Medical School, Dundee, U.K
| | - K E McKenna
- Department of Dermatology, Belfast City Hospital, Belfast, U.K
| | - R Mallipeddi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - H Moseley
- The Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital & Medical School, Dundee, U.K
| | - D Seukeran
- The James Cook University Hospital, Middlesborough, U.K
| | - K A Ward
- Cannock Chase Hospital, Cannock, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, U.K
| | - A C Green
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K.,CR-UK Manchester Institute, The University of Manchester, Manchester, U.K.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - L E Rhodes
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| |
Collapse
|
11
|
Vignion-Dewalle AS, Baert G, Thecua E, Lecomte F, Vicentini C, Abi-Rached H, Mortier L, Mordon S. Comparison of 10 efficient protocols for photodynamic therapy of actinic keratosis: How relevant are effective light dose and local damage in predicting the complete response rate at 3 months? Lasers Surg Med 2018; 50:576-589. [PMID: 29667728 DOI: 10.1002/lsm.22827] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Topical photodynamic therapy is an established treatment modality for various dermatological conditions, including actinic keratosis. In Europe, the approved protocols for photodynamic therapy of actinic keratosis involve irradiation with either an Aktilite CL 128 lamp or daylight, whereas irradiation with the Blu-U illuminator is approved in the United States. Many other protocols using irradiation by a variety of light sources are also clinically efficient. OBJECTIVES This paper aims to compare 10 different protocols with clinically proven efficacy for photodynamic therapy of actinic keratosis and the available spectral irradiance of the light source. Effective irradiance, effective light dose, and local damage are compared. We also investigate whether there is an association between the complete response rate at 3 months and the effective light dose or local damage. METHODS The effective irradiance, also referred to as protoporphyrin IX-weighted irradiance, is obtained by integrating the spectral irradiance weighted by the normalized absorption spectrum of protoporphyrin IX over the wavelength. Integrating the effective irradiance over the irradiation time yields the effective light dose, which is also known as the protoporphyrin IX-weighted light dose. Local damage, defined as the total cumulative singlet oxygen molecules produced during treatment, is estimated using mathematical modeling of the photodynamic therapy process. This modeling is based on an iterative procedure taking into account the spatial and temporal variations in the protoporphyrin IX absorption spectrum during treatment. RESULTS The protocol for daylight photodynamic therapy on a clear sunny day, the protocol for daylight photodynamic therapy on an overcast day, the photodynamic therapy protocol for a white LED lamp for operating rooms and the photodynamic therapy protocol for the Blu-U illuminator perform better than the six other protocols-all involving red light illumination-in terms of both effective light dose and local damage. However, no association between the complete response rate at 3 months and the effective light dose or local damage was found. CONCLUSIONS Protocols that achieve high complete response rates at 3 months and low pain scores should be preferred regardless of the effective light dose and local damage. Lasers Surg. Med. 50:576-589, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Anne-Sophie Vignion-Dewalle
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
| | - Gregory Baert
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
| | - Elise Thecua
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
| | - Fabienne Lecomte
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
| | - Claire Vicentini
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France.,Department of Dermatology, CHU Lille, Lille, F-5900, France
| | - Henry Abi-Rached
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France.,Department of Dermatology, CHU Lille, Lille, F-5900, France
| | - Laurent Mortier
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France.,Department of Dermatology, CHU Lille, Lille, F-5900, France
| | - Serge Mordon
- Univ. Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
| |
Collapse
|
12
|
|
13
|
Lima CA, Goulart VP, Bechara EJH, Correa L, Zezell DM. Optimization and therapeutic effects of PDT mediated by ALA and MAL in the treatment of cutaneous malignant lesions: A comparative study. J Biophotonics 2016; 9:1355-1361. [PMID: 27653310 DOI: 10.1002/jbio.201600164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/01/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
5-aminolevulinic acid (ALA) and its methylated ester (MAL) are the most common topical agents used in photodynamic therapy (PDT) as precursors of the photosensitizer protoporphyrin IX (PpIX). The induction of newly PpIX depends on incubation time of each photosensitizer in the tissue and the presence of high intralesional porphyrin levels is an important parameter for the PDT effectiveness. This study used laser-induced fluorescence (LIF) spectroscopy to evaluate the optimum time to light exposure of PDT mediated by ALA (20% w/w) and MAL (10% w/w) to treat malignant lesions precursors of cutaneous squamous cell carcinoma induced in mice. The therapeutic effects obtained by optimized ALA- and MAL-PDT were assessed 10 and 20 days after treatments. Higher PpIX levels were evidenced in the lesions photosensitized by ALA than MAL and according to LIF measurements the PDT irradiation was performed, respectively, at 300 and 330 minutes after ALA and MAL incubation. Histopathological analysis evidenced necrosis and epithelial atrophy after 10 days of PDT using both prodrugs, as well as reepitelization and collagen deposition at 20 days. Thus, despite the distinct concentration of ALA and MAL used in the formulation of each photosensitizing cream, PDT mediated by both photosensitizing agents obtained similar therapeutic outcomes.
Collapse
Affiliation(s)
- Cassio Aparecido Lima
- Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Universidade de Sao Paulo, Av. Prof. Lineu Prestes 2242, 05508-000, Sao Paulo-SP, Brazil
| | - Viviane Pereira Goulart
- Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Universidade de Sao Paulo, Av. Prof. Lineu Prestes 2242, 05508-000, Sao Paulo-SP, Brazil
| | | | - Luciana Correa
- Faculdade de Odontologia, Universidade de Sao Paulo, Av. Prof. Lineu Prestes 2227, 05508-000, Sao Paulo-SP, Brazil
| | - Denise Maria Zezell
- Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Universidade de Sao Paulo, Av. Prof. Lineu Prestes 2242, 05508-000, Sao Paulo-SP, Brazil
| |
Collapse
|
14
|
Abstract
Kennedy and Pottier discovered that photodynamic therapy (PDT) could be carried out using a procedure consisting of topical application of the porphyrin-precursor, 5-aminolevulinic acid (ALA) to the skin, followed after some time by illumination with various light parameters in the 1980s. Since then, ALA-PDT has expanded enormously and now covers most aspects of dermatological disease. The purpose of this review is to discuss a range of ingenious strategies that investigators have devised for improving the overall outcome (higher efficiency and lower side effects) of ALA-PDT. The big advance of using ALA esters instead of the free acid to improve skin penetration was conceived in the 1990s. A variety of more recent innovative approaches can be divided into three broad groups: (a) those relying on improving delivery or penetration of ALA into the skin; (b) those relying on ways to increase the synthesis of protoporphyrin IX inside the skin; (c) those relying on modification of the illumination parameters. In the first group, we have improved delivery of ALA with penetration-enhancing chemicals, iontophoresis, intracutaneous injection, or fractionated laser. There is also a large group of nanotechnology-related approaches with ALA being delivered using liposomes/ethosomes, ALA dendrimers, niosomes, mesoporous silica nanoparticles, conjugated gold nanoparticles, polymer nanoparticles, fullerene nanoparticles, and carbon nanotubes. In the second group, we can find the use of cellular differentiating agents, the use of iron chelators, and the effect of increasing the temperature. In the third group, we find methods designed to reduce pain as well as improve efficiency including fractionated light, daylight PDT, and wearable light sources for ambulatory PDT. This active area of research is expected to continue to provide a range of intriguing possibilities.
Collapse
Affiliation(s)
- Connor Thunshelle
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard College, Cambridge, MA 02138, USA
| | - Rui Yin
- Southwest Hospital, Third Military Medical University, Chongqing 40038, China
| | - Qiquan Chen
- Southwest Hospital, Third Military Medical University, Chongqing 40038, China
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
| |
Collapse
|
15
|
Fonda-Pascual P, Moreno-Arrones OM, Alegre-Sanchez A, Saceda-Corralo D, Buendia-Castaño D, Pindado-Ortega C, Fernandez-Gonzalez P, Velazquez-Kennedy K, Calvo-Sánchez MI, Harto-Castaño A, Perez-Garcia B, Bagazgoitia L, Vaño-Galvan S, Espada J, Jaen-Olasolo P. In situ production of ROS in the skin by photodynamic therapy as a powerful tool in clinical dermatology. Methods 2016; 109:190-202. [PMID: 27422482 DOI: 10.1016/j.ymeth.2016.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/17/2022] Open
Abstract
Photodynamic therapy (PDT) is a clinical modality of photochemotherapy based on the accumulation of a photosensitizer in target cells and subsequent irradiation of the tissue with light of adequate wavelength promoting reactive oxygen species (ROS) formation and cell death. PDT is used in several medical specialties as an organ-specific therapy for different entities. In this review we focus on the current dermatological procedure of PDT. In the most widely used PDT protocol in dermatology, ROS production occurs by accumulation of the endogenous photosensitizer protoporphyrin IX after treatment with the metabolic precursors 5-methylaminolevulinic acid (MAL) or 5-aminolevulinic acid (ALA). To date, current approved dermatological indications of PDT include actinic keratoses (AK), basal cell carcinoma (BCC) and in situ squamous cell carcinoma (SCC) also known as Bowen disease (BD). With regards to AKs, PDT can also treat the cancerization field carrying an oncogenic risk. In addition, an increasing number of pathologies, such as other skin cancers, infectious, inflammatory or pilosebaceous diseases are being considered as potentially treatable entities with PDT. Besides the known therapeutic properties of PDT, there is a modality used for skin rejuvenation and aesthetic purposes defined as photodynamic photorejuvenation. This technique enables the remodelling of collagen, which in turn prevents and treats photoaging stygmata. Finally we explore a new potential treatment field for PDT determined by the activation of follicular bulge stem cells caused by in situ ROS formation.
Collapse
Affiliation(s)
- Pablo Fonda-Pascual
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Oscar M Moreno-Arrones
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Adrian Alegre-Sanchez
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - David Saceda-Corralo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Kyra Velazquez-Kennedy
- Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María I Calvo-Sánchez
- Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Lorea Bagazgoitia
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sergio Vaño-Galvan
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jesus Espada
- Laboratorio de Bionanotecnolgía, Universidad Bernardo ÓHiggins, Santiago, Chile.
| | - Pedro Jaen-Olasolo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| |
Collapse
|
16
|
Erkiert-Polguj A, Halbina A, Polak-Pacholczyk I, Rotsztejn H. Light-emitting diodes in photodynamic therapy in non-melanoma skin cancers--own observations and literature review. J COSMET LASER THER 2016; 18:105-10. [PMID: 26735126 DOI: 10.3109/14764172.2015.1114635] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Photodynamic therapy (PDT) employs light activation of tissue-localized photosensitizer in an oxygen-dependent process which initiates oxidative stress, inflammation, and cell death. There are many indications for PDT, although the main ones are still non-melanoma skin cancers. The light sources used include coherent and non-coherent ones, but we would like to focus on the use of light-emitting diodes (LED) in PDT. We present four patients with skin lesions successfully treated with LED-based photodynamic therapy. The main advantage of that source is narrow emission spectrum that can correspond well with maximum absorption photosensitizers. Also, using LED source seems to be cheaper and simpler, and the field of irradiation is larger. The data showed good clinical and cosmetic outcome of LED-based PDT in actinic keratosis, basal cell carcinoma, and Bowen's disease. Since these diseases often appear on sun-exposed skin, aesthetic results are very important. The effect of LED treatment is as good or in some data even better than those in older types of PDT.
Collapse
Affiliation(s)
- Anna Erkiert-Polguj
- a Department of Cosmetology and Aesthetic Dermatology , University of Lodz , Poland
| | | | | | - Helena Rotsztejn
- a Department of Cosmetology and Aesthetic Dermatology , University of Lodz , Poland.,b Dermed Medical Center , Lodz , Poland
| |
Collapse
|
17
|
Affiliation(s)
- R.S. Dawe
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| |
Collapse
|
18
|
Pérez-pérez L, García-gavín J, Gilaberte Y. Daylight-Mediated Photodynamic Therapy in Spain: Advantages and Disadvantages. Actas Dermo-Sifiliográficas (English Edition) 2014; 105:663-74. [DOI: 10.1016/j.adengl.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
19
|
Pérez-Pérez L, García-Gavín J, Gilaberte Y. Terapia fotodinámica con luz de día en España: ventajas y limitaciones. Actas Dermo-Sifiliográficas 2014; 105:663-74. [DOI: 10.1016/j.ad.2013.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/03/2013] [Accepted: 10/09/2013] [Indexed: 01/10/2023] Open
|
20
|
|
21
|
Basset-Seguin N. Revue Panoramique de la PDT Principe, photo-sensibilisateurs, sources de lumières et indications validées en dermatologie. Ann Dermatol Venereol 2013; 140 Suppl 2:223-8. [DOI: 10.1016/s0151-9638(13)70138-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
22
|
Allison RR, Moghissi K. Oncologic photodynamic therapy: clinical strategies that modulate mechanisms of action. Photodiagnosis Photodyn Ther 2013; 10:331-41. [PMID: 24284082 DOI: 10.1016/j.pdpdt.2013.03.011] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/17/2013] [Accepted: 03/28/2013] [Indexed: 01/08/2023]
Abstract
Photodynamic therapy (PDT) is an elegant minimally invasive oncologic therapy. The clinical simplicity of photosensitizer (PS) drug application followed by appropriate illumination of target leading to the oxygen dependent tumor ablative Photodynamic Reaction (PDR) has gained this treatment worldwide acceptance. Yet the true potential of clinical PDT has not yet been achieved. This paper will review current mechanisms of action and treatment paradigms with critical commentary on means to potentially improve outcome using readily available clinical tools.
Collapse
Affiliation(s)
- Ron R Allison
- Medical Director 21st Century Oncology, 801 WH Smith Boulevard, Greenville, NC 27834, USA.
| | | |
Collapse
|
23
|
Ibbotson SH, Ferguson J. Ambulatory photodynamic therapy using low irradiance inorganic light-emitting diodes for the treatment of non-melanoma skin cancer: an open study. Photodermatol Photoimmunol Photomed 2013; 28:235-9. [PMID: 22971187 DOI: 10.1111/j.1600-0781.2012.00681.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Conventional photodynamic therapy (PDT) can be inconvenient and uncomfortable. We studied low irradiance PDT using an ambulatory inorganic light-emitting diode. METHODS Fifty-three patients with 61 lesions [superficial basal cell carcinoma (n = 30), Bowen's disease (n = 30), and actinic keratosis (AK; n = 1)] were studied. Two treatments of ambulatory PDT were undertaken 1 week apart (one treatment for AK). Clinical response was determined at 3 months, and the treatment cycle was repeated if there was residual disease. The endpoints assessed were pain during treatment (numerical rating scale (NRS); 0-10) and outcome at 1 year. Twenty-three of these patients also received conventional PDT to separate lesions. RESULTS The median NRS pain scores during first and second treatment were 2 (range 0-9) and 4 (0-9), respectively. Lesion clearance rate at 1 year after ambulatory PDT was 84% (21/25 lesions in 22 patients). Of the twenty-three patients treated with both ambulatory and conventional PDT, the median NRS was 1 (0-7) and 5 (1.5-9), respectively, with most patients preferring ambulatory PDT. CONCLUSION Ambulatory PDT is effective for superficial non-melanoma skin cancer, with 1 year clearance rates comparative to conventional PDT. Low irradiance ambulatory PDT may be less painful and more convenient than conventional PDT.
Collapse
|
24
|
Morton CA, Szeimies RM, Sidoroff A, Braathen LR. European guidelines for topical photodynamic therapy part 1: treatment delivery and current indications - actinic keratoses, Bowen's disease, basal cell carcinoma. J Eur Acad Dermatol Venereol 2012. [PMID: 23181594 DOI: 10.1111/jdv.12031] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Topical photodynamic therapy (PDT) is a widely used non-invasive treatment for certain non-melanoma skin cancers, permitting treatment of large and multiple lesions with excellent cosmesis. High efficacy is demonstrated for PDT using standardized protocols in non-hyperkeratotic actinic keratoses, Bowen's disease, superficial basal cell carcinomas (BCC) and in certain thin nodular BCC, with superiority of cosmetic outcome over conventional therapies. Recurrence rates following PDT are typically equivalent to existing therapies, although higher than surgery for nodular BCC. PDT is not recommended for invasive squamous cell carcinoma. Treatment is generally well tolerated, but tingling discomfort or pain is common during PDT. New studies identify patients most likely to experience discomfort and permit earlier adoption of pain-minimization strategies. Reduced discomfort has been observed with novel protocols including shorter photosensitizer application times and in daylight PDT for actinic keratoses.
Collapse
Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, UK.
| | | | | | | |
Collapse
|
25
|
Ibbotson SH. Irradiance is an important determinant of pain experienced during topical photodynamic therapy. J Am Acad Dermatol 2011; 65:201-2. [PMID: 21679812 DOI: 10.1016/j.jaad.2010.11.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 11/10/2010] [Accepted: 11/20/2010] [Indexed: 11/29/2022]
|
26
|
Wiegell S, Fabricius S, Stender I, Berne B, Kroon S, Andersen B, Mørk C, Sandberg C, Jemec G, Mogensen M, Brocks K, Philipsen P, Heydenreich J, Haedersdal M, Wulf H. A randomized, multicentre study of directed daylight exposure times of 1½ vs. 2½ h in daylight-mediated photodynamic therapy with methyl aminolaevulinate in patients with multiple thin actinic keratoses of the face and scalp. Br J Dermatol 2011; 164:1083-90. [DOI: 10.1111/j.1365-2133.2011.10209.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
27
|
Abstract
Photodynamic therapy (PDT) is a noninvasive procedure that involves a photosensitizing drug and its subsequent activation by light to produce reactive oxygen species that specifically destroy target cells. Recently, PDT has been widely used in treating non-melanoma skin malignancies, the most common cancer in the USA, with superior cosmetic outcomes compared with conventional therapies. The topical 'photosensitizers' commonly used are 5-aminolevulinic acid (ALA) and its esterified derivative methyl 5-aminolevulinate, which are precursors of the endogenous photosensitizer protoporphyrin IX. After treatment with ALA or methyl 5-aminolevulinate, protoporphyrin IX preferentially accumulates in the lesion area of various skin diseases, which allows not only PDT treatment but also fluorescence diagnosis with ALA-induced porphyrins. Susceptible lesions include various forms of non-melanoma skin cancer such as actinic keratosis, basal cell carcinoma and squamous cell carcinoma. The most recent and promising developments in PDT include the discovery of new photosensitizers, the exploitation of new drug delivery systems and the combination of other modalities, which will all contribute to increasing PDT therapeutic efficacy and improving outcome. This article summarizes the main principles of PDT and its current clinical use in the management of non-melanoma skin cancers, as well as recent developments and possible future research directions.
Collapse
Affiliation(s)
- Baozhong Zhao
- Laboratory of Toxicology and Pharmacology, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC 27709, USA
| | | |
Collapse
|
28
|
Attili SK, Dawe R, Ibbotson S. A review of pain experienced during topical photodynamic therapy--our experience in Dundee. Photodiagnosis Photodyn Ther 2011; 8:53-7. [PMID: 21333935 DOI: 10.1016/j.pdpdt.2010.12.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/30/2010] [Indexed: 12/18/2022]
Abstract
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.
Collapse
|
29
|
Frost GA, Halliday GM, Damian DL. Photodynamic therapy-induced immunosuppression in humans is prevented by reducing the rate of light delivery. J Invest Dermatol. 2011;131:962-968. [PMID: 21248771 DOI: 10.1038/jid.2010.429] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Photodynamic therapy (PDT) of non-melanoma skin cancers currently carries failure rates of 10-40%. The optimal irradiation protocol is as yet unclear. Previous studies showed profound immunosuppression after PDT, which may compromise immune-mediated clearance of these antigenic tumors. Slower irradiation prevents immunosuppression in mice, and may be at least as effective as high-fluence-rate PDT in preliminary clinical trials. The photosensitizers 5-aminolaevulinic acid and/or methyl aminolaevulinate were applied to discrete areas on the backs of healthy Mantoux-positive volunteers, followed by narrowband red light irradiation (632 nm) at varied doses and fluence rates. Delayed type hypersensitivity (Mantoux) reactions were elicited at test sites and control sites to determine immunosuppression. Human ex vivo skin received low- and high-fluence-rate PDT and was stained for oxidative DNA photolesions. PDT caused significant, dose-responsive immunosuppression at high (75 mW cm(-2)) but not low (15 or 45 mW cm(-2)) fluence rates. DNA photolesions, which may be a trigger for immunosuppression, were observed after high-fluence-rate PDT but not when light was delivered more slowly. This study demonstrates that the current clinical PDT protocol (75 mW cm(-2)) is highly immunosuppressive. Simply reducing the rate of irradiation, while maintaining the same light dose, prevented immunosuppression and genetic damage and may have the potential to improve skin cancer outcomes.
Collapse
|
30
|
Miller I, Nielsen J, Lophaven S, Jemec G. Factors related to pain during routine photodynamic therapy: a descriptive study of 301 patients. J Eur Acad Dermatol Venereol 2011; 25:1275-81. [DOI: 10.1111/j.1468-3083.2010.03964.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
31
|
Valentine RM, Ibbotson SH, Brown CTA, Wood K, Moseley H. A Quantitative Comparison of 5-Aminolaevulinic Acid- and Methyl Aminolevulinate-Induced Fluorescence, Photobleaching and Pain During Photodynamic Therapy. Photochem Photobiol 2010; 87:242-9. [DOI: 10.1111/j.1751-1097.2010.00829.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
32
|
Fernández-Guarino M, Harto A, Jaén P. Terapia fotodinámica: estudios con metilaminolevulinato en queratosis actínicas. Actas Dermo-Sifiliográficas 2010. [DOI: 10.1016/j.ad.2009.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
33
|
Fernández-Guarino M, Harto A, Jaén P. Studies of Methyl Aminolevulinate Photodynamic Therapy for Actinic Keratosis. Actas Dermo-Sifiliográficas (English Edition) 2010. [DOI: 10.1016/s1578-2190(10)70641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
34
|
Ibbotson SH. An overview of topical photodynamic therapy in dermatology. Photodiagnosis Photodyn Ther 2009; 7:16-23. [PMID: 20230989 DOI: 10.1016/j.pdpdt.2009.12.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 11/26/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
Abstract
This article is a review of the use of topical photodynamic therapy in dermatology and its current role in 2009 and future developments. The content of this article was presented at the EPPM in Wroclaw, September 2009.
Collapse
Affiliation(s)
- Sally H Ibbotson
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK.
| |
Collapse
|
35
|
Smits T, Moor AC. New aspects in photodynamic therapy of actinic keratoses. Journal of Photochemistry and Photobiology B: Biology 2009; 96:159-69. [DOI: 10.1016/j.jphotobiol.2009.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 03/19/2009] [Accepted: 06/08/2009] [Indexed: 11/21/2022]
|
36
|
Attili S, Lesar A, McNeill A, Camacho-Lopez M, Moseley H, Ibbotson S, Samuel I, Ferguson J. An open pilot study of ambulatory photodynamic therapy using a wearable low-irradiance organic light-emitting diode light source in the treatment of nonmelanoma skin cancer. Br J Dermatol 2009; 161:170-3. [DOI: 10.1111/j.1365-2133.2009.09096.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Attili SK, Ibbotson SH. How we treat Bowen's disease with topical photodynamic therapy in Dundee. Photodiagnosis Photodyn Ther 2009; 6:41-5. [DOI: 10.1016/j.pdpdt.2009.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
|
38
|
Abstract
Multicentre randomized controlled studies now demonstrate high efficacy of topical photodynamic therapy (PDT) for actinic keratoses, Bowen's disease (BD) and superficial basal cell carcinoma (BCC), and efficacy in thin nodular BCC, while confirming the superiority of cosmetic outcome over standard therapies. Long-term follow-up studies are also now available, indicating that PDT has recurrence rates equivalent to other standard therapies in BD and superficial BCC, but with lower sustained efficacy than surgery in nodular BCC. In contrast, current evidence does not support the use of topical PDT for squamous cell carcinoma. PDT can reduce the number of new lesions developing in patients at high risk of skin cancer and may have a role as a preventive therapy. Case reports and small series attest to the potential of PDT in a wide range of inflammatory/infective dermatoses, although recent studies indicate insufficient evidence to support its use in psoriasis. There is an accumulating evidence base for the use of PDT in acne, while detailed study of an optimized protocol is still required. In addition to high-quality treatment site cosmesis, several studies observe improvements in aspects of photoageing. Management of treatment-related pain/discomfort is a challenge in a minority of patients, and the modality is otherwise well tolerated. Long-term studies provide reassurance over the safety of repeated use of PDT.
Collapse
Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Royal Infirmary, Stirling FK2 8AU, UK.
| | | | | | | |
Collapse
|
39
|
Abstract
Photodynamic therapy (PDT) uses light-activated drugs to treat diseases ranging from cancer to age-related macular degeneration and antibiotic-resistant infections. This paper reviews the current status of PDT with an emphasis on the contributions of physics, biophysics and technology, and the challenges remaining in the optimization and adoption of this treatment modality. A theme of the review is the complexity of PDT dosimetry due to the dynamic nature of the three essential components -- light, photosensitizer and oxygen. Considerable progress has been made in understanding the problem and in developing instruments to measure all three, so that optimization of individual PDT treatments is becoming a feasible target. The final section of the review introduces some new frontiers of research including low dose rate (metronomic) PDT, two-photon PDT, activatable PDT molecular beacons and nanoparticle-based PDT.
Collapse
Affiliation(s)
- Brian C Wilson
- Division of Biophysics and Bioimaging, Ontario Cancer Institute and Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
| | | |
Collapse
|
40
|
Leung SC, Lo PC, Ng DK, Liu WK, Fung KP, Fong WP. Photodynamic activity of BAM-SiPc, an unsymmetrical bisamino silicon(IV) phthalocyanine, in tumour-bearing nude mice. Br J Pharmacol 2008; 154:4-12. [PMID: 18332853 DOI: 10.1038/bjp.2008.82] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND PURPOSE Ever since the discovery of photodynamic therapy, there has been a continuous search for more potent photosensitizers. Towards that end, we have synthesized a number of novel phthalocyanine derivatives. The unsymmetrical bisamino silicon(IV) phthalocyanine BAM-SiPc is one of the most potent compounds. In in vitro cell culture, it exhibits high phototoxicity against a number of cancer cell lines. EXPERIMENTAL APPROACH In the present investigation, the in vivo effect of BAM-SiPc was studied in the tumour-bearing nude mice model. The biodistribution of BAM-SiPc was followed to evaluate its tumour selectivity and rate of clearance. The tumour volume in the hepatocarcinoma HepG2- and the colorectal adenocarcinoma HT29-bearing nude mice was measured after photodynamic therapy. The level of intrinsic toxicity induced was also investigated. Finally, the metabolism of BAM-SiPc in the 'normal' WRL68 liver cells and the hepatocarcinoma HepG2 cells was compared. KEY RESULTS The results not only showed significant tumour regression of HepG2 and growth inhibition of HT29 in the tumour-bearing nude mice, but also no apparent hepatic or cardiac injury with the protocol used. Histological analyses showed that apoptosis was induced in the solid tumour. BAM-SiPc could be metabolized by WRL68 liver cells but not by the hepatocarcinoma HepG2 cells. Unfortunately, BAM-SiPc did not show any specific targeting towards the tumour tissue. CONCLUSIONS AND IMPLICATIONS The efficiency of BAM-SiPc in inhibiting tumour growth makes it a good candidate for further evaluation. Enhancement of its uptake in tumour tissue by conjugation with biomolecules is currently under investigation.
Collapse
|
41
|
|
42
|
|
43
|
Pieslinger A, Plaetzer K, Oberdanner CB, Berlanda J, Mair H, Krammer B, Kiesslich T. Characterization of a simple and homogeneous irradiation device based on light-emitting diodes: A possible low-cost supplement to conventional light sources for photodynamic treatment. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.mla.2006.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
44
|
Moseley H, Ibbotson S, Woods J, Brancaleon L, Lesar A, Goodman C, Ferguson J. Clinical and research applications of photodynamic therapy in dermatology: Experience of the scottish PDT centre. Lasers Surg Med 2006; 38:403-16. [PMID: 16788933 DOI: 10.1002/lsm.20369] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The Scottish PDT Centre has carried out 3,442 treatments on 762 patients with superficial skin lesions, especially superficial basal cell carcinoma (sBCC), Bowen's disease (BD) and actinic keratosis (AK). STUDY DESIGN MATERIALS AND METHODS: The article reviews our experience of various light sources and associated dosimetry; thereafter we discuss clinical outcome followed by some of our research studies in clinically important areas. RESULTS We show that improved dosimetry is required to ensure an optimal light dose is delivered to the tumour. We have shown that photosensitizers and proteins interact in such a way that their photophysical and photochemical properties are modified. We have also demonstrated the presence of DNA strand breaks with two different photosensitizers, but there is no evidence that PDT is significantly mutagenic in clinical practice. CONCLUSIONS In our experience, topical PDT is generally well tolerated and is an effective treatment of sBCC, BD, AK, field change and lesions at sites of poor healing.
Collapse
Affiliation(s)
- H Moseley
- The Photobiology Unit & Scottish PDT Centre, University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, Scotland, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|