Photodynamic therapy for cutaneous squamous cell carcinoma in situ: impact of anatomic location, tumor diameter and incubation time on effectiveness

Background Photodynamic therapy (PDT) has been reported as a treatment for cutaneous squamous cell carcinoma in situ (SCCis) but there is limited data on the effectiveness of PDT with aminolevulinic acid (ALA-PDT). Objective To review the outcomes of SCCis treated with ALA-PDT and examine factors associated with response. Methods Retrospective review identified 58 patients with 68 primary SCCis lesions treated with ALA-PDT and blue light illumination. Patient demographics, lesion features, treatment details, clinical response, and subsequent recurrence were extracted from medical record review. Results Upon completion of PDT, the initial complete response rate was 77.9% and was not associated with the number of PDT treatments. On multivariate analysis, the factors associated with response were location on the face, tumor diameter <2 centimeters, and longer ALA incubation time. Lesions treated with a maximum incubation time of <3 hours had a 53.3% response compared with 84.9% for longer incubation. Subsequent recurrence of SCCis was noted in 7 of 53 cases (13.2%) at a median time of 11.7 months. Limitations This was a retrospective study performed at a single institution without systematic follow-up. Conclusions ALA-PDT may be an effective treatment for selected cases of SCCis. Effectiveness is impacted by anatomic location, tumor diameter, and ALA incubation time. This Dataset is Supplementary Data for the manuscript, "Photodynamic therapy for cutaneous squamous cell carcinoma in situ: impact of anatomic location, tumor diameter and incubation time on effectiveness." Authors: Nour Kibbi, MD, Yuemei Zhang, MD, MBA, David J. Leffell, MD, and Sean R. Christensen, MD, PhD Accepted for publication by Journal of the American Academy of Dermatology 2019 (JAAD-D-19-01312R1). Supplementary Figure 1. Response of SCCis according to number of PDT treatments. A, Initial complete response for all lesions and according to number of PDT treatments. B, Durable complete response at final follow-up for all lesions and according to number of PDT treatments. Supplementary Figure 2. Occlusion during PDT incubation period was significantly associated with incubation time. P value was calculated using the Spearman correlation. Supplementary Table. Factors associated with recurrence of SCCis after initial complete response.

背景：已有研究证实光动力疗法（Photodynamic therapy，PDT）可用于治疗皮肤原位鳞状细胞癌（cutaneous squamous cell carcinoma in situ，SCCis），但针对氨基酮戊酸光动力疗法（aminolevulinic acid-PDT，ALA-PDT）疗效的相关临床数据仍较为匮乏。目的：本研究旨在回顾性分析氨基酮戊酸光动力疗法治疗皮肤原位鳞状细胞癌的临床疗效，并探讨与治疗应答相关的影响因素。方法：本回顾性研究共纳入58例患者的68处原发性皮肤原位鳞状细胞癌病灶，所有病灶均采用氨基酮戊酸光动力疗法联合蓝光照射治疗。通过查阅患者病历资料，提取人口统计学信息、病灶特征、治疗细节、临床应答情况及后续复发数据。结果：完成全部光动力疗法疗程后，所有病灶的初始完全应答率为77.9%，且该应答率与光动力疗法的治疗次数无显著关联。多因素分析显示，与治疗应答相关的因素包括病灶位于面部、肿瘤直径＜2cm以及更长的氨基酮戊酸孵育时间。其中，氨基酮戊酸孵育时间＜3小时的病灶应答率仅为53.3%，而孵育时间更长的病灶应答率可达84.9%。53例患者中共有7例（13.2%）出现皮肤原位鳞状细胞癌复发，中位复发时间为11.7个月。局限性：本研究为单中心回顾性研究，且未采用系统性随访方案。结论：氨基酮戊酸光动力疗法可作为部分皮肤原位鳞状细胞癌患者的有效治疗手段，其疗效受解剖部位、肿瘤直径及氨基酮戊酸孵育时间的影响。本数据集为论文《Photodynamic therapy for cutaneous squamous cell carcinoma in situ: impact of anatomic location, tumor diameter and incubation time on effectiveness》的补充数据。作者为Nour Kibbi, MD、Yuemei Zhang, MD, MBA、David J. Leffell, MD及Sean R. Christensen, MD, PhD。本文已被《美国皮肤病学会杂志》（Journal of the American Academy of Dermatology）2019年刊接收，稿件编号为JAAD-D-19-01312R1。补充图1：皮肤原位鳞状细胞癌按光动力疗法治疗次数的应答情况。A：所有病灶及按治疗次数分组的初始完全应答情况；B：所有病灶及按治疗次数分组的末次随访时的持久完全应答情况。补充图2：光动力疗法孵育期间的封包处理与孵育时间显著相关，P值采用斯皮尔曼相关性分析计算得出。补充表：初始完全应答后皮肤原位鳞状细胞癌复发的相关影响因素。