title: Two-fold illumination in topical 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) for superficial basal cell carcinoma (sBCC): A retrospective case series and cohort study.
abstract: BACKGROUND
  There is limited literature on efficacy using a 2-fold illumination scheme in aminolevulinic acid (ALA) photodynamic therapy for superficial basal cell carcinoma (sBCC).
  
  
  OBJECTIVE
  We sought to determine the efficacy of ALA photodynamic therapy for sBCC using a 2-fold illumination scheme after a single ALA application. Treatment failure within 12 months posttreatment was assessed.
  
  
  METHODS
  In this retrospective case series and cohort study, electronic files from patients treated between January 2010 and August 2011 were reviewed. Follow-up data were gathered until March 2014.
  
  
  RESULTS
  A total of 323 sBCC were analyzed for recurrence. Cumulative probability of clinical recurrence-free survival was 88.8% (95% confidence interval [CI] 85.4-92.4), 81.8% (95% CI 77.3-86.3), and 77.1% (95% CI 71.0-83.6) at 12, 24, and 48 months, respectively. For histologically confirmed recurrences this was 90.2% (95% CI 86.9-93.5), 85.4% (95% CI 75.5-89.3), and 81.8% (95% CI 75.5-88.1), respectively. A worse recurrence-free survival for tumors in the head and neck area and tumors larger than 10 mm was observed.
  
  
  CONCLUSIONS
  The retrospective nature and the lack of a control group are limitations.
  
  
  CONCLUSIONS
  ALA photodynamic therapy using a 2-fold illumination scheme might be a feasible treatment option with acceptable long-term results for small sBCC located outside the head and neck area.
authors.affiliation: Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW School for Developmental Biology and Oncology, Maastricht University, Maastricht, The Netherlands. Electronic address: janneke.kessels@mumc.nl.
authors.forename: Janneke
authors.initials: J
authors.lastname: Kessels
authors.affiliation: Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Hendriks
authors.affiliation: Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Patty
authors.initials: P
authors.lastname: Nelemans
authors.affiliation: Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW School for Developmental Biology and Oncology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Klara
authors.initials: K
authors.lastname: Mosterd
authors.affiliation: Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW School for Developmental Biology and Oncology, Maastricht University, Maastricht, The Netherlands; Department of Dermatology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kelleners-Smeets
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D010778:Photochemotherapy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000622:Aminolevulinic Acid
keywords: 5-aminolevulinic acid; efficacy; methyl aminolevulinic acid; photodynamic therapy; treatment protocol