The purpose of this randomized, two-center study was to compare the efficacy and tolerability of photodynamic therapy (PDT) and topical 5-fluorouracil (5-FU) in Bowen's Disease (BD). PDT involves the activation of a photosensitizing agent by visible light to produce activated oxygen species that promote tumor destruction. 5-aminolaevulinic acid (ALA) is topically applied and converted within cells into the active photosensitizer protoporphyrin IX, with preferential accumulation in tumor cells. In comparison, 5-fluorouracil induces inhibition of DNA synthesis and subsequent cell death, targeting rapidly multiplying tumor cells.
Forty patients with one to three lesions of previously untreated, histologically proven BD measuring .5-4.0 cm were randomized to receive either PDT or 5-FU. Patients in the PDT group first applied ALA 20%, and these lesions were illuminated 4 hours later with narrowband red light (approx 630 nm). Those in the 5-FU group applied their respective medication once daily for the first week, then subsequently increased to twice daily for the remaining 4 weeks of the trial.
All patients were reviewed at 6 weeks and treatment repeated if required. Following clinical clearance, patients were reviewed for 12 months. 88% of the PDT-treated lesions showed complete clinical clearance, while the remaining lesions showed partial clearance. In contrast, complete clinical clearance was observed by 67% of those treated with 5-FU. Recurrences included two lesions from the PDT group and six in the 5-FU group. Both treatment groups reported pain, with the median pain score showing no statistically significant difference.
Salim A, et al. Randomized comparison of photodynamic therapy with topical 5-fluorouracil in Bowen's disease. Br J Derm 2003; 148:539-543.
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