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Laser-assisted photodynamic therapy for actinic keratosis: A systematic review and meta-analysis - 14/03/19

Doi : 10.1016/j.jaad.2018.09.021 
Theresa Steeb, MPH, Justin Gabriel Schlager, MD, Christoph Kohl, MSc, Thomas Ruzicka, MD, Markus V. Heppt, MD, MSc, Carola Berking, MD
 Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany 

Reprint requests: Carola Berking, MD, Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstrasse 9-11, 80337 Munich, Germany.Department of Dermatology and AllergyUniversity Hospital, LMU MunichFrauenlobstrasse 9-11Munich80337Germany

Abstract

Background

Photodynamic therapy (PDT) is an effective intervention for actinic keratosis and field cancerization. Ablative fractional lasers may facilitate the delivery of photosensitizers and thereby improve the effects of PDT.

Objective

To summarize the current evidence on the efficacy and safety of laser-assisted PDT.

Methods

We performed a systematic literature research in Medline, Embase, and the Cochrane Central Register of Controlled Trials and hand-searched pertinent trial registers for eligible randomized controlled trials. Results from individual studies were pooled by using a random-effects model. The risk of bias was estimated with the Cochrane Risk of Bias Tool, and the quality of evidence of the outcomes was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation approach.

Results

Of 817 records initially identified, 7 randomized controlled trials were included in the qualitative analysis and 4 were included in the meta-analysis. Laser-assisted PDT showed significantly higher clearance rates than did PDT monotherapy (risk ratio, 1.33; 95% confidence interval, 1.24-1.42; I2 = 25%; P < .01). There was no difference in pain intensity between laser-assisted PDT and other interventions (mean difference, 0.31; 95% confidence interval, −0.12 to 0.74; I2 = 0%; P = .16). The included studies showed a high risk of bias.

Limitations

The clinical heterogeneity of included studies.

Conclusion

Laser-assisted PDT is more efficient but not more painful than PDT or laser treatment only.

Le texte complet de cet article est disponible en PDF.

Key words : actinic keratosis, carbon dioxide laser, erbium:yttrium-argon-garnet laser, general oncology, meta-analysis, photodynamic therapy, senile keratosis, solar keratosis, systematic review

Abbreviations used : AFXL, AK, ALA, CI, cSCC, dPDT, MAL, OTR, PDT, RCT, RR


Plan


 Ms Steeb and Dr Schlager are cofirst authors.
 Dr Heppt and Dr Berking contributed equally to this article.
 Funding sources: Ms Steeb is supported by the German Cancer Aid, grant no 70112351 to Dr Berking.
 Disclosure: Dr Berking has been member of advisory boards for Almirall Hermal, Biofrontera, Galderma, ISDIN, and Leo Pharma; she has received speaker's honoraria from Almirall Hermal, Galderma, and Leo Pharma and has received funding for clinical research from Leo Pharma. Ms Steeb, Dr Schlager, Dr Kohl, Dr Ruzicka, and Dr Heppt have no conflicts of interests to disclose.


© 2018  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 80 - N° 4

P. 947-956 - avril 2019 Retour au numéro
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