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Proceedings Paper

Fractionated PDT with 5-aminolevulinic acid: effective, cost effective, and patient friendly
Author(s): Hannah C de Vijlder; Tom A. Middelburg; Henriette S. de Bruijn; Dominic J. Robinson; H. A. Martino Neumann; Ellen R. M. de Haas
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Paper Abstract

PDT with ALA and MAL is established as a relatively effective treatment for non-melanoma skin cancer and premalignancies. PDT is often repeated, because a single treatment gives poor long term results. Preclinical studies showed that ALA-PDT applying a fractionated illumination scheme with a small first light fraction and a second larger light fraction separated by a dark interval of two hours resulted in a significant increase in efficacy. Whereas the efficacy was not enhanced by fractionating MAL-PDT, indicating that ALA-PDT mechanism is not the same as MAL-PDT mechanism. The increase in efficacy using fractionated PDT was confirmed clinically. A randomized comparative clinical study comparing fractionated ALA-PDT versus non-fractionated ALA-PDT in the treatment of superficial basal cell carcinoma showed a significant higher response rate in the lesions treated with fractionated ALA-PDT after a follow-up of one year ( p<0.002, log-rank test). The five year follow-up is studied at moment. So far the complete response in the group treated with fractionated ALA-PDT seems to be only a few percentages lower compared to the one year follow-up. Besides the gain in response rate, fractionated ALA PDT is cost effective. ALA gel is less expensive than the commercially available MAL (Metvix) and moreover fractionated ALA-PDT takes one treatment day, instead of two treatment days using the Metvix treatment protocol (two MAL-PDT treatments separated by one week), both reducing direct and indirect costs and the burden to the patient.

Paper Details

Date Published: 13 July 2009
PDF: 4 pages
Proc. SPIE 7380, Photodynamic Therapy: Back to the Future, 73806A (13 July 2009); doi: 10.1117/12.828542
Show Author Affiliations
Hannah C de Vijlder, Erasmus Medical Ctr. (Netherlands)
Tom A. Middelburg, Erasmus Medical Ctr. (Netherlands)
Henriette S. de Bruijn, Erasmus Medical Ctr. (Netherlands)
Dominic J. Robinson, Erasmus Medical Ctr. (Netherlands)
H. A. Martino Neumann, Erasmus Medical Ctr. (Netherlands)
Ellen R. M. de Haas, Erasmus Medical Ctr. (Netherlands)

Published in SPIE Proceedings Vol. 7380:
Photodynamic Therapy: Back to the Future
David H. Kessel, Editor(s)

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