title: Fractionated illumination significantly improves the response of superficial basal cell carcinoma to aminolevulinic acid photodynamic therapy.
abstract: Photodynamic therapy (PDT) of superficial basal cell carcinoma (sBCC) using topical 5-aminolevulinic acid (ALA) and a light fluence of 75-100 J cm(-2) yields unsatisfactory long-term results. In several animal models, illumination with two light fractions 2 hours apart was considerably more effective than single illumination. Response is further enhanced if the fluence of the first light fraction is reduced, although the cumulative fluence is maintained. We compared the response of sBCC to a single illumination and 2-fold illumination scheme in which two light fractions of 20 and 80 J cm(-2) are performed 4 and 6 hours after the application of a single dose of 20% ALA. We randomly assigned 154 patients with a total of 505 primary sBCC into two treatment groups. Two hundred and forty-three lesions were treated using a single illumination of 75 J cm(-2) at a fluence rate of 50 mW cm(-2). Fractionated PDT, at the same fluence rate, was performed on 262 lesions. The complete response (CR) following a 2-fold illumination scheme is significantly greater than that following a single light fraction (P=0.002, log-rank test). Twelve months after therapy, CR rate to a 2-fold illumination is 97%, whereas the CR to a single illumination is 89%.
authors.affiliation: Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands. e.r.m.dehaas@erasmusmc.nl
authors.forename: Ellen R M
authors.initials: ER
authors.lastname: de Haas
authors.forename: Bastiaan
authors.initials: B
authors.lastname: Kruijt
authors.forename: Henricus J C M
authors.initials: HJ
authors.lastname: Sterenborg
authors.forename: H A
authors.initials: HA
authors.lastname: Martino Neumann
authors.forename: Dominic J
authors.initials: DJ
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000188:drug therapy*; D003624:Darkness; D006801:Humans; D008027:Light; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid