[3 min read] Photodynamic therapy for Bowen’s disease

How effective and safe is photodynamic therapy in treating Bowen’s disease? Bowen’s disease is an intraepidermal squamous cell carcinoma (SCC). There are several alternatives for treatment of Bowen’s disease, including photodynamic therapy. A new study investigated the efficacy and safety of photodynamic therapy in treating the skin condition.

Bowen’s disease is a common problem in the elderly and particularly on the lower limbs where healing can be an issue. It also occurs on the face where one is hesitant to use excision for a non-invasive malignancy.

Photodynamic therapy has the advantage of being unlikely to cause ulceration on the leg. Photosensitiser precursors used in Europe include methyl-5-aminolaevulinate (MAL) and 5-aminolaevulinic acid (BF-200 ALA).

However, photodynamic therapy is associated with significant failure rates. Further, ALA or MAL- based photodynamic therapy regimens are expensive both in terms of medication costs and treatment times. The combination of high out of pocket costs and treatment failure will always stress the doctor-patient relationship.

A study published recently in Science Direct posed the difficult question of whether the only approved, Veterans Affairs funded photodynamic therapy treatment in Australia is sub-optimal.

Over six years, 171 patients (191 lesions) with Bowen’s disease were enrolled in the study (95 women and 76 men; average age of 74.31 years). Lesions were treated with one 5-aminolaevulinic acid (BF-200 ALA)-PDT or methyl-5-aminolaevulinate (MAL)-PDT cycle of two sessions in one week. A second treatment cycle was performed in cases of clinical persistence at 12 weeks.

The results showed that 47 out of 55 lesions were resolved (84.75%) after one or two ALA-PDT cycle and 75 out of 136 lesions (55.15%) after one or two MAL-PDT cycles, in the 12-month follow-up.

The study concluded that photodynamic therapy is a safe and non-invasive treatment option in Bowen’s disease. In addition, the results suggest a better response with ALA-PDT over MAL-PDT.

Source: https://www.sciencedirect.com/science/article/abs/pii/S1572100019303758


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