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Ablative fractional laser-primed photodynamic therapy may be used to treat microinvasive SCC

Ablative fractional laser-primed photodynamic therapy may be used as an alternative treatment for microinvasive squamous cell carcinoma when the patient is not a candidate for surgical treatment, according to study results published in JAMA Dermatology.

Researchers conducted a randomized, comparative study of 45 Korean patients with microinvasive squamous cell carcinoma (SCC). Treatment with a single ablative fractional laser-primed photodynamic therapy (AFL-PDT) was administered to 21 patients (mean age, 76.4 years; 71.4% female) while 24 patients (mean age, 75.1 years; 54.2% female) received two conventional methyl aminolevulinate-photodynamic therapy (MAL-PDT) sessions with a 1-week interval between sessions.

Measurements for efficacy, recurrence rate, cosmetic outcomes and safety were taken at 1 week, and 3, 12 and 24 months after the last treatment.

The AFL-PDT treatment resulted in an overall complete response rate at 3 months of 84.2% (95% CI, 67.4-99.9), while the MAL-PDT treatment resulted in a response rate of 52.4% (95% CI, 30.5-74.3). At 24-months follow-up, the differences in efficacy remained significant for both cohorts.

The AFL-PDT treatment resulted in a significantly lower recurrence rate at 12 months (12.5%; 95% CI, 0.1-29.2) compared with the MAL-PDT treatment (63.6%; 95% CI, 33.8-93.5), with the differences remaining significant at 24 months.

There was no difference between the two treatments in cosmetic outcomes, adverse events or pain intensity.

“In the present study, we found that AFL-PDT is more efficacious than conventional mal-PDT for treating microinvasive SCC lesions,” the researchers concluded. “This treatment may be offered if the patient is not a candidate for surgical treatment, which remains the treatment of choice for microinvasive SCC. Although our approach was not as successful as surgical treatment, we suggest that AFL-PDT could be a good alternative treatment option for microinvasive SCC, considering that only one session of AFL-PDT was performed.

“Most patients who were diagnosed with SCC were elderly. Therefore, we recommend deciding the treatment modality according to the invasion depth rather than unconditionally choosing surgery because many elderly patients have health-related issues and are ineligible for surgery. For such patients, AFL-PDT could be a good alternative in cases of superficial SCC (microinvasive SCC and SCC in situ).” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.