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Photodynamic therapy for the treatment of extramammary Paget's disease
1Department of Dermatology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
Background:
Surgical and ablative treatment modalities for extramammary Paget's disease (EMPD) have high recurrence rates and can be associated with significant morbidity.
Objectives:
To evaluate photodynamic therapy (PDT) for the treatment of EMPD.
Methods:
We conducted a retrospective review of notes and histology of five men with anogenital, groin and axillary EMPD treated with PDT at Roswell Park Cancer Institute between 20 April 1995 and 1 February 2001.
Results:
Sixteen EMPD lesions were treated with topical aminolaevulinic acid (ALA)-PDT. Eleven of these lesions had failed previous Mohs micrographic surgery, excision or laser ablation. When evaluated 6 months after one treatment with ALA-PDT, eight of 16 (50%) sites achieved a complete clinical response (CR); six of eight CRs were in lesions that had failed prior conventional therapies. Three of the eight CRs (37.5%) recurred at 9, 10 and 10 months. One patient who was partially responsive to topical ALA-PDT subsequently received systemic Photofrin(R)-PDT, with a complete clinical and histological response at 1 year. Functional and cosmetic outcome was excellent in all patients.
Conclusions:
PDT is an effective treatment for EMPD. Recurrence rates are high with topical ALA-PDT, but comparable with standard therapies. Topical ALA-PDT causes little scarring and is preferred for superficial disease and mucosal surfaces. Systemic Photofrin(R)-PDT may be better suited for bulky disease. While further studies are indicated, PDT is well tolerated and appears to be a useful therapy for EMPD.
Insights
Photodynamic therapy (PDT) offers an effective treatment for extramammary Paget's disease (EMPD), with topical ALA-PDT showing comparable recurrence rates to standard therapies. This method results in minimal scarring, making it suitable for superficial EMPD.
Area of Science:
- Dermatology
- Oncology
- Photomedicine
Background:
- Extramammary Paget's disease (EMPD) treatments like surgery often lead to high recurrence and morbidity.
- Conventional therapies for EMPD have limitations in efficacy and patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of photodynamic therapy (PDT) as a treatment for extramammary Paget's disease (EMPD).
Main Methods:
- Retrospective review of five male patients with anogenital, groin, and axillary EMPD treated with PDT.
- Involved topical aminolaevulinic acid (ALA)-PDT for 16 EMPD lesions, with some cases having failed prior treatments.
Main Results:
- 50% complete response (CR) rate with topical ALA-PDT after 6 months; 6 of 8 CRs were in previously treated lesions.
- 37.5% recurrence rate among complete responses at 9-10 months.
- Systemic Photofrin(R)-PDT achieved a complete response in one patient with bulky disease; excellent functional and cosmetic outcomes were noted.
Conclusions:
- PDT is a viable and well-tolerated treatment option for EMPD.
- Topical ALA-PDT is effective for superficial EMPD with low scarring, while systemic PDT may be better for bulky disease.
- Recurrence rates with topical ALA-PDT are comparable to standard treatments, warranting further investigation.
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