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A Prospective Study of Pain Control by a 2-Step Irradiance Schedule During Topical Photodynamic Therapy of Nonmelanoma Skin Cancer

Zeitouni, Nathalie C. MD*; Sunar, Ulas PhD; Rohrbach, Daniel J. BS; Paquette, Anne D. BSN; Bellnier, David A. PhD; Shi, Yi MS§; Wilding, Gregory PhD§; Foster, Thomas H. PhD; Henderson, Barbara W. PhD

doi: 10.1097/DSS.0000000000000183
Original Article

BACKGROUND Topical photodynamic therapy (PDT) for selected nonmelanoma skin cancer using 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) has yielded high long-term complete response rates with very good cosmesis. Pain during light activation of the photosensitizer can be a serious adverse event. A 2-step irradiance protocol has previously been shown to minimize ALA-PDT pain.

OBJECTIVE To determine the irradiance-dependent pain threshold for MAL-PDT, to adapt the 2-step protocol to a light-emitting diode (LED) light source, and assess clinical response.

METHODS In this prospective study, 25 superficial basal cell carcinoma (sBCC) received an initial irradiance by laser at 40 or 50 mW/cm2, or LED at 35 mW/cm2 followed by an irradiance at 70 mW/cm2 for a total of 75 J/cm2. Pain levels were recorded for both irradiance steps. Efficacy was assessed at 6, 12, or 24 months.

RESULTS Pain was mild in the 40/70 mW/cm2 laser cohort. Three instances of irradiance-limiting pain occurred at 50/70 mW/cm2. Pain was minimal in the 35/70 mW/cm2 LED cohort. Clinical response rates were 80% in the 50/70 mW/cm2 laser cohort and 90% in the 35/70 mW/cm2 LED cohort.

CONCLUSION Topical PDT can be effectively delivered to sBCC with minimal treatment-related pain by a 2-step irradiance protocol.

*Department of Dermatology, University of Arizona Cancer Center, Tucson, Arizona;

Departments of Cell Stress Biology/PDT Center,

Dermatology, and

§Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York;

Department of Imaging Sciences, University of Rochester, Rochester, New York

Supported by NCI grants P01CA55791 and P30CA16056 and a grant from the Roswell Park Alliance.

The authors have indicated no significant interest with commercial supporters.

© 2014 by the American Society for Dermatologic Surgery, Inc. Published by Lippincott Williams & Wilkins
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