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Photodynamic therapy in combination with CO2 laser for the treatment of Bowen’s disease

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Abstract

Photodynamic therapy (PDT) involves the activation of a previously administered photosensitizing agent by visible light to induce tumor necrosis. Photosensitizers are topically applied in the treatment of skin tumors to avoid systemic side effects. In this study, we evaluated the feasibility and efficacy of aminolevulinic acid (ALA) as a photosensitizer (ALA-PDT) in combination with CO2 laser in the treatment of Bowen’s disease (BD; intraepithelial squamous cell carcinoma). Twenty-two lesions from 18 patients were randomized into two groups: 11 lesions were treated with topical ALA-PDT (180 J/cm2 at 100 mW/cm2) + CO2 laser for one to three sessions. The remaining 11 lesions were treated with CO2 laser alone, serving as control group. All patients were reviewed at ≤1-week intervals. Biopsies were taken from BD lesions prior to treatment. The initial evaluation was undertaken 1 month after treatment, and biopsies were harvested for histological evaluation. Patients who did not respond to the three sessions of treatment were referred to surgical treatment. In the ALA-PDT + CO2 laser group, 72.73 % (8/11) of BD lesions showed complete remission, with an overall clearance of 90.91 %, and only one recurred (9 %) during follow-up. Local side effects included mild erythema, edema, erosion, and burning and/or stinging sensation. No systemic side effects were observed. In the control group, 63.63 % (7/11) of lesions had complete remission and the overall clearance was 54.55 %. However, five lesions (45.45 %) had recurrence. Local side effects included mild to moderate edema, erosion, ulceration, delayed healing, prolonged pain, and scarring. There existed a significant difference in recurrence rate between the two groups (P < 0.05). Moreover, after ALA-PDT plus CO2 laser treatment, complete necrosis was observed in responsive lesions, and 3 months later, the atypical BD cells were replaced by normal keratinocytes. Topical ALA-PDT in combination with CO2 laser is safe, effective, and is associated with low recurrence and reduced side effects.

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References

  1. Wang X-L, Wang H-W, Yuan K-H, Li F-L, Huang Z (2011) Combination of photodynamic therapy and immunomodulation for skin diseases—update of clinical aspects. Photochem Photobiol Sci 10:704–711

    Article  CAS  PubMed  Google Scholar 

  2. Butani AK, Arbesfeld DM, Schwartz RA (2005) Premalignant and early squamous cell carcinoma. Clin Plast Surg 32(2):223–235

    Article  PubMed  Google Scholar 

  3. Kaushal S, Merideth M, Kopparthy P, Pulanic TK, Stratton P (2012) Treatment of multifocal Bowen's disease in immunocompromised women with surgery and topical imiquimod. Obstet Gynecol 119(2):442–444

    Article  PubMed Central  PubMed  Google Scholar 

  4. Young LC, Tuxen AJ, Goodman G (2012) Mohs’ micrographic surgery as treatment for squamous dysplasia of the nail unit. Australas J Dermatol 53(2):123–127

    Article  PubMed  Google Scholar 

  5. Li L, Deng Y, Zhang L, Liao W, Luo R, Huang Z (2009) Treatment of perianal Paget's disease using photodynamic therapy with assistance of fluorescence examination: case report. Lasers Med Sci 24(6):981–984

    Article  PubMed  Google Scholar 

  6. Wang XL, Wang HW, Guo MX, Xu SZ (2008) Treatment of skin cancer and pre-cancer using topical ALA-PDT–a single hospital experience. Photodiagnosis Photodyn Ther 5(2):127–133

    Article  PubMed  Google Scholar 

  7. Kacerovská D, Pizinger K, Majer F, Smíd F (2008) Photodynamic therapy of nonmelanoma skin cancer with topical hypericum perforatum extract—a pilot study. Photochem Photobiol 84(3):779–785

    Article  PubMed  Google Scholar 

  8. Calin MA, Diaconeasa A, Savastru D, Tautan M (2011) Photosensitizers and light sources for photodynamic therapy of the Bowen’s disease. Arch Dermatol Res 303(3):145–151

    Article  CAS  PubMed  Google Scholar 

  9. Shieh S, Dee AS, Cheney RT, Frawley NP, Zeitouni NC, Oseroff AR (2002) Photodynamic therapy for the treatment of extramammary Paget’s disease. Br J Dermatol 146(6):1000–1005

    Article  CAS  PubMed  Google Scholar 

  10. Blázquez-Castro A, Carrasco E, Calvo MI, Jaén P, Stockert JC, Juarranz A, Sánz-Rodríguez F, Espada J (2012) Protoporphyrin IX-dependent photodynamic production of endogenous ROS stimulates cell proliferation. Eur J Cell Biol 91(3):216–223

    Article  PubMed  Google Scholar 

  11. Attili SK, Ibbotson SH (2009) How we treat Bowen's disease with topical photodynamic therapy in Dundee. Photodiagnosis Photodyn Ther 6(1):41–45

    Article  PubMed  Google Scholar 

  12. Neubert T, Lehmann P (2008) Bowen's disease—a review of newer treatment options. Ther Clin Risk Manag 4(5):1085–1095

    CAS  PubMed Central  PubMed  Google Scholar 

  13. Mizutani K, Akita Y, Yanagishita T, Kimura M, Tanaka T, Kinoshita Y, Nakano A, Tamada Y, Matsumoto Y, Watanabe D (2012) Comparison of the efficacy of ALA-PDT using an excimer-dye laser (630 nm) and a metal-halide lamp (600 to 740 nm) for treatment of Bowen's disease. Photodermatol Photoimmunol Photomed 28(3):142–146

    Article  CAS  PubMed  Google Scholar 

  14. Sotiriou E, Lallas A, Apalla Z, Ioannides D (2011) Treatment of giant Bowen’s disease with sequential use of photodynamic therapy and imiquimod cream. Photodermatol Photoimmunol Photomed 27(3):164–166

    Article  PubMed  Google Scholar 

  15. Cai H, Gu Y, Sun Q, Zeng J, Dong N, Zhao G (2011) Effect of hematoporphyrin monomethyl ether-mediated photodynamic therapy on hypertrophic scar fibroblasts. Photodermatol Photoimmunol Photomed 27(2):90–96

    Article  CAS  PubMed  Google Scholar 

  16. Tierney E, Barker A, Ahdout J, Hanke CW, Moy RL, Kouba DJ (2009) Photodynamic therapy for the treatment of cutaneous neoplasia, inflammatory disorders, and photoaging. Dermatol Surg 35(5):725–746

    Article  CAS  PubMed  Google Scholar 

  17. Anquez F, El Yazidi-Belkoura I, Randoux S, Suret P, Courtade E (2012) Cancerous cell death from sensitizer free photoactivation of singlet oxygen. Photochem Photobiol 88(1):167–174

    Article  CAS  PubMed  Google Scholar 

  18. Sailer R, Strauss WS, Wagner M et al (2007) Relation between intracellular location and photodynamic efficacy of 5-aminolevulinic acid-induced protoporphyrin IX in vitro. Comparison between human glioblastoma cells and other cancer cell lines. Photochem Photobiol Sci 6(2):145–151

    Article  CAS  PubMed  Google Scholar 

  19. Hasegawa T, Suga Y, Mizuno Y, Haruna K, Ogawa H, Ikeda S (2010) Efficacy of photodynamic therapy with topical 5-aminolevulinic acid using intense pulsed light for Bowen's disease. J Dermatol 37(7):623–628

    Article  CAS  PubMed  Google Scholar 

  20. Johansson A, Palte G, Schnell O, Tonn JC, Herms J, Stepp H (2010) 5-Aminolevulinic acid-induced protoporphyrin IX levels in tissue of human malignant brain tumors. Photochem Photobiol 86(6):1373–1378

    Article  CAS  PubMed  Google Scholar 

  21. Sidoroff A, Thaler P (2010) Taking treatment decisions in non-melanoma skin cancer–the place for topical photodynamic therapy (PDT). Photodiagnosis Photodyn Ther 7(1):24–32

    Article  CAS  PubMed  Google Scholar 

  22. Steinbauer JM, Schreml S, Babilas P, Zeman F, Karrer S, Landthaler M, Szeimies R-M (2009) Topical photodynamic therapy with porphyrin precursors—assessment of treatment-associated pain in a retrospective study. Photochem Photobiol Sci 8(8):1111–1116

    Article  CAS  PubMed  Google Scholar 

  23. Arits AH, van de Weert MM, Nelemans PJ, Kelleners-Smeets NW (2010) Pain during topical photodynamic therapy: uncomfortable and unpredictable. J Eur Acad Dermatol Venereol 24(12):1452–1457

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We are indebted to Dr. Jiangbei Cao for his support of the research project. We also want to thank the members of the Department of Dermatology of the Air Force General Hospital for their technical support.

Funding

Contract grant sponsor: National Natural Science Foundation of China (grant number 81301386).

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Authors and Affiliations

  1. Department of Dermatology, Air Force General Hospital, PLA, Beijing, 100142, People’s Republic of China

    Hong Cai, Yi-xia Wang, Ping Sun, Zhi-yong Yang, Yuan-li Li, Xiao-yong Liu, Qiang Li & Wei Liu

  2. Department of Pathology, Air Force General Hospital, PLA, Beijing, 100142, People’s Republic of China

    Ji-Chun Zheng

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  1. Hong Cai
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  2. Yi-xia Wang
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  3. Ji-Chun Zheng
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  4. Ping Sun
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  5. Zhi-yong Yang
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  6. Yuan-li Li
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  7. Xiao-yong Liu
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  8. Qiang Li
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  9. Wei Liu
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Correspondence to Wei Liu.

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Cai, H., Wang, Yx., Zheng, JC. et al. Photodynamic therapy in combination with CO2 laser for the treatment of Bowen’s disease. Lasers Med Sci 30, 1505–1510 (2015). https://doi.org/10.1007/s10103-015-1754-1

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  • DOI: https://doi.org/10.1007/s10103-015-1754-1

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