Abstract:
Introduction: Photodynamic therapy (PDT) had been used for benign and malignant skin lesions for some time. It can disinfect caries dentin before restoration or oral tissues before or during surgical procedures, treat denture stomatitis, and oral candidiasis in immunocompromised patients, etc. Radiation-induced ulcers are difficult to treat. PDT promotes wound healing while its clinical use is not investigated in human for radiation-induced skin ulcers.
Methods and Materials: We documented the first Canadian in-human case and searched the PubMed literature using “PDT" AND "radiation" AND "ulcer" terms.
Results: PDT has been used by our team to treat a chest wall ulcer of 5-year duration, which developed after mastectomy and adjuvant radiotherapy. There are 6 laboratory literature reports (total 95 rats) of radiation-induced skin ulcers with an overall efficacy of 90%. Topically applied 5-aminolevulinic acid (5-ALA) was activated by red light (wavelength 630 nm) after incubation for 5 hours. Our regimen was three 30-minute treatments at months 0, 1, 5; and regimen can vary depending on response. Comparing with hyperbaric oxygen therapy (HBOT), PDT is non-invasive with fewer complications: skin irritation/swelling (rarely requiring steroid treatment), photosensitivity and retinal damage. PDT is much cheaper: 5-ALA costs only CAN$500/session for Metvix (methyl 5-ALA, currently approved by Health Canada) vs HBOT requiring 30 sessions (about CAN$15,000). PDT procedure is an innovative emerging therapeutic modality for dentists, oncologists, family doctors and nurse practitioners as it is simple and easy to use.
Conclusions: Laboratory publications substantiate the efficacy of PDT on radiation-induced skin ulcer healing. The first Canadian clinical case was documented by us. It is cost-effective, with growing applications in different medical fields. Further clinical studies are warranted to evaluate the optimal treatment schema and effects on quality of life. Hopefully it can be widely available with costs covered by the Canadian government.
