Photodynamic therapy in the treatment of basal cell carcinoma: a systematic review and meta-analysis.
OBJECTIVE
This meta-analysis was designed to compare the efficacy, cosmetic outcome and safety of photodynamic therapy (PDT) with other procedures for the treatment of primary basal cell carcinoma (BCC).


METHODS
A computerized search through electronic databases was performed to search for relevant randomized controlled trials (RCTs) published before October 2013. Only RCTs that compared PDT to non-PDT for patients with BCC were selected. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated.


RESULTS
Eight studies with a total of 1583 patients met the inclusion criteria. PDT was associated with lower complete clearance rate (RR: 0.93, 95% CI: 0.89-0.98), higher 1-year recurrence rate (RR: 12.42, 95% CI: 2.34-66.02) and 5-year recurrence rate (RR: 6.79, 95% CI: 2.43-18.96) when compared with surgical excision. There was no statistically significant difference in complete clearance rate (RR: 0.92, 95% CI: 0.85-1.00), 1-year recurrence rate (RR: 1.04, 95% CI: 0.46 to 2.39) or 5-year recurrence rate (RR: 1.08, 95% CI: 0.62-1.86) when PDT was compared with cryotherapy. PDT had higher complete clearance rate compared with placebo but no statistically significant difference in complete clearance rate and 1-year recurrence rate when compared with pharmacologic treatment (topical imiquimod and 5-fluorouracil). PDT had a significantly better cosmetic outcome than surgery and cryotherapy.


CONCLUSIONS
PDT is a useful method for the treatment of BCC, more efficient than placebo and with a similar efficiency to cryosurgery and pharmacologic treatment. Even though it is less effective than surgical excision, PDT has cosmetic advantages over surgery and cryosurgery.
Dermatology, No.1 Hospital of China Medical University, Shenyang, China.
Hongfei
H
Wang
Yuanyuan
Y
Xu
Jingpu
J
Shi
Xinghua
X
Gao
Long
L
Geng
D000287:Administration, Topical; D000634:Aminoquinolines / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D000077271:Imiquimod; D015994:Incidence; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D010778:Photochemotherapy / Q000379:methods*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D013997:Time Factors
D000634:Aminoquinolines; D000964:Antimetabolites, Antineoplastic; D000077271:Imiquimod; D005472:Fluorouracil
basal cell carcinoma; meta-analysis; photodynamic therapy