[Photodynamic therapy with methylaminooxopentanoate (Metvix) and a broad band light source (PhotoDyn 501): practical experiences in problem-patients with actinic keratoses and basal cell carcinomas].
BACKGROUND
Actinic keratoses (AK) and basal cell carcinomas (BCC) may represent a therapeutic challenge because of special subtypes, location, previous therapy or accompanying diseases. Photodynamic therapy (PDT) offers a semi-conservative treatment option for selected indications.


METHODS
28 outpatients who had been admitted as complicated dermato-oncologic cases because of AK (n = 22) and BCC (n = 6) were treated with PDT, using methylaminooxopentanoate (MAOP, Methyl-Ala, Metvix) and a broad band light source (PhotoDyn 501). The treatment was evaluated for efficacy and subjective tolerance (local discomfort and pain).


RESULTS
A complete remission (CR) was achieved in 11/22 AK (50%) and 4/6 BCC (67%) cases. All three cases of a superficial BCC subtype underwent a CR. Among responders, tolerance was good in 12/15 cases (80%), as compared to 4/13 cases (31%) in non-responders. Focusing on 16/28 patients with good tolerance (57%), there was a CR in 12 cases (75% rate), whereas for the 12/28 patients with moderate to poor tolerance a CR was achieved in only 3 cases (25% rate). In a subgroup of 8 patients who, partly due to secondary diseases, were taking systemic retinoids or immunosuppressive-cytostatic medications, a CR was achieved in 3/8 cases (38%) with a good tolerance in only 1/8 cases (13%).


CONCLUSIONS
These observations confirm a good efficacy and tolerance of PDT in > or = 50% of a AK/BCC problem patient cohort. We found indications for 1) a positive correlation between efficacy and subjective tolerance as well as 2) the presumptive existence of a retinoid-dependent cutaneous PDT hyperalgesia. Effective pain control seems to be an essential cofactor for the success of PDT.
Kreutzer
Katharina
K
Klinik für Dermatologie und Venerologie, Otto-von-Guericke-Universität, Magdeburg.
Bonnekoh
Bernd
B
Franke
Ingolf
I
Gollnick
Harald
H
D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002280:Basal Cell Carcinoma / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007642:Keratosis / Q000188:drug therapy* / Q000209:etiology; D008029:Lighting / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000295:instrumentation* / Q000379:methods*; D010787:Photosensitivity Disorders / Q000150:complications / Q000188:drug therapy*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid