Photodynamic Therapy Safe For Basal Cell Carcinoma Syndrome In Children

NEW YORK (Reuters Health) - Large areas of basal cell carcinoma (BCC) and basaloid follicular hamartoma (BFH) in children with nevoid BCC syndrome can be safely and effectively treated with wide-area topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT), according to a report in the January issue of the Archives of Dermatology.

"ALA-PDT is life transforming for the few kids who have this disorder," Dr. Allan R. Oseroff from Roswell Park Cancer Institute, Buffalo, New York told Reuters Health. "Our results are generalizable in that the procedure is likely to be safe and effective in adults who have large areas of BCC."

Dr. Oseroff and colleagues used wide-area ALA-PDT to treat three children with BCC and BFH involving 12% to 25% of their body surface area.

Areas up to 2000 square centimeters, corresponding to 20% of body surface area, were treated within a single session under general anesthesia, the authors report, with light doses as high as 200 J/square centimeter (lamp light) and 240 J/square centimeter (laser light).

The median response to initial treatment was 75% with lamp light and 85% with laser light, the report indicates, and laser light doses of at least 150 J/square centimeter were predicted to provide treatment responses of 85% or more.

Cumulative treatments produced 98%, 90%, and 85% clearance in the three patients, the researchers note, and there is no evidence of new BCC in the treated areas 8.9, 4.9, and 3.2 years, respectively, after their initial treatment and 6, 1.8, and 1.8 years after their last treatment.

The treatments were associated with erythema resolving within 3 to 6 weeks, mild discomfort after the procedure, and superficial desquamation resembling a mild sunburn reaction during the week after treatment, the results indicate.

"To our knowledge," the investigators write, "this study is the first report of topical ALA-PDT for very large body surface areas as well as the first application of this therapy in children.

In an effort to explain why the procedure also prevents recurrent BCC, the investigators have begun a trial in adults with the syndrome. Half the body will be treated with ALA-PDT and the other half will remain untreated.

"This should allow us to see whether there is a difference in new cancer formation between the halves (suggesting that ALA-PDT kills unseen smaller cancers) or not (suggesting that ALA-PDT contributes to the immune response against new BCC)," Dr. Oseroff explained.

"We are also looking at T cell responses to tumor antigens before and after ALA-PDT," Dr. Oseroff said.

Source: Arch Dermatol 2005;141:60-67. [ Google search on this article ]

MeSH Headings: Clinical Trials : Environment and Public Health : Epidemiologic Methods : Evaluation Studies : Health : Health Occupations : Health Services Administration : Medicine : Investigative Techniques : Population Characteristics : Preventive Medicine : Public Health : Quality of Health Care : Specialties, Medical : Epidemiologic Study Characteristics : Health Care Quality, Access, and Evaluation : Health Care Evaluation Mechanisms : Analytical, Diagnostic and Therapeutic Techniques and Equipment : Biological Sciences : Health Care