RESUMO
INTRODUCTION: Conventional methods of basal cell carcinomas (BCC) treatment bring many severe side effects, especially, if they are repeated many times. The aim of this study is to present the clinical effectiveness of photodynamic method in the treatment and prevention of BCC relapses on the face and to propose a management algorithm. METHODS: In a patient with Gorlin-Goltz syndrome (NBCCS) lesions on the face were assessed clinically and with photodynamic diagnostics (PDD), initially and in follow-up every 3 months, for a total of 12 months. Detected BCCs were treated with photodynamic therapy three times every week. RESULTS: In whole follow-up period no clinical relapses were shown. However, in PDD after 6 month in one irradiated and in one initially clinically clear area red fluorescence indicating atypical foci was observed and irradiated additional one time. DISCUSSION: Photodynamic therapy is not limited by previous treatments, can be repeated without adverse events, heals multiple lesions at once and prevents new ones. Because BCC in NBCCS will occur constantly, the implementation of PDD to control the condition of the skin in long-term care should be obligatory. We indicate the validity of using the photodynamic diagnostic and therapy, as a medical procedures of choice.
Assuntos
Síndrome do Nevo Basocelular , Carcinoma Basocelular , Fotoquimioterapia , Neoplasias Cutâneas , Algoritmos , Síndrome do Nevo Basocelular/diagnóstico , Síndrome do Nevo Basocelular/tratamento farmacológico , Carcinoma Basocelular/tratamento farmacológico , Humanos , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
Actinic keratosis (AK) is the most common in situ cancerous skin lesion. Compared with other approved treatment modalities photodynamic therapy is preferred by patients due to faster recovery and improved cosmetic outcome. However, pain during irradiation is an important drawback. The aim of this study was to compare the effectiveness and tolerability of topical aminolaevulinic acid-photodynamic therapy in the treatment of AK on the head using red and green light. Complete remissions after 3 sessions of photodynamic therapy at 2-week intervals following 9 months of observation were 91.67% for red light and 86.67% for green light (difference not significant). The mean pain value was significantly greater in areas irradiated with red light compared with green light for all 3 sessions. This comparative study demonstrates that aminolaevulinic acid-photodynamic therapy with green light is of similar efficacy as that with red light in the treatment of middle/moderate AK, but causes less pain.
Assuntos
Ácido Aminolevulínico/administração & dosagem , Ceratose Actínica/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/administração & dosagem , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/efeitos adversos , Feminino , Humanos , Ceratose Actínica/diagnóstico , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Polônia , Indução de Remissão , Fatores de Tempo , Resultado do TratamentoAssuntos
Ácido Aminolevulínico/uso terapêutico , Herpes Genital/tratamento farmacológico , Herpes Labial/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Adulto , Idoso , Ácido Aminolevulínico/efeitos adversos , Feminino , Herpes Genital/diagnóstico , Herpes Genital/virologia , Herpes Labial/diagnóstico , Herpes Labial/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Projetos Piloto , Recidiva , Indução de Remissão , Fatores de Tempo , Resultado do TratamentoRESUMO
Early diagnosis and therapy of precancerous lesions and malignant tumors belong to the most challenging tasks in modern medicine. Photodynamic diagnosis can help diagnose both precancerous lesions and early carcinoma. Actinic keratosis (AK) is the most common precancerous lesion of the skin. The available data show a high effectiveness of diclofenac in treating multifocal AK. We report a case of a 52-year-old woman who complained of multiple disseminated AK lesions predominantly on the lower limbs and trunk with a significant exacerbation within the last 6 months. Due to the spreading of disease and a high number of AK foci, as well as technical problems with visiting the hospital (PDT Laboratory), photodynamic therapy was not applied. The patient was treated for 2 months with a combination of local administration of 3% diclofenac and 0.1% tazaroten and 3% diclofenac only as a half side (left-right) comparison. The effects of therapy were later clinically evaluated and verified by means of photodynamic diagnosis (PDD) directly after therapy and at a follow-up examination 3 months later. The evaluation of treatment was blinded. Treatment with diclofenac only on the right side of the body resulted in clearing of 55% of all treated lesions, which increased to 60% three months after finishing therapy. On the left side of the body, where combined therapy (diclofenac 2 times daily on uneven dates and diclofenac once a day + tazaroten once a day on even dates) was used, 77.5% pathologic lesions disappeared, but this did not increase at follow up. The treatment of multifocal, disseminated AK is a difficult task and also burdensome for the patient due to side effects like scarring or burning and itching which occur during most therapies. Combined therapy with diclofenac and tazaroten supported by PDD may improve the effects of routine treatment of AK.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Diclofenaco/uso terapêutico , Ceratose Actínica/tratamento farmacológico , Ácidos Nicotínicos/uso terapêutico , Fotoquimioterapia , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Fractal dimension analysis (FDA) is modern mathematical method widely used to describing of complex and chaotic shapes when classic methods fail. The main aim of this study was evaluating the influence of photodynamic therapy (PDT) with cystein proteases inhibitors (CPI) on the number and morphology of blood vessels inside tumor and on increase of effectiveness of combined therapy in contrast to PDT and CPI used separately. Animals were divided into four groups: control, treated using only PDT, treated using only CPI and treated using combined therapy, PDT and CPI. Results showed that time of animal survival and depth of necrosis inside tumor were significantly higher in CPI+PDT group in contrast to other groups. The higher value of fractal dimension (FD) was observed in control group, while the lowest value was found in the group which was treated by cystein protease inhibitors. The differences between FD were observed in CPI group and PDT+CPI group in comparison to control group. Our results revealed that fractal dimension analysis is a very useful tool in estimating differences between irregular shapes like blood vessels in PDT treated tumors. Thus, the implementation of FDA algorithms could be useful method in evaluating the efficacy of PDT.
Assuntos
Vasos Sanguíneos/patologia , Inibidores de Cisteína Proteinase/farmacologia , Fotoquimioterapia/métodos , Adenocarcinoma/patologia , Algoritmos , Animais , Biologia Computacional/métodos , Simulação por Computador , Feminino , Fractais , Neoplasias Mamárias Animais/patologia , Modelos Teóricos , Necrose , Transplante de Neoplasias , Ratos , Ratos Wistar , Reprodutibilidade dos Testes , SoftwareRESUMO
5-Aminolevulinic acid (5-ALA) is a well characterized precursor in the synthesis of various endogenous porphyrins used in photodynamic therapy (PDT). It is most often administered topically into a tumor which is then irradiated with visible light at established wavelength to sensitize porphyrins accumulated therein. Our main aim in the present study was to increase the penetration of 5-ALA through the altered skin by application of 3% azone (1-dodecyl-azepan-2-one) before the application of 20% 5-ALA in patients with plantar warts: mosaic warts (MW) and myrmecia (MY). We also used 20% 5-ALA only to treat warts in other patients. We compared the therapeutic and cosmetic effects of the two treatment modalities. The lesions treated with modification of 5-ALA-PDT by pretreatment with azone responded with better effectiveness. In 18 patients subjected to 5-ALA-PDT plus 3% azone, we observed 66.7% complete response of MW and 100% of MY following PDT repeated two or three times; whereas in other 18 patients treated with 5-ALA-PDT alone, we observed only 37.5% complete response of MW and 70% of MY. These results provide evidence that the pretreatment with azone should be considered as the step that enhances 5-ALA penetration in tissues and thus increases the effectiveness of applied PDT.
Assuntos
Azepinas/uso terapêutico , Fotoquimioterapia , Absorção Cutânea/efeitos dos fármacos , Adolescente , Adulto , Ácido Aminolevulínico/uso terapêutico , Azepinas/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fármacos Fotossensibilizantes/uso terapêutico , VerrugasRESUMO
5-aminolevulinic acid (5-ALA) is a precursor in synthesis of endogenous porphyrins used to sensitize tumor tissues in photodynamic therapy (PDT). It is administered topically into a tumor which after the certain time, required for porphyrins to accumulate, is irradiated with visible light from the proper source at established wavelength. Our main aim in the present study was to increase the penetration of 5-ALA through the skin and other tissues by addition of glycolic acid (GA) to 5-ALA on cell lines in vitro and on animals. We also applied 5-ALA ointment with glycolic acid to patients suffering from squamous cell carcinoma (SCC). In our study, we used 5-ALA, dimethyl sulfoxide (DMSO), ethylenediaminetetraacetic acid, disodium salt (EDTA) and GA together in one formulation (5-ALA-GA) on eucerin support. We compared both therapeutic and cosmetic effects in 5-ALA-GA-PDT and in control group of patients. Our results showed that modification of 5-ALA ointment by addition of 5% GA caused that the treated lesions responded with rapid regression. In 12 patients with single lesions of SCC type subjected to 5-ALA-GA-PDT, we observed 100% regression of tumors following single or repeated two-three times PDT. In vitro and in vivo in animals total porphyrin levels after addition of 5% GA increased significantly (P<0.01). These results provide evidence that addition of glycolic acid should be considered as the agent which enhances 5-ALA penetration in tissues and thus increases the effectiveness of photodynamic therapy.
Assuntos
Ácido Aminolevulínico/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Glicolatos/administração & dosagem , Neoplasias/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/administração & dosagem , Adenocarcinoma/tratamento farmacológico , Administração Cutânea , Idoso , Animais , Carcinoma de Células Escamosas/tratamento farmacológico , Linhagem Celular Tumoral , Neoplasias do Colo/tratamento farmacológico , Dimetil Sulfóxido/administração & dosagem , Ácido Edético/administração & dosagem , Feminino , Fibroblastos , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Pessoa de Meia-Idade , Neoplasias Cutâneas/tratamento farmacológico , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
In the present study we have checked whether photodynamic therapy (PDT) may influence concentration of basic Fibroblast Growth Factor (bFGF) in in vivo conditions. We have implanted malignant tumor, i.e. BFS1 fibrosarcoma into BALB/c mice and have them treated using well established photosensitizer, hematoporphyrin derivative and new compound, hydroxygallium (III) phthalocyanine tetrasulfonic acid tetrasodium salt, BON-6. The administration of those compounds was followed by light irradiation using a halogen lamp at proper wavelengths. Our results indicate that in vivo photodynamic therapy may cause a significant decrease in bFGF concentration and this phenomenon is accompanied by prolongation of survival of treated animals.
Assuntos
Fator 2 de Crescimento de Fibroblastos/sangue , Fibrossarcoma/sangue , Fibrossarcoma/terapia , Fototerapia , Animais , Antineoplásicos/uso terapêutico , Transplante de Células , Derivado da Hematoporfirina/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Compostos Organometálicos/uso terapêutico , Fármacos Fotossensibilizantes/uso terapêuticoRESUMO
MATERIAL/METHODS: We implanted a malignant tumour, BFS1 fibrosarcoma, into BALB/c mice and then treated them using a new photosensitizer, hydroxygallium (III) phthalocyanine tetrasulfonic acid tetrasodium salt, BON-6. The administration of this compound was followed by light irradiation using a halogen lamp at 680 nm. VEGF concentrations were measured in sera from the mice and compared to the time of tumor growth. RESULTS: BON-6 was found to be effective in PDT. This feature was accompanied by low levels of VEGF after BON-6+PDT, and also prolongation of the time of survival of treated animals. The mice which received BON-6+PDT survived 83.8 days (SD 10.23). The mean survival time in control groups did not exceed 35 days. Additionally, measurement of tumor size showed total regression in single cases after BON-6+PDT. CONCLUSIONS: PDT, by decreasing VEGF serum levels, may influence the capability of tumor tissue to form new vessels.