A Randomized Controlled Trial of a Full and a Fractional Ablative Carbon Dioxide Laser as Pretreatment for Photodynamic Therapy in the Management of Superficial Non Melanoma Skin Cancer
Overview
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University Hospital, Ghent
- Enrollment
- 16
- Locations
- 1
- Primary Endpoint
- Clinical efficacy after twelve months of follow up
Overview
Brief Summary
Photodynamic therapy (PDT) is a well established treatment option for superficial non melanoma skin cancer, such as superficial basal cell carcinoma (sBCC) and Bowen Disease (BD). However, a limited uptake of the topically applied photosensitizer methyl aminolevulinate (MAL) may reduce its efficacy. Pretreatment with an ablative carbon dioxide (CO2) laser has recently been studied in order to enhance the skin penetration of this photosensitizer. This study compares the results of a full ablative and a fractional ablative CO2 laser mode as pretreatment of PDT in the management of sBCC and BD. The endpoints efficacy, pain, aesthetics and patient preference are investigated during twelve months of follow up.
Detailed Description
Superficial Basal Cell Carcinoma (sBCC) and Bowen Disease (BD) are malignant skin tumors localised in the superficial epidermis. These tumors are highly prevalent in the caucasian population. Diagnosis of sBCC and BD is often delayed because the clinical manifestation may be discrete and lesions are sometimes wrongly diagnosed and treated as eczema. Once the diagnosis is established, the lesions may cover an extensive area, making surgical excision more difficult. At that moment, the physician can make use of less invasive techniques such as photodynamic therapy (PDT). Pretreatment with an ablative carbon dioxide (CO2) laser has recently been studied in order to enhance the skin penetration of the photosensitizer methyl aminolevulinate (MAL). This study compares the results of a full ablative and a fractional ablative CO2 laser mode as pretreatment of PDT in the management of sBCC and BD. Ablation of the upper epiderm of the cancer results in an deeper penetration of MAL. Fractional ablation is known to result in better wound healing compared to full ablative CO2 laser ablation, because only small skin columns are ablated instead of the entire epidermal layer. Patients with non operable sBCC or BD lesions covering an area of at least 5 cm2 or with the presence of two small separated lesions, will be investigated. Lesions greater than 5 cm2 are divided in two. After randomization, the half of the lesions will be pretreated with the full ablative CO2 laser, while the other half with the fractional ablative CO2 laser. Afterwards, the entire surface is treated with MAL-PDT. Such as in our current clinical practice, this treatment modality is repeated after a two week interval. Thus, every subject undergoes both treatment modalities, making within-patient comparison possible. The endpoints efficacy, pain, aesthetics and patient preference are investigated during twelve months of follow up.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •patients with the presence of
- •non operable superficial Basal Cell Carcinoma or Bowen's Disease lesions
- •and the presence of at least two lesions or the presence of one lesion covering an area greater than 5cm2
Exclusion Criteria
- •pregnancy and/or breast feeding
Arms & Interventions
Full ablative CO2 laser + MAL PDT
The treatment starts with a full ablative CO2 laser pretreatment under local anaesthesia with injectable lidocaine hydrochloride 2% with epinephrine. This ablation is followed by photodynamic therapy: MAL is topically applied, followed by a 3 hours incubation under occlusion, whereafter 10 minutes of illumination with a LED lamp. This treatment is repeated after 14 days.
Intervention: full ablative CO2 laser (Device)
Full ablative CO2 laser + MAL PDT
The treatment starts with a full ablative CO2 laser pretreatment under local anaesthesia with injectable lidocaine hydrochloride 2% with epinephrine. This ablation is followed by photodynamic therapy: MAL is topically applied, followed by a 3 hours incubation under occlusion, whereafter 10 minutes of illumination with a LED lamp. This treatment is repeated after 14 days.
Intervention: MAL (Drug)
Full ablative CO2 laser + MAL PDT
The treatment starts with a full ablative CO2 laser pretreatment under local anaesthesia with injectable lidocaine hydrochloride 2% with epinephrine. This ablation is followed by photodynamic therapy: MAL is topically applied, followed by a 3 hours incubation under occlusion, whereafter 10 minutes of illumination with a LED lamp. This treatment is repeated after 14 days.
Intervention: LED lamp (Device)
Full ablative CO2 laser + MAL PDT
The treatment starts with a full ablative CO2 laser pretreatment under local anaesthesia with injectable lidocaine hydrochloride 2% with epinephrine. This ablation is followed by photodynamic therapy: MAL is topically applied, followed by a 3 hours incubation under occlusion, whereafter 10 minutes of illumination with a LED lamp. This treatment is repeated after 14 days.
Intervention: lidocaine hydrochloride 2% with epinephrine (Drug)
Fractional ablative CO2 laser+ MAL PDT
The treatment starts with a fractional ablative CO2 laser ablation under local anaesthesia with injectable lidocaine hydrochloride 2% with epinephrine. This ablation is followed by photodynamic therapy: MAL is topically applied, followed by a 3 hours incubation under occlusion, whereafter 10 minutes of illumination with LED lamp. This treatment is repeated after 14 days.
Intervention: fractional ablative CO2 laser (Device)
Fractional ablative CO2 laser+ MAL PDT
The treatment starts with a fractional ablative CO2 laser ablation under local anaesthesia with injectable lidocaine hydrochloride 2% with epinephrine. This ablation is followed by photodynamic therapy: MAL is topically applied, followed by a 3 hours incubation under occlusion, whereafter 10 minutes of illumination with LED lamp. This treatment is repeated after 14 days.
Intervention: MAL (Drug)
Fractional ablative CO2 laser+ MAL PDT
The treatment starts with a fractional ablative CO2 laser ablation under local anaesthesia with injectable lidocaine hydrochloride 2% with epinephrine. This ablation is followed by photodynamic therapy: MAL is topically applied, followed by a 3 hours incubation under occlusion, whereafter 10 minutes of illumination with LED lamp. This treatment is repeated after 14 days.
Intervention: LED lamp (Device)
Fractional ablative CO2 laser+ MAL PDT
The treatment starts with a fractional ablative CO2 laser ablation under local anaesthesia with injectable lidocaine hydrochloride 2% with epinephrine. This ablation is followed by photodynamic therapy: MAL is topically applied, followed by a 3 hours incubation under occlusion, whereafter 10 minutes of illumination with LED lamp. This treatment is repeated after 14 days.
Intervention: lidocaine hydrochloride 2% with epinephrine (Drug)
Outcomes
Primary Outcomes
Clinical efficacy after twelve months of follow up
Time Frame: month 12
A three point scale with complete regression (CR), partial regression (PR) and no regression (NR) defined respectively as 100%, 25-99% and 0-25% regression.
Secondary Outcomes
- Histological efficacy after twelve months of follow up(month 12)
- Pain during the first treatment session(immediately after the first treatment session (day 1))
- Pain during the second treatment session(immediately after the second treatment session (day 14))
- Side effects after the first treatment session(immediately after the first treatment session (day 1))
- Side effects after one week of follow up, telephone survey(day 7)
- Side effects before the second treatment session(before initiation of the second treatment session (day 14))
- Side effects after the second treatment(immediately after the second treatment session (day 14))
- Side effects after two weeks of follow up, telephone survey(day 21)
- Aesthetic result according to the patient after three months of follow up(month 3)
- Aesthetic result after three months of follow up(month 3)
- Aesthetic result after six months of follow up(month 6)
- Aesthetic result after twelve months of follow up(month 12)
- Clinical efficacy after six months of follow up(month 6)
- Clinical efficacy after three months of follow up(month 3)
- Side effects after three months follow up(month 3)
- Side effects after six months of follow up(month 6)
- Side effects after twelve months of follow up(month 12)
- Aesthetic result according to the patient after six months of follow up(month 6)
- Aesthetic result according to the patient after twelve months of follow up(month 12)
- Technique of preference according to the patient(month 12)