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Brown and Ibbotson highlight the many advantages of photodynamic
therapy (PDT) for cancer treatment [1]. For non-melanoma skin tumours,
especially Basal carcinoma, PDT can be very effective, especially for
smaller and superficial lesions. Particular advantages include excellent
cosmetic outcomes and avoidance of surgery - which has implications
especially for those with multiple lesions such a transplant patients [2]
or for those on anticoagulant medications. However, the 20% recurrence
rate quoted for treatment of BCCs (some quote more) is one concern which
precludes PDT being a gold-standard treatment. This is especially the case
for the common nodular tumour subtype. One problem is the limited depth of
penetration of 2mm. Whilst the suggestion that further research and
development of photosensitising drugs and refinement of treatment
parameters is one important direction to follow, we have achieved
excellent results with BCCs especially of the nodular variety by
pretreating the lesion with the ablative (and haemostatic) carbon dioxide
laser before PDT is undertaken at the same sitting. The preliminary
results we published [3] demonstrated efficacy and safety, and our
extended series of hundreds of lesions with up to 5 years followup due to
be published in the near future demonstrates excellent cosmesis but
minimal recurrence. Novel strategies for pain management during the
photoactivation phase of treatment are also needed, and one area we have
been investogating.
We would agree with the suggestion that PDT facilities should be
expanded in a multidisciplinary setting, and believe that a dual-modality
strategy provides all the advantages of PDT, but minimises the
recurrences. This latter fact will increase the appeal for patients and
clinicians alike, not least because long-term close follow-up after
combined CO2 laser with PDT treatment may be less often required.
References:
1) Brown, SB, Ibbotson, SH. Photodynamic therapy and cancer.
Promising results need to be followed by development of more selective
drugs. BMJ 2009;339:b2459
2) Shokrollahi K., Whitaker IS, Marsden N., James, W., Murison MSCM.
Laser-PDT, keeping the BCCs at bay for renal transplant patients: a case
report. Cases Journal, in press (accepted July 2009).
3) Whitaker IS, Shokrollahi K, James W, Mishra A, Lohana P, Murison
MC. Combined CO2 laser with photodynamic therapy for the treatment of
nodular basal cell carcinomas. Ann Plast Surg. 2007 Nov;59(5):484-8.
Competing interests:
None declared
Competing interests:
No competing interests
03 August 2009
Kayvan Shokrollahi
Specialist Registrar in Plastic Surgery
Maxwell Murison, Consultant Plastic Surgeon, Welsh Centre for Burns and Plastic Surgery
Indications for and efficacy of photodynamic therapy for skin cancer radically altered by combination carbon dioxide laser treatment
Brown and Ibbotson highlight the many advantages of photodynamic
therapy (PDT) for cancer treatment [1]. For non-melanoma skin tumours,
especially Basal carcinoma, PDT can be very effective, especially for
smaller and superficial lesions. Particular advantages include excellent
cosmetic outcomes and avoidance of surgery - which has implications
especially for those with multiple lesions such a transplant patients [2]
or for those on anticoagulant medications. However, the 20% recurrence
rate quoted for treatment of BCCs (some quote more) is one concern which
precludes PDT being a gold-standard treatment. This is especially the case
for the common nodular tumour subtype. One problem is the limited depth of
penetration of 2mm. Whilst the suggestion that further research and
development of photosensitising drugs and refinement of treatment
parameters is one important direction to follow, we have achieved
excellent results with BCCs especially of the nodular variety by
pretreating the lesion with the ablative (and haemostatic) carbon dioxide
laser before PDT is undertaken at the same sitting. The preliminary
results we published [3] demonstrated efficacy and safety, and our
extended series of hundreds of lesions with up to 5 years followup due to
be published in the near future demonstrates excellent cosmesis but
minimal recurrence. Novel strategies for pain management during the
photoactivation phase of treatment are also needed, and one area we have
been investogating.
We would agree with the suggestion that PDT facilities should be
expanded in a multidisciplinary setting, and believe that a dual-modality
strategy provides all the advantages of PDT, but minimises the
recurrences. This latter fact will increase the appeal for patients and
clinicians alike, not least because long-term close follow-up after
combined CO2 laser with PDT treatment may be less often required.
References:
1) Brown, SB, Ibbotson, SH. Photodynamic therapy and cancer.
Promising results need to be followed by development of more selective
drugs. BMJ 2009;339:b2459
2) Shokrollahi K., Whitaker IS, Marsden N., James, W., Murison MSCM.
Laser-PDT, keeping the BCCs at bay for renal transplant patients: a case
report. Cases Journal, in press (accepted July 2009).
3) Whitaker IS, Shokrollahi K, James W, Mishra A, Lohana P, Murison
MC. Combined CO2 laser with photodynamic therapy for the treatment of
nodular basal cell carcinomas. Ann Plast Surg. 2007 Nov;59(5):484-8.
Competing interests:
None declared
Competing interests: No competing interests