A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer

Nathalie C. Zeitouni; Ulas Sunar; Daniel J. Rohrbach; Anne D. Paquette; David A. Bellnier; Yi Shi; Gregory Wilding; Thomas H. Foster; Barbara W. Henderson

doi:10.1097/DSS.0000000000000183

A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer

Nathalie C. Zeitouni
, Ulas Sunar
, Daniel J. Rohrbach
, Anne D. Paquette
, David A. Bellnier
, Yi Shi
, Gregory Wilding
, Thomas H. Foster
, Barbara W. Henderson

University of Arizona
Roswell Park Cancer Institute
University of Rochester

Research output: Contribution to journal › Article › peer-review

21 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	1390-1394
Number of pages	5
Journal	Dermatologic Surgery
Volume	40
Issue number	12
DOIs	https://doi.org/10.1097/DSS.0000000000000183
State	Published - Dec 11 2014

Access to Document

10.1097/DSS.0000000000000183

Cite this

@article{942ea94300b84f6499413b8930b8224c,

title = "A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer",

abstract = "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.",

author = "Zeitouni, \{Nathalie C.\} and Ulas Sunar and Rohrbach, \{Daniel J.\} and Paquette, \{Anne D.\} and Bellnier, \{David A.\} and Yi Shi and Gregory Wilding and Foster, \{Thomas H.\} and Henderson, \{Barbara W.\}",

note = "Publisher Copyright: {\textcopyright} 2014 by the American Society for Dermatologic Surgery, Inc.",

year = "2014",

month = dec,

day = "11",

doi = "10.1097/DSS.0000000000000183",

language = "English",

volume = "40",

pages = "1390--1394",

journal = "Dermatologic Surgery",

issn = "1076-0512",

number = "12",

}

TY - JOUR

T1 - A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer

AU - Zeitouni, Nathalie C.

AU - Sunar, Ulas

AU - Rohrbach, Daniel J.

AU - Paquette, Anne D.

AU - Bellnier, David A.

AU - Shi, Yi

AU - Wilding, Gregory

AU - Foster, Thomas H.

AU - Henderson, Barbara W.

PY - 2014/12/11

Y1 - 2014/12/11

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/84916624349

U2 - 10.1097/DSS.0000000000000183

DO - 10.1097/DSS.0000000000000183

M3 - Article

C2 - 25393353

AN - SCOPUS:84916624349

SN - 1076-0512

VL - 40

SP - 1390

EP - 1394

JO - Dermatologic Surgery

JF - Dermatologic Surgery

IS - 12

ER -

A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer

Abstract

Access to Document

Other files and links

Fingerprint

Cite this