Fractionated Photodynamic therapy Has a Better Complete Response Rate on Superficial Basal Cell Carcinoma than Single Illumination: A Systematic Review and Meta-Analysis

Objective: Photodynamic therapy (PDT) has been regarded as one of the effective treatment options for superficial subtype basal cell carcinoma (BCC). Several studies found that fractionated phototherapy along with... [ view full abstract ]

Objective: Photodynamic therapy (PDT) has been regarded as one of the effective treatment options for superficial subtype basal cell carcinoma (BCC). Several studies found that fractionated phototherapy along with 5-aminolevulinic (ALA) acid has a better complete response rate than single illumination. We conducted a meta-analysis to further investigate this relationship between the increased complete response rate of superficial BCC using fractionated PDT with ALA. 

Methods: Online database search of PubMed, MEDLINE, EMBASE, SCOPUS, COCHRANE, and GOOGLE SCHOLAR was performed. Randomized control studies comparing superficial BCC treatment treated with single illumination and fractionated PDT with ALA were included. Odds ratio with the corresponding 95% confidence intervals (CI) by random effects models of pooled data were calculated. Study quality was assessed using STROBE criteria. 

Results: The total number of studied lesions were 1250. The illumination dosage for the fractionated illumination arm was 20+80 J/cm² and 75 J/cm² for the single illumination arm. Compared to single illumination, the fractionated illumination arm has better outcomes with the total odds ratio for 12-month complete response rate at 4.05 (CI: 2.33, 7.04, P<0.001), while the combined total odds ratio for the 24-month complete response rate was 4.67(CI: 2.97, 7.36, P<0.001).

Conclusion: Fractionated PDT is significantly better than single illumination PDT in terms of complete response rate for the treatment of superficial BCC. Although fractionated PDT has been investigated on several other cancer types, more investigation is needed to study its potential for wider application.