光动力联合冷冻治疗中老年头面部非黑色素瘤性皮肤癌及癌前病变:一项对比研究

Photodynamic therapy combined with cryotherapy for non-melanoma skin cancers and precancerous lesions on the head and face of the middle-aged and elderly: a comparative study

目的:探讨5-氨基酮戊酸光动力疗法(ALA-PDT)联合冷冻治疗头面部非黑色素瘤性皮肤癌及癌前病变的近期疗效。方法:选取2014年6月—2018年6月该院皮肤科门诊75例头面部非黑色素瘤性皮肤癌及癌前病变的中老年患者。将其随机分为3组:治疗组Ⅰ(25例)予冷冻治疗2周后行ALA-PDT治疗;治疗组Ⅱ(25例)冷冻后立即予ALA-PDT治疗;对照组(25例)仅单纯予ALA-PDT治疗。治疗12周后,比较3组的疗效、疼痛评分及患者满意度。结果:治疗12周后,治疗组Ⅰ及治疗组Ⅱ临床皮损完全清除率、首次治疗有效率及患者满意度均高于对照组(P<0.05),且2组所需平均治疗次数均明显少于对照组。治疗组Ⅱ疼痛评分稍高于治疗组Ⅰ(P>0.05),但明显高于对照组(P<0.05)。结论:ALA-PDT联合冷冻治疗中老年头面部非黑色素瘤性皮肤癌及癌前病变获得较好的近期疗效和患者满意度,可能为不适宜手术切除且有强烈的治疗愿望的患者提供新的选择。

Objective : To investigate the short-term efficacy of 5-aminolevulinic acid photodynamic therapy( ALA-PDT) combined with cryotherapy for non-melanoma skin cancers and precancerous lesions on the head and face. Methods : From June 2014 to June 2018, 75 cases of non-melanoma skin cancers and precancerous lesions in their dermatology clinic were randomly divided into 3 groups. The patients were treated with ALA-PDT either 2 weeks (treatment group Ⅰ, 25 cases) or immediately ( treatment group Ⅱ, 25 cases) after cryotherapy, and the remaining 25 patients treated with ALA-PDT alone served as the control group. The differences in efficacy, pain scores, and patients’ satisfaction were evaluated 12 weeks after treatments. Results: After 12 weeks of treatment, the rates of complete clearance of clinical lesions, the effective rates after the first treatment and patients’ satisfaction were higher in the treatment groups than in the controls( P<0.05). In addition,the average number of treatments required was fewer in the treatment groups than in the controls. The pain scores in treatment group Ⅱ were slightly higher than that in treatment group Ⅰ( P > 0.05 ), but significantly higher than that in the control group( P<0.05). Conclusions: ALA-PDT combined with cryotherapy can achieve better short-term efficacy and patients* satisfaction for nonmelanoma skin cancers and precancerous lesions on the head and face of middle- aged and older people. This may be a new option for patients who are not suitable for surgical resection, but have a strong desire for treatment.