Fotodynamická terapie (PDT) je moderní, neinvazivní léčebná a diagnostická metoda využívaná v dermatologii k terapii především nemelanomových kožních nádorů (NMSC). Princip PDT je založen na fotodynamické reakci. Fotosenzibilizátor po aktivaci červeným světlem za přítomnosti kyslíku přechází v cílových buňkách do excitovaného stavu za současného uvolňování kyslíkových radikálů, které působí cytotoxicky. Výsledky ošetření nemelanomových kožních nádorů (NMSC) pomocí PDT jsou srovnatelné s jinými neinvazivními (imiquimod, ingenol mebutát) i invazivními (kryalizace) metodami.

Photodynamic therapy is a modern, noninvasive treatment and diagnostic method used in dermatology for non - melanoma skincancer care. PDT is based on photodynamic reaction. It involves the activation of a photosensitizing drug by red light to producereactive oxygen species within target cells, resulting in their destruction. Recurrence rates are typically equivalent to other noninvasive(imiquimod, ingenol mebutate) and invasive (cryotherapy) therapies.

• MeSH
• fotochemoterapie * dějiny   metody   využití   MeSH
• fotosenzibilizující látky farmakokinetika   terapeutické užití   MeSH
• kyselina aminolevulová analogy a deriváty   farmakokinetika   terapeutické užití   MeSH
• lidé MeSH
• nádory kůže terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

OBJECTIVE: The objective of the study was to investigate the efficacy and safety of hexaminolevulinate (HAL) photodynamic therapy (PDT), a novel therapy for women with cervical intraepithelial neoplasia (CIN)1/2, to define the appropriate population and endpoints for a phase 3 program. STUDY DESIGN: This was a double-blind, randomized, placebo-controlled, dose-finding study that included a total of 262 women with biopsy-confirmed CIN 1/2 based on local pathology. Patients received 1 or 2 topical treatments of HAL hydrochloride 0.2%, 1%, 5%, and placebo ointment and were evaluated for response after 3-6 months based on biopsy, Papanicolaou test, and oncogenic human papillomavirus (HPV) test. All efficacy analyses were performed on blinded central histology review to avoid interreader variability. Adverse events, blood biochemistry, and vital signs were assessed after 3 months. RESULTS: There were no statistically significant differences between placebo and either the CIN 1 or combined CIN 1/2 populations. A clear dose effect with a statistically significant response in the HAL 5% group of 95% (18/19 patients) compared to 57% (12/21 patients) in the placebo group (P < .001) was observed at 3 months in women with CIN 2, including an encouraging 83% (5/6 patients) clearance of HPV 16/18 compared to 33% (2/6 patients) in the placebo group at 6 months. The treatment was easy to use and well accepted by patients and gynecologists. Only local self-limiting adverse reactions including discharge, discomfort, and spotting were reported. CONCLUSION: HAL PDT is a novel therapy that shows promise in the treatment of CIN 2 including clearance of oncogenic HPV, but not of CIN 1. The positive risk/benefit balance makes HAL PDT a tissue-preserving alternative in women of childbearing age who wish to preserve the cervix. Confirmatory studies are planned.

• MeSH
• analýza podle původního léčebného záměru MeSH
• aplikace lokální MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• dysplazie děložního hrdla farmakoterapie   patologie   MeSH
• fotochemoterapie * MeSH
• fotosenzibilizující látky terapeutické užití   MeSH
• kyselina aminolevulová analogy a deriváty   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory děložního čípku farmakoterapie   patologie   MeSH
• rozvrh dávkování léků MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze II MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

CONTEXT: Non-muscle-invasive bladder cancer (NMIBC) is associated with a high recurrence risk, partly because of the persistence of lesions following transurethral resection of bladder tumour (TURBT) due to the presence of multiple lesions and the difficulty in identifying the exact extent and location of tumours using standard white-light cystoscopy (WLC). Hexaminolevulinate (HAL) is an optical-imaging agent used with blue-light cystoscopy (BLC) in NMIBC diagnosis. Increasing evidence from long-term follow-up confirms the benefits of BLC over WLC in terms of increased detection and reduced recurrence rates. OBJECTIVE: To provide updated expert guidance on the optimal use of HAL-guided cystoscopy in clinical practice to improve management of patients with NMIBC, based on a review of the most recent data on clinical and cost effectiveness and expert input. EVIDENCE ACQUISITION: PubMed and conference searches, supplemented by personal experience. EVIDENCE SYNTHESIS: Based on published data, it is recommended that BLC be used for all patients at initial TURBT to increase lesion detection and improve resection quality, thereby reducing recurrence and improving outcomes for patients. BLC is particularly useful in patients with abnormal urine cytology but no evidence of lesions on WLC, as it can detect carcinoma in situ that is difficult to visualise on WLC. In addition, personal experience of the authors indicates that HAL-guided BLC can be used as part of routine inpatient cystoscopic assessment following initial TURBT to confirm the efficacy of treatment and to identify any previously missed or recurrent tumours. Health economic modelling indicates that the use of HAL to assist primary TURBT is no more expensive than WLC alone and will result in improved quality-adjusted life-years and reduced costs over time. CONCLUSIONS: HAL-guided BLC is a clinically effective and cost-effective tool for improving NMIBC detection and management, thereby reducing the burden of disease for patients and the health care system. PATIENT SUMMARY: Blue-light cystoscopy (BLC) helps the urologist identify bladder tumours that may be difficult to see using standard white-light cystoscopy (WLC). As a result, the amount of tumour that is surgically removed is increased, and the risk of tumour recurrence is reduced. Although use of BLC means that the initial operation costs more than it would if only WLC were used, over time the total costs of managing bladder cancer are reduced because patients do not need as many additional operations for recurrent tumours.

• MeSH
• analýza nákladů a výnosů MeSH
• časové faktory MeSH
• cystektomie ekonomika   metody   normy   MeSH
• cystoskopie ekonomika   metody   normy   MeSH
• ekonomické modely MeSH
• invazivní růst nádoru MeSH
• kvalita života MeSH
• kvalitativně upravené roky života MeSH
• kyselina aminolevulová analogy a deriváty   ekonomika   MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• nádory močového měchýře ekonomika   patologie   chirurgie   MeSH
• náklady na zdravotní péči * MeSH
• prediktivní hodnota testů MeSH
• přežití bez známek nemoci MeSH
• progrese nemoci MeSH
• reziduální nádor MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

BACKGROUND: The major limitation of photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is proper photosensitizer penetration. The nodular form of BCC (nBCC) is perceived as a contraindication to ALA-PDT because the tumor layer is thicker than 2 mm. We have improved on the results of previous studies that used an ablative laser to limit tumor thickness. A fractional laser produces skin microtubules that can improve the penetration of ALA into tumors. OBJECTIVE: To evaluate the use of a fractional laser as pretreatment before ALA-PDT for nBCC treatment in an 18-month single-blind clinical trial. METHODS: Fifty-six verified nBCCs were ablated using a diode laser under ultrasound control. Half of the tumors were treated 3 weeks later using a fractional carbon dioxide laser, and the other half were treated using curettage (control). We then immediately treated with ALA-PDT. Fluorescence and photography were evaluated and compared each month, and a final histopathologic examination was performed. RESULTS: Fifty-two of 56 nBCCs in the fractional laser treatment group responded to ALA-PDT, compared with only 45 of 56 in the control group. Fluorescence was higher in 53 cases in the treatment group; 3 cases demonstrated the same fluorescence level in both groups. Healing took longer in the treatment group, and there were more side effects. CONCLUSION: Fractional laser pretreatment increases the fluorescence and clinical effectiveness of ALA-PDT for the treatment of nBCC.

• MeSH
• bazocelulární karcinom patologie   chirurgie   MeSH
• fotochemoterapie * MeSH
• fotosenzibilizující látky aplikace a dávkování   MeSH
• invazivní růst nádoru MeSH
• kombinovaná terapie MeSH
• kyselina aminolevulová aplikace a dávkování   analogy a deriváty   MeSH
• lasery plynové terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   MeSH
• mikrotubuly MeSH
• nádory kůže patologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: With proper noninvasive ultrasound measurement of tumor depth, case selection for laser pre-ablation followed by PDT is possible. This combination of methods provides a less invasive approach to the treatment of BCC. BACKGROUND DATA: Basal cell carcinoma (BCC) primarily affects the face, and, therefore, radical excision is problematic because of the possibility of poor aesthetic outcomes. Photodynamic therapy (PDT) offers an advantage in aesthetic outcomes, but topical PDT is only effective for tumors with a depth up to 2 mm. MATERIALS AND METHODS: Seventy-five histologically verified BCCs from 67 patients were selected and divided into three therapeutic groups based on the tumor depth, which was determined by 20 MHz skin ultrasound. The three groups were: A/<2 mm (PDT), B/ 2-3 mm (Er:YAG laser ablation+PDT), and C/>3 mm (diode laser ablation+PDT). The treatment consisted of laser ablation (or no ablation) followed by the application of methyl-aminolevulinate (MAL) and a 3-h treatment period using an occlusive bandage. Subsequently, illumination with 630 nm (MAL-PDT) was performed. MAL-PDT was repeated 1-3 weeks after the first treatment. A clinical evaluation was performed after 6 months. RESULTS: A 100% clearance rate (CR) in the group with the deepest tumors was observed. In addition, a 94.7% CR occurred in the group with tumors 2-3 mm in depth, and an 81.2% CR was observed in the group with superficial tumors. CONCLUSIONS: With proper ultrasound case selection and laser ablation before MAL-PDT, the depth of a BCC lesion is not a limiting factor for PDT, and aesthetic outcomes are very good. Therefore, ultrasound-guided ablative laser-assisted PDT of BCC can be the method of choice, particularly in aesthetically challenging cases.

• MeSH
• bazocelulární karcinom patologie   terapie   ultrasonografie   MeSH
• dospělí MeSH
• estetika MeSH
• fotochemoterapie metody   MeSH
• hodnocení rizik MeSH
• imunohistochemie MeSH
• jehlová biopsie MeSH
• kohortové studie MeSH
• kombinovaná terapie MeSH
• kyselina aminolevulová analogy a deriváty   farmakologie   MeSH
• laserová terapie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory kůže patologie   terapie   ultrasonografie   MeSH
• následné studie MeSH
• obličej MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Necrobiosis lipoidica (NL) is a granulomatous skin disease of unknown origin, and no reliably effective treatment option exists to handle this often disfiguring disease. Recently, a patient with long-lasting NL was reported to be cured by topical photodynamic therapy (PDT). OBJECTIVE: To evaluate the overall potential of PDT in the treatment of NL on the lower legs. METHODS: Retrospective study of 18 patients (aged 16-62 years) from 3 European university departments of dermatology treated with PDT for NL. Methyl aminolevulinate or 5-aminolevulinic acid were used as topically applied photosensitizers. Illumination followed with red light-emitting diode light. RESULTS: Complete response was seen in 1/18 patients after 9 PDT cycles, and partial response in 6/18 patients (2-14 PDT cycles) giving an overall response rate of 39% (7/18). CONCLUSION: Although almost 40% of the cases showed some degree of response, PDT cannot currently be recommended as first-line therapy of NL. Subpopulations of therapy-resistant NL patients may, however, benefit from PDT.

• MeSH
• aplikace kožní MeSH
• bérec patologie   MeSH
• dospělí MeSH
• fotochemoterapie metody   MeSH
• fotosenzibilizující látky aplikace a dávkování   MeSH
• kyselina aminolevulová aplikace a dávkování   analogy a deriváty   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• necrobiosis lipoidica farmakoterapie   patologie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika MeSH
• Dánsko MeSH
• Německo MeSH

BACKGROUND: Mycosis fungoides, or cutaneous T-cell lymphoma (CTCL), is one of the most common skin lymphomas, with a chronic and lethal course. It is characterized by the expansion of CD4+ and CDw29+ immunophenotype T-cell clones lacking normal antigens. These altered T-lymphocytes are predominantly located in the skin, but some of them retain their ability to migrate and exit the skin through the lymphatics into the circulatory system. CASE REPORT: We report on a 78-year-old man with an 8-year history of histologically verified Mycosis fungoides. Twenty-five years ago, the patient was incorrectly diagnosed with psoriasis vulgaris and received therapy with only slight effect. In 1999 the patient underwent full body actinotherapy (30 Gy) which resulted in complete remission of CTCL lesions on the skin. In October 2005 the patient presented at our department with a new partially infiltrated lesion 14x6 cm in his right groin. Because photochemotherapy and local therapy with corticosteroids had already been used without significant results, we opted for photodynamic therapy (PDT) with methyl aminolevulinate (MAL).

• MeSH
• fotochemoterapie MeSH
• kyselina aminolevulová analogy a deriváty   terapeutické užití   MeSH
• lidé MeSH
• mycosis fungoides farmakoterapie   patologie   MeSH
• nádory kůže farmakoterapie   patologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUNDS AND OBJECTIVES: Photodynamic therapy (PDT), via topical aminolevulinic acid (ALA) is an effective treatment for basal cell carcinomas not exceeding a depth of 2 mm. This limits the treatment of basal cell carcinoma (non-melanoma skin cancer) to superficial forms and nodular therapy (only in aesthetically desired locations). This paper addresses the effectiveness of reducing tumor mass via initial Er:YAG laser ablation to depths that are therapeutically responsive to PDT with ALA.

• MeSH
• bazocelulární karcinom patologie   terapie   MeSH
• financování organizované MeSH
• fotochemoterapie MeSH
• fotosenzibilizující látky terapeutické užití   MeSH
• kombinovaná terapie MeSH
• kyselina aminolevulová analogy a deriváty   terapeutické užití   MeSH
• laserová terapie metody   přístrojové vybavení   MeSH
• lasery pevnolátkové terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory hlavy a krku patologie   terapie   MeSH
• nádory kůže patologie   terapie   MeSH
• následné studie MeSH
• prospektivní studie MeSH
• randomizované kontrolované studie jako téma MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH

V posledních asi 20 letech se na celém světě zvyšuje úsilí na využití fotoaktivních látek, které, inkorporované do buněk, jsou následně schopné využít energii neinvazivně působícího záření k likvidaci nemocných buněk naprogramovanou smrtí, tzv. apoptózou. Toto úsilí se v poslední době začíná zúročovat registrací nového léku obsahujícího metylaminolevulinát – hydrofilní ester kyseliny δ-aminolevulové. Hledají se ale i jiné senzibilizátory, které by mohly rozšířit nabídku a popřípadě umožnit terapeutovi výběr podle nemocných buněk, umístění poškozené tkáně apod.

In about last 20 years there has been a growing effort in making use of photoactive substances that after incorporation in cells are able to use the energy of noninvasive radiation to liquidate diseased cells by programmed death, so called apoptosis. This effort begins to be effective by registration of a new medication containing methylaminolevulinate – a hydrophilic ester of δ-aminolevulinic acid. Other sensibilizers that could broaden the treatment choice and potentially enable a choice according diseased cells, location of involved tissue etc. are being explored.

• MeSH
• apoptóza účinky záření   MeSH
• fotochemoterapie metody   využití   MeSH
• fotosenzibilizující látky terapeutické užití   MeSH
• kosmetické techniky využití   MeSH
• kožní nemoci farmakoterapie   terapie   MeSH
• kyselina aminolevulová analogy a deriváty   aplikace a dávkování   terapeutické užití   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

• MeSH
• dospělí MeSH
• fotochemoterapie metody   využití   MeSH
• kyselina aminolevulová analogy a deriváty   aplikace a dávkování   terapeutické užití   MeSH
• lidé MeSH
• methylaminy terapeutické užití   MeSH
• necrobiosis lipoidica farmakoterapie   terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH