Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis

N. J. Collier; A. K. Haylett; T. H. Wong; C. A. Morton; S. H. Ibbotson; K. E. McKenna; R. Mallipeddi; H. Moseley; D. Seukeran; K. A. Ward; M. F. Mohd Mustapa; L. S. Exton; A. C. Green; L. E.  Rhodes

doi:10.1111/bjd.16838

Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis

N. J. Collier, A. K. Haylett, T. H. Wong, C. A. Morton, S. H. Ibbotson, K. E. McKenna, R. Mallipeddi, H. Moseley, D. Seukeran, K. A. Ward, M. F. Mohd Mustapa, L. S. Exton, A. C. Green, L. E. Rhodes (Lead / Corresponding author)

Undergraduate Medicine

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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 following outcomes: 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.

Original language	English
Pages (from-to)	1277-1296
Number of pages	20
Journal	British Journal of Dermatology
Volume	179
Issue number	6
Early online date	11 Jun 2018
DOIs	https://doi.org/10.1111/bjd.16838
Publication status	Published - 3 Dec 2018

Keywords

Photodynamic therapy
Basal Cell Carcinoma
Cosmesis
Imiquimod
Fluorouracil

ASJC Scopus subject areas

Dermatology

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10.1111/bjd.16838

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Collier, N. J., Haylett, A. K., Wong, T. H., Morton, C. A., Ibbotson, S. H., McKenna, K. E., Mallipeddi, R., Moseley, H., Seukeran, D., Ward, K. A., Mohd Mustapa, M. F., Exton, L. S., Green, A. C., & Rhodes, L. E. (2018). Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis. British Journal of Dermatology, 179(6), 1277-1296. https://doi.org/10.1111/bjd.16838

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title = "Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis",

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 following outcomes: 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.",

keywords = "Photodynamic therapy, Basal Cell Carcinoma, Cosmesis, Imiquimod, Fluorouracil",

author = "Collier, {N. J.} and Haylett, {A. K.} and Wong, {T. H.} and Morton, {C. A.} and Ibbotson, {S. H.} and McKenna, {K. E.} and R. Mallipeddi and H. Moseley and D. Seukeran and Ward, {K. A.} and {Mohd Mustapa}, {M. F.} and Exton, {L. S.} and Green, {A. C.} and Rhodes, {L. E.}",

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doi = "10.1111/bjd.16838",

language = "English",

volume = "179",

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journal = "British Journal of Dermatology",

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Collier, NJ, Haylett, AK, Wong, TH, Morton, CA, Ibbotson, SH, McKenna, KE, Mallipeddi, R, Moseley, H, Seukeran, D, Ward, KA, Mohd Mustapa, MF, Exton, LS, Green, AC & Rhodes, LE 2018, 'Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis', British Journal of Dermatology, vol. 179, no. 6, pp. 1277-1296. https://doi.org/10.1111/bjd.16838

TY - JOUR

T1 - Conventional and combination topical photodynamic therapy for basal cell carcinoma

T2 - systematic review and meta-analysis

AU - Collier, N. J.

AU - Haylett, A. K.

AU - Wong, T. H.

AU - Morton, C. A.

AU - Ibbotson, S. H.

AU - McKenna, K. E.

AU - Mallipeddi, R.

AU - Moseley, H.

AU - Seukeran, D.

AU - Ward, K. A.

AU - Mohd Mustapa, M. F.

AU - Exton, L. S.

AU - Green, A. C.

AU - Rhodes, L. E.

PY - 2018/12/3

Y1 - 2018/12/3

N2 - 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 following outcomes: 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.

AB - 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 following outcomes: 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.

KW - Photodynamic therapy

KW - Basal Cell Carcinoma

KW - Cosmesis

KW - Imiquimod

KW - Fluorouracil

UR - http://www.scopus.com/inward/record.url?scp=85052925090&partnerID=8YFLogxK

U2 - 10.1111/bjd.16838

DO - 10.1111/bjd.16838

M3 - Review article

C2 - 29889302

SN - 0007-0963

VL - 179

SP - 1277

EP - 1296

JO - British Journal of Dermatology

JF - British Journal of Dermatology

IS - 6

ER -

Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis

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Keywords

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