Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
A retrospective review of pain control by a two-step irradiance schedule during topical ALA-photodynamic therapy of non-melanoma skin cancer†
Article first published online: 6 FEB 2013
Copyright © 2013 Wiley Periodicals, Inc.
Lasers in Surgery and Medicine
Special Issue: Dermatology and Plastic Surgery
Volume 45, Issue 2, pages 89–94, February 2013
How to Cite
Zeitouni, N. C., Paquette, A. D., Housel, J. P., Shi, Y., Wilding, G. E., Foster, T. H. and Henderson, B. W. (2013), A retrospective review of pain control by a two-step irradiance schedule during topical ALA-photodynamic therapy of non-melanoma skin cancer. Lasers Surg. Med., 45: 89–94. doi: 10.1002/lsm.22118
- Issue published online: 25 FEB 2013
- Article first published online: 6 FEB 2013
- Manuscript Accepted: 10 JAN 2013
- NCI. Grant Numbers: P01CA55791, P30CA16056
- Roswell Park Alliance
- δ-aminolevulinic acid;
- basal cell carcinoma;
- Bowen's disease;
- protoporphyrin IX
Background and Objective
Photodynamic therapy (PDT) with topical δ-aminolevulinic acid (ALA) of non-melanoma skin cancers is often associated with treatment-limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two-step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here, we present a retrospective review of recent clinical experience in a broad patient population.
Study Design/Materials and Methods
This was a retrospective review of an existing dermatology database. Fourteen caucasion patients—nine men and five women, ages 18–80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions—were included. ALA was applied to each lesion for approximately 4 hours. Lesions received an initial irradiance of 30–50 mW/cm2 for 20 J/cm2, followed by 150 mW/cm2 for a total fluence of 200–300 J/cm2. Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6–12 months.
Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA-PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes.
A two-step irradiance protocol in ALA-PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time. Lasers Surg. Med. 45: 89–94, 2013. © 2013 Wiley Periodicals, Inc.