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[5 min read] Photodynamic therapy vs conventional treatments for basal cell carcinoma
Topical photodynamic therapy is an established treatment option for low‐risk basal cell carcinoma (BCC), but how does its efficacy, cosmesis and tolerability compare with alternative treatments?
A study was conducted of 15 randomised controlled trials of photodynamic therapy for nodular and superficial BCC reporting at least one of these outcomes: clearance at three months and sustained at one or five years; recurrence at one year or later; cosmesis; adverse events; and tolerability. In total, 3,509 BCCs were included in the study of 2,327 patients.
The study found that the efficacy of photodynamic therapy (over five years of sustained clearance) was high but inferior to excisional surgery [nodular BCC 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 (superficial BCC: RR 0·81; 95% CI 0·70–0·95) and similar to fluorouracil (superficial BCC: RR 0·88; 95% CI 0·75–1·04).
Five‐year sustained clearance was inferior with conventional versus fractionated photodynamic therapy (superficial BCC: RR 0·76; 95% CI 0·68–0·84). Photodynamic therapy cosmesis was superior to surgery (superficial BCC: RR 1·68, 95% CI 1·32–2·14; nodular BCC: 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 (superficial BCC: RR 1·01, 95% CI 0·85–1·19) and fluorouracil (superficial BCC: RR 1·04, 95% CI 0·88–1·24).
Peak pain was higher but of shorter duration with photodynamic therapy than topical treatments. Serious adverse reactions were rarer with photodynamic therapy than imiquimod (superficial BCC: RR 0·05, 95% CI 0·00–0·84) and fluorouracil (superficial BCC: RR 0·11, 95% CI 0·01–2·04). Combination photodynamic therapy regimens demonstrated reduced recurrence and improved cosmesis; however, results from these small studies were often non-significant.
The study found that photodynamic therapy is an effective treatment for low‐risk BCC, with excellent cosmesis and safety. Highest efficacy is with excisional surgery, while imiquimod has higher efficacy than single‐cycle photodynamic therapy but more adverse effects. However, fractionated and combination photodynamic therapy options warrant further study.