Acta Dermato-Venereologica issue 50:1 98-1CompleteContent | Page 27

116 SHORT COMMUNICATION Photodynamic Therapy: Influence of Clinical and Procedure Variables on Treatment Response in Basal Cell Carcinoma and Bowen Disease Tamara GRACIA-CAZAÑA 1 , Marta MASCARAQUE 2 , Nerea SALAZAR 2 , Jesús VERA-ÁLVAREZ 3 , María PILAR FRÍAS 4 , Salvador GONZÁLEZ 5 , Ángeles JUARRANZ 2 and Yolanda GILABERTE 4 1 Department of Dermatology, Hospital de Barbastro, Av Pirineos nº 11 1ºA, P.O. Box: 22011 – Barbastro, Huesca, 2 Departament of Biology, Universidad Autónoma de Madrid, Madrid, 3 Department of Pathology, 4 Department of Dermatology, Hospital San Jorge, Huesca, Spain, and 5 Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, USA. E-mail: [email protected] Accepted Jul 31, 2017; Epub ahead of print Aug 1, 2017 Photodynamic therapy (PDT) is one of the most com- monly used non-invasive treatments in non-melanoma skin cancer (NMSC). High rates of complete remission can be obtained using PDT with methyl-aminolevulinate (MAL); for basal cell carcinoma (BCC) the response rate is 91% at 3 months and 76% at 5 years, with 5-year recur- rence rates of 22% in superficial BCC (sBCC) and 14% in nodular BCC (nBCC) (1, 2), and for Bowen disease (BD) the rate ranges from 88% to 100% at 3 months with 68% to 89% of treated lesions remaining clear for 17 to 50 months, besides PDT provides excellent cosmetic results and a high patient satisfaction rate (1–3). The primary limiting factors for MAL-PDT are pain during irradiation, tumoural thickness, tumour location (reduced sustained clearance rates for H-zone lesions), and certain histological features of BCCs such as pig- mentary, morphoeaform, and infiltrative variants are con- sidered contra-indications to treatment (3). Although the PDT procedure has changed little since its introduction, we conducted a retrospective analysis to evaluate how individual procedural variables relating to PDT influence the clinical response of BCC and BD. MATERIALS AND METHODS This retrospective observational study analysed clinical and pro- cedural variables for all cases of BD, nBCC and sBCC treated with MAL-PDT at San Jorge Hospital (Huesca, Spain) between January 2006 and December 2015. Patients were treated with MAL-PDT (Metvix ® , Galderma, La Defense Cedex, France) following the standard procedure (3). Patients with nBCC first underwent curettage debulking of the lesions. After applying haemostatic pressure, MAL was applied to the lesion and a surrounding area of 1 cm in diameter, and was incubated for 3 h under occlusion. The treated area was illuminated with a coherent monochromatic diode light source (630 nm, 37 J/ cm 2 , Aktilite ® , PhotoCure ASA, Norway). The clinical records of all patients were reviewed and data gathered for the following variables: age at onset, sex, phototype (Fitzpatrick scale I–IV), predisposing factors, location, size and type of tumour. The following procedural variables were conside- red: number of PDT sessions; fluorescence emitted by the lesion in response to a Wood’s lamp; interruption of illumination due to pain; analgesia prior to irradiation and pain score as evaluated using a visual analogue scale (0–10). Clinical response was eva- luated at the end of patient follow-up. Statistical analyses were performed using the statistical package SPSS, version 19.0 (IBM, Armonk, NY, USA). Associations between qualitative variables were assessed using the Pearson chi-squared test or Fisher exact test. The normal distribution of doi: 10.2340/00015555-2756 Acta Derm Venereol 2018; 98: 116–118 quantitative variables was evaluated using the Kolmogorov-Smir- nov test. Depending on the data distribution, associations between binary and quantitative variables were evaluated using either the Student’s t-test or Mann-Whitney U-test. In cases of variables with more than two categories, the ANOVA or the Kruskal-Wallis tests were used. Analyses of the odds ratio (OR) of a good response to PDT were performed using logistic regression. p-values < 0.05 were considered statistically significant. The study protocol was approved by the Ethical Committee for Clinical Research of Aragon, Spain (CP-CI PI12/0096). RESULTS The study population consisted of 472 tumours in 249 patients, with a mean  ±  standard deviation (SD) age of 71.7  ±  13.78 years. Of these, 59% were men and 41% women. The majority (92.6%) had no relevant medical history, only 6.6% had received prior radiotherapy, and the remainder had received transplants. The mean  ±  SD age of treatment responders (69.98  ±  14.27 years) was lower than that of non-responders (74.45  ±  11.1 years) (p < 0.01). The majority of the lesions analysed were nBCCs (60.4%), followed by sBCCs (25.2%), and BD lesions (14.4%). The back was the most common tumour lo- cation (19.3%) followed by the forehead (16.1%), it was associated with treatment response, with a poorer response observed for lesions located on the face. Of non-responding patients, 70% had lesions located on the face (p < 0.01). In the statistical analysis when we divided the lesions according to the facial anatomical area affected, we verified th at of the total of 71 lesions that were located in the nose, only 63.4%, demonstrating that the nasal localization was an independent predictor of poor response (p = 0.01). A complete clinical response was observed for 81.1% of patients, the mean  ±  SD follow-up time was 35.96  ±  23.46 months. The number of PDT sessions ad- ministered was as follows: 1 session, 11.7% of tumours; 2 sessions, 85.6% of tumours; 3 sessions, 2.6% of tumours. Bivariate analysis revealed a statistically significant association between clinical response and the follo- wing variables: age (69.98  ±  4.27 years in responders vs 74.46  ±  11.07 years in non-responders; p = 0.01); location, with best response rate (92%) observed for lesions located on the trunk, and the worst response rate (75.62%) observed for those located on the head and This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica.