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Photodynamic Therapy for large lesions: better than surgery
374
Abstracts / Photodiagnosis and Photodynamic Therapy 12 (2015) 325–375
immediately before illumination. Pain was assessed during illumination and asked to the patients every two minutes. No pain or low pain was defined as scores of 0–3, moderate pain as scores of 4–6 and severe pain as scores of 7–10.
new prototype LED Kerato PDT® could represent a promising therapeutic alternative for widespread AK of arms, since larger areas can be treated at one single section with excellent outcome. http://dx.doi.org/10.1016/j.pdpdt.2015.07.192
http://dx.doi.org/10.1016/j.pdpdt.2015.07.190 What is better for nodular basal cell carcinoma: ALA PDT or MAL PDT?
Photodynamic Therapy for disseminated actinic porokeratosis a case report of a successful treatment
Ana Gabriela Salvio 1 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Elisangela Ramos de Oliveira 1 , Vanderlei Salvador Bagnato 2
Ana Gabriela Salvio 1 , Cristina Kurachi 2 , Elisangela Ramos de Oliveira 1 , Natalia Mayumi Inada 2 , Vanderlei Salvador Bagnato 2
1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics, University of Sao Paulo, Brazil
1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
Many studies in literature try to define the best photosensitizer used in photodynamic therapy (PDT) for the treatment of basal cell carcinoma (BCC). In this study it was selected 378 patients with nodular BCC and divided in two groups. The first group (n=189) had their lesions curetted and treated with 20% MAL (methyl aminolevulinate, PDTPharma, Brazil), and the other with 20% ALA (aminolevulinic acid, PDTPharma, Brazil). All the lesions were illuminated using the device LINCE® (MMOptics, São Carlos-SP, Brazil) and received an irradiance of 125 mW/cm2 for 20 minutes, (150 J/cm2). After treatment they had a 6 month follow up. The group treated with MAL PDT had a complete response of 86%, and the ALA PDT had 90%. The 6 months follow up showed 1% recurrence for the ALA group and 2% for the MAL group. The difference has no statistical significance. According to these data, there is no difference in cure rates when using ALA nor MAL PDT for nodular basal cell carcinoma treatment.
Disseminated superficial actinic porokeratosis (DSAP) is a chronic disorder of keratinization characterized by papules distributed over sun-exposed sites. This skin condition usually shows poor response to different modalities of treatment. We report a case of 56 years old female, that presented 1-5 mm papules delineated by a thin slightly raised hyperkeratotic ring with central atrophy located at face and upper limbs. The diagnosis of DSAP was confirmed by histology examination. The lesions were light curetted and a 20% metyl-aminolevulinate cream was applied and occluded for 3 hours. After this, the illumination with 125mW/cm2 of a red light device (630 nm) for 20 minutes was performed totalizing a delivered energy of 150J/cm2. Three sessions were performed with 15 days interval. The same device that also has a LED array emitting at 400-450 nm used to demonstrate the fluorescence of protoporphyrin IX before treatment and its consumption after treatment. During the PDT treatment no other treatment for DSAP was done. The facial lesion had complete response and those at upper limbs had 50% of response. Our results suggest that PDT may be promising for this dermatosis. Neverless only few isolated and disagreed reports have been published making further studies necessary.
http://dx.doi.org/10.1016/j.pdpdt.2015.07.191 Evaluation of 120 patients treated through MAL 15% Photodynamic Therapy using a new light source device for large area of upper limbs Ana Gabriela Salvio 1 , Elisangela Ramos de Oliveira 1 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Vanderlei Salvador Bagnato 2 1
Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
http://dx.doi.org/10.1016/j.pdpdt.2015.07.193 Photodynamic Therapy for large lesions: better than surgery Ana Gabriela Salvio 1 , Elisangela Ramos de Oliveira 1 , Dora Patricia Ramirez 2 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Vanderlei Salvador Bagnato 2 1
Photodynamic therapy (PDT) is an alternative treatment for actinic keratoses (AK). Since the treatment of widespread AK is a challenge, the PDT with metyl-aminolevulinate (MAL) 15% was evaluated using a new anatomic designed light source named Kerato PDT. This device was designed to allow the uniform illumination of upper limbs, providing the treatment of cancerization field. It was selected 120 patients with widespread AK of upper limbs. The MAL 15% cream was applied over the forearm and hands and the occlusion was performed for 3 hours. The patients had their limbs treated for 40 minutes with a delivered energy of 36 J/cm2 by the prototypebased LED Kerato PDT®. Medical visual analysis of the number of AK were performed after and 30 days before PDT treatment. The media number of AK lesions per patient was 142 and decreased to 46. It was observed a reduction of 67% in the number of AK after 30 days. The values were analyzed by Mann-Whitney and showed statistical significance (p<0.001). Topical PDT using this anatomic
Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil After a skin cancer diagnostic, it is very important to choose the best treatment option, considering clearance of the lesion and aesthetics outcome. It was selected 26 patients with large area lesions of Bowen’s disease (BD), superficial basal cell carcinoma (BCC) and actinic keratosis (AK). The lesions were smoothly curetted and next, the application of 20% MAL cream (methyl aminolevulinate). Three hours after, the lesions were illuminated during 17 minutes with a prototype with LED emitting at 630 nm (125mW/cm2, 128 J/cm2). After 7 days another session was performed. The mean age was 71 years. The 26 lesions comprised 15 superficial BCC, seven BD and four AK. Most of the lesions (54%/n=14) were located on the head and neck area, followed by trunk (27%/n=7) and upper limbs
Abstracts / Photodiagnosis and Photodynamic Therapy 12 (2015) 325–375
(19%/n=5). The area of the lesions ranged from 3 to 48 cm2, with a mean of 14.7cm2. A total response was observed in 69% of the cases (18). In the eight remained lesions (30%) was observed a reduction of at least 50% of the area. This study shows an important contribution of PDT treatment in large area lesions, avoiding surgery for big reconstructions flaps or grafts in old patients with comorbidities. http://dx.doi.org/10.1016/j.pdpdt.2015.07.194 Long- term follow-up of nodular basal cell carcinoma after Photodynamic Therapy Ana Gabriela Salvio 1 , Elisangela Ramos de Oliveira 1 , Dora Patricia Ramirez 2 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Vanderlei Salvador Bagnato 2 1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
Studies about the long-term follow-up of nodular basal cell carcinoma (nBCC) underwent through photodynamic therapy is few reported. This clinical research describes a total of 56 cases of nBCC less than 1 cm diagnosed and treated during 2010 and 2011 at Amaral Carvalho Hospital with Photodynamic Therapy (PDT) (topic 15% MAL-PDT, illuminated at 630 nm with a total delivered energy of 100 J/cm2). Most of the nBCC were located at head and neck area (57%/n=32) followed by trunk (30%/n=17) and upper limbs (13%/n=7). During a total time follow up of 53 months (with a median follow up of 30,8 months (0 to 53 months), the recurrence was observed in only 5% of the patients and it occurred in the first 14 months of follow up. For this group it can be considered a free disease follow up of 93.7%. It can be concluded that PDT for nodular BCC is safe treatment with low rates of late recurrence. http://dx.doi.org/10.1016/j.pdpdt.2015.07.195 Reduction in surgical procedures in patients with Gorlin syndrome when management associated with Topical Photodynamic therapy: report of two cases Ana Gabriela Salvio 1 , Dora Patricia Ramirez 2 , Elisangela Ramos de Oliveira 1 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Vanderlei Salvador Bagnato 2 1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
Gorlin Syndrome (GS), also named nevoid basal cell carcinoma syndrome is a rare autosomal dominate syndrome caused by mutation in the suppressor gene (PTCH). It is characterized for appear the
375
multiple basal cell carcinoma in early age, odontogenic keratocysts of the jaws, skeletal abnormalities, hyperkeratosis of palms and soles, skeletal abnormalities and facial dysmorphism. The treatment requires multiple surgical excisions and may lead to scars and multiples hospitalizations. Two patients with GS were included this report. Photodynamic therapy (PDT) was performed with 20% MALA cream and irradiation with a fluence of 150J/cm2, two sessions with one-week interval. The number of surgical excisions and hospitalizations were quantified before and after 12 months the first PDT procedure. The first patient had 20 surgical procedures before the first PDT and she had been hospitalized for 3 times. After starting PDT treatment, in the 12 months follow up, the patient did not have any surgery and 24 months after the patient experienced only 3 hospitalizations and 10 surgical excisions. The similar behavior was observed in the second patient. In conclusion, PDT may be considered the main options for the treatment of BCCs in GS, reducing surgical excisions. http://dx.doi.org/10.1016/j.pdpdt.2015.07.196 Photodynamic therapy for widespread actinic keratosis of the upper limbs: comparison of pain and response using aminolevulinic acid 15% and methyl aminolevulinate 15% through a new light source device Elisangela Ramos de Oliveira 1 , Natalia Mayumi Inada 2 , Dora Patricia Ramirez 2 , Vanderlei Salvador Bagnato 2 , Ana Gabriela Salvio 1 1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
Photodynamic therapy (PDT) for actinic keratosis (AK) is one of the multiple treatment options, as cryotherapy, chemical peels and electrosurgery. Pain is the most important factor that limits its use. The aim of this study was to evaluate and compare pain and PDT efficacy between methyl-aminolaevulinate (M-ALA) and aminolaevulinic acid (ALA). It was selected 40 patients with multiple AK of the upper limbs and divided in two groups. The AK number was quantified after and 30 days before treatment. After curetted, a cream with ALA 15% or M-ALA 15% was applied over the forearm and hand. After 3 hours of occlusion they were illuminated for 40 minutes with a delivered energy of 36 J/cm2 by the prototypebased LED Kerato PDT®. At every 5 minutes a numerical scale (0 to 10) was applied to measure pain. The results showed no statistically significant difference between the two groups considering the clearance and the pain (p=0.701). Both treatment showed 72% reduction of AK (p<0.001). It was concluded that both ALA and MALA can be used for the PDT of widespread AK of upper limbs with the same efficacy with http://dx.doi.org/10.1016/j.pdpdt.2015.07.197
Abstracts / Photodiagnosis and Photodynamic Therapy 12 (2015) 325–375
immediately before illumination. Pain was assessed during illumination and asked to the patients every two minutes. No pain or low pain was defined as scores of 0–3, moderate pain as scores of 4–6 and severe pain as scores of 7–10.
new prototype LED Kerato PDT® could represent a promising therapeutic alternative for widespread AK of arms, since larger areas can be treated at one single section with excellent outcome. http://dx.doi.org/10.1016/j.pdpdt.2015.07.192
http://dx.doi.org/10.1016/j.pdpdt.2015.07.190 What is better for nodular basal cell carcinoma: ALA PDT or MAL PDT?
Photodynamic Therapy for disseminated actinic porokeratosis a case report of a successful treatment
Ana Gabriela Salvio 1 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Elisangela Ramos de Oliveira 1 , Vanderlei Salvador Bagnato 2
Ana Gabriela Salvio 1 , Cristina Kurachi 2 , Elisangela Ramos de Oliveira 1 , Natalia Mayumi Inada 2 , Vanderlei Salvador Bagnato 2
1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics, University of Sao Paulo, Brazil
1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
Many studies in literature try to define the best photosensitizer used in photodynamic therapy (PDT) for the treatment of basal cell carcinoma (BCC). In this study it was selected 378 patients with nodular BCC and divided in two groups. The first group (n=189) had their lesions curetted and treated with 20% MAL (methyl aminolevulinate, PDTPharma, Brazil), and the other with 20% ALA (aminolevulinic acid, PDTPharma, Brazil). All the lesions were illuminated using the device LINCE® (MMOptics, São Carlos-SP, Brazil) and received an irradiance of 125 mW/cm2 for 20 minutes, (150 J/cm2). After treatment they had a 6 month follow up. The group treated with MAL PDT had a complete response of 86%, and the ALA PDT had 90%. The 6 months follow up showed 1% recurrence for the ALA group and 2% for the MAL group. The difference has no statistical significance. According to these data, there is no difference in cure rates when using ALA nor MAL PDT for nodular basal cell carcinoma treatment.
Disseminated superficial actinic porokeratosis (DSAP) is a chronic disorder of keratinization characterized by papules distributed over sun-exposed sites. This skin condition usually shows poor response to different modalities of treatment. We report a case of 56 years old female, that presented 1-5 mm papules delineated by a thin slightly raised hyperkeratotic ring with central atrophy located at face and upper limbs. The diagnosis of DSAP was confirmed by histology examination. The lesions were light curetted and a 20% metyl-aminolevulinate cream was applied and occluded for 3 hours. After this, the illumination with 125mW/cm2 of a red light device (630 nm) for 20 minutes was performed totalizing a delivered energy of 150J/cm2. Three sessions were performed with 15 days interval. The same device that also has a LED array emitting at 400-450 nm used to demonstrate the fluorescence of protoporphyrin IX before treatment and its consumption after treatment. During the PDT treatment no other treatment for DSAP was done. The facial lesion had complete response and those at upper limbs had 50% of response. Our results suggest that PDT may be promising for this dermatosis. Neverless only few isolated and disagreed reports have been published making further studies necessary.
http://dx.doi.org/10.1016/j.pdpdt.2015.07.191 Evaluation of 120 patients treated through MAL 15% Photodynamic Therapy using a new light source device for large area of upper limbs Ana Gabriela Salvio 1 , Elisangela Ramos de Oliveira 1 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Vanderlei Salvador Bagnato 2 1
Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
http://dx.doi.org/10.1016/j.pdpdt.2015.07.193 Photodynamic Therapy for large lesions: better than surgery Ana Gabriela Salvio 1 , Elisangela Ramos de Oliveira 1 , Dora Patricia Ramirez 2 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Vanderlei Salvador Bagnato 2 1
Photodynamic therapy (PDT) is an alternative treatment for actinic keratoses (AK). Since the treatment of widespread AK is a challenge, the PDT with metyl-aminolevulinate (MAL) 15% was evaluated using a new anatomic designed light source named Kerato PDT. This device was designed to allow the uniform illumination of upper limbs, providing the treatment of cancerization field. It was selected 120 patients with widespread AK of upper limbs. The MAL 15% cream was applied over the forearm and hands and the occlusion was performed for 3 hours. The patients had their limbs treated for 40 minutes with a delivered energy of 36 J/cm2 by the prototypebased LED Kerato PDT®. Medical visual analysis of the number of AK were performed after and 30 days before PDT treatment. The media number of AK lesions per patient was 142 and decreased to 46. It was observed a reduction of 67% in the number of AK after 30 days. The values were analyzed by Mann-Whitney and showed statistical significance (p<0.001). Topical PDT using this anatomic
Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil After a skin cancer diagnostic, it is very important to choose the best treatment option, considering clearance of the lesion and aesthetics outcome. It was selected 26 patients with large area lesions of Bowen’s disease (BD), superficial basal cell carcinoma (BCC) and actinic keratosis (AK). The lesions were smoothly curetted and next, the application of 20% MAL cream (methyl aminolevulinate). Three hours after, the lesions were illuminated during 17 minutes with a prototype with LED emitting at 630 nm (125mW/cm2, 128 J/cm2). After 7 days another session was performed. The mean age was 71 years. The 26 lesions comprised 15 superficial BCC, seven BD and four AK. Most of the lesions (54%/n=14) were located on the head and neck area, followed by trunk (27%/n=7) and upper limbs
Abstracts / Photodiagnosis and Photodynamic Therapy 12 (2015) 325–375
(19%/n=5). The area of the lesions ranged from 3 to 48 cm2, with a mean of 14.7cm2. A total response was observed in 69% of the cases (18). In the eight remained lesions (30%) was observed a reduction of at least 50% of the area. This study shows an important contribution of PDT treatment in large area lesions, avoiding surgery for big reconstructions flaps or grafts in old patients with comorbidities. http://dx.doi.org/10.1016/j.pdpdt.2015.07.194 Long- term follow-up of nodular basal cell carcinoma after Photodynamic Therapy Ana Gabriela Salvio 1 , Elisangela Ramos de Oliveira 1 , Dora Patricia Ramirez 2 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Vanderlei Salvador Bagnato 2 1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
Studies about the long-term follow-up of nodular basal cell carcinoma (nBCC) underwent through photodynamic therapy is few reported. This clinical research describes a total of 56 cases of nBCC less than 1 cm diagnosed and treated during 2010 and 2011 at Amaral Carvalho Hospital with Photodynamic Therapy (PDT) (topic 15% MAL-PDT, illuminated at 630 nm with a total delivered energy of 100 J/cm2). Most of the nBCC were located at head and neck area (57%/n=32) followed by trunk (30%/n=17) and upper limbs (13%/n=7). During a total time follow up of 53 months (with a median follow up of 30,8 months (0 to 53 months), the recurrence was observed in only 5% of the patients and it occurred in the first 14 months of follow up. For this group it can be considered a free disease follow up of 93.7%. It can be concluded that PDT for nodular BCC is safe treatment with low rates of late recurrence. http://dx.doi.org/10.1016/j.pdpdt.2015.07.195 Reduction in surgical procedures in patients with Gorlin syndrome when management associated with Topical Photodynamic therapy: report of two cases Ana Gabriela Salvio 1 , Dora Patricia Ramirez 2 , Elisangela Ramos de Oliveira 1 , Natalia Mayumi Inada 2 , Cristina Kurachi 2 , Vanderlei Salvador Bagnato 2 1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
Gorlin Syndrome (GS), also named nevoid basal cell carcinoma syndrome is a rare autosomal dominate syndrome caused by mutation in the suppressor gene (PTCH). It is characterized for appear the
375
multiple basal cell carcinoma in early age, odontogenic keratocysts of the jaws, skeletal abnormalities, hyperkeratosis of palms and soles, skeletal abnormalities and facial dysmorphism. The treatment requires multiple surgical excisions and may lead to scars and multiples hospitalizations. Two patients with GS were included this report. Photodynamic therapy (PDT) was performed with 20% MALA cream and irradiation with a fluence of 150J/cm2, two sessions with one-week interval. The number of surgical excisions and hospitalizations were quantified before and after 12 months the first PDT procedure. The first patient had 20 surgical procedures before the first PDT and she had been hospitalized for 3 times. After starting PDT treatment, in the 12 months follow up, the patient did not have any surgery and 24 months after the patient experienced only 3 hospitalizations and 10 surgical excisions. The similar behavior was observed in the second patient. In conclusion, PDT may be considered the main options for the treatment of BCCs in GS, reducing surgical excisions. http://dx.doi.org/10.1016/j.pdpdt.2015.07.196 Photodynamic therapy for widespread actinic keratosis of the upper limbs: comparison of pain and response using aminolevulinic acid 15% and methyl aminolevulinate 15% through a new light source device Elisangela Ramos de Oliveira 1 , Natalia Mayumi Inada 2 , Dora Patricia Ramirez 2 , Vanderlei Salvador Bagnato 2 , Ana Gabriela Salvio 1 1 Skin Department of Amaral Carvalho Hospital, Brazil 2 São Carlos Institute of Physics University of Sao Paulo, Brazil
Photodynamic therapy (PDT) for actinic keratosis (AK) is one of the multiple treatment options, as cryotherapy, chemical peels and electrosurgery. Pain is the most important factor that limits its use. The aim of this study was to evaluate and compare pain and PDT efficacy between methyl-aminolaevulinate (M-ALA) and aminolaevulinic acid (ALA). It was selected 40 patients with multiple AK of the upper limbs and divided in two groups. The AK number was quantified after and 30 days before treatment. After curetted, a cream with ALA 15% or M-ALA 15% was applied over the forearm and hand. After 3 hours of occlusion they were illuminated for 40 minutes with a delivered energy of 36 J/cm2 by the prototypebased LED Kerato PDT®. At every 5 minutes a numerical scale (0 to 10) was applied to measure pain. The results showed no statistically significant difference between the two groups considering the clearance and the pain (p=0.701). Both treatment showed 72% reduction of AK (p<0.001). It was concluded that both ALA and MALA can be used for the PDT of widespread AK of upper limbs with the same efficacy with http://dx.doi.org/10.1016/j.pdpdt.2015.07.197