Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis.
Br J Dermatol
; 179(6): 1277-1296, 2018 12.
Article
em En
| MEDLINE
| ID: mdl-29889302
ABSTRACT
BACKGROUND:
Topical photodynamic therapy (PDT) is an established treatment option for low-risk basal cell carcinoma (BCC).OBJECTIVES:
To compare efficacy, cosmesis and tolerability of PDT for BCC with alternative treatments.METHODS:
MEDLINE, PubMed, Embase and CENTRAL databases were searched from inception until 1 September 2017. Included studies were randomized controlled trials (RCTs) of PDT for nodular (n) and superficial (s) BCC reporting at least one of the followingoutcomes:
clearance at 3 months and sustained at 1 or 5 years; recurrence at ≥ 1 year; cosmesis; adverse events; tolerability.RESULTS:
From 2331 search results, 15 RCTs (2327 patients; 3509 BCCs) were included. PDT efficacy (5-year sustained clearance) was high but inferior to excisional surgery [nBCC pooled risk ratio (RR) 0·76; 95% confidence interval (CI) 0·63-0·91], and without re-treatment of partially responding lesions, was modestly inferior to imiquimod (sBCC RR 0·81; 95% CI 0·70-0·95) and similar to fluorouracil (sBCC RR 0·88; 95% CI 0·75-1·04). Five-year sustained clearance was inferior with conventional vs. fractionated PDT (sBCC RR 0·76; 95% CI 0·68-0·84). PDT cosmesis was superior to surgery (sBCC RR 1·68, 95% CI 1·32-2·14; nBCC RR 1·82, 95% CI 1·19-2·80) and cryosurgery (BCC RR 3·73, 95% CI 1·96-7·07), and without re-treatment of partially responding lesions was similar to imiquimod (sBCC RR 1·01, 95% CI 0·85-1·19) and fluorouracil (sBCC RR 1·04, 95% CI 0·88-1·24). Peak pain was higher but of shorter duration with PDT than topical treatments. Serious adverse reactions were rarer with PDT than imiquimod (sBCC RR 0·05, 95% CI 0·00-0·84) and fluorouracil (sBCC RR 0·11, 95% CI 0·01-2·04). Combination PDT regimens demonstrated reduced recurrence and improved cosmesis; however, results from these small studies were often nonsignificant.CONCLUSIONS:
PDT is an effective treatment for low-risk BCC, with excellent cosmesis and safety. Imiquimod has higher efficacy than single-cycle PDT but more adverse effects. Highest efficacy is with excisional surgery. Fractionated and combination PDT options warrant further study.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fotoquimioterapia
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Neoplasias Cutâneas
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Carcinoma Basocelular
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Fármacos Fotossensibilizantes
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Antineoplásicos
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article