Advances in enhancing photodynamic therapy for actinic keratoses and field-damage with laser pretreatments: A scoping review

IF 2.7 3区医学 Q2 ONCOLOGY

Photodiagnosis and Photodynamic Therapy Pub Date : 2026-08-01 Epub Date: 2026-07-23 DOI:10.1016/j.pdpdt.2026.105584

Mehdi Boostani, Cerrene N. Giordano, Drew Kuraitis, Kimberly L. Brady, Michael J. Bax, Norbert Kiss, Nathalie C. Zeitouni, Gyorgy Paragh

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引用次数: 0

Abstract

Background

Actinic keratoses (AKs) arise in chronically ultraviolet-damaged skin and may progress to cutaneous squamous cell carcinoma. Photodynamic therapy (PDT) is an established field-directed treatment, but efficacy may be limited by lesion thickness, hyperkeratosis, inadequate photosensitizer penetration, acral location, and immunosuppression. Laser pretreatment may enhance PDT by disrupting the epidermal barrier and improving photosensitizer delivery.

Objective

To identify and summarize the clinical evidence on laser pretreatment before PDT for AKs and field cancerization, and compare outcomes with non-laser-pretreated PDT.

Methods

A scoping review was conducted according to PRISMA-ScR guidance. Embase, Scopus, and PubMed were searched on May 6, 2026, for English-language human studies evaluating laser pretreatment before PDT for AKs or field cancerization. Data were extracted on study design, population, laser device, PDT protocol, outcomes, and adverse events. Methodological quality was assessed using the Mixed Methods Appraisal Tool.

Results

14 studies were included. Seven used carbon dioxide (CO₂) ablative fractional laser pretreatment, six used erbium:yttrium-aluminum-garnet (Er:YAG) ablative fractional laser pretreatment, and one used fractional 1927-nm thulium laser pretreatment. Eleven studies directly compared laser-pretreated PDT with non-laser PDT, and three provided supportive evidence without a non-laser PDT comparator. Overall, laser pretreatment improved AK clearance, early lesion reduction, or sustained clearance. Laser pretreatment also reduced recurrence in several trials and maintained higher lesion-specific clearance. Benefits were most evident for thicker lesions and treatment-resistant fields. Adverse events were usually local and transient.

Conclusion

Laser pretreatment, particularly with ablative fractional Er:YAG or CO₂ lasers, can improve outcomes for AKs and field cancerization.

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激光预处理增强光动力治疗光化性角化病和场损伤的进展：综述。

背景：光化性角化病（AKs）发生于慢性紫外线损伤的皮肤，并可能发展为皮肤鳞状细胞癌。光动力疗法（PDT）是一种成熟的现场定向治疗方法，但其疗效可能受到病变厚度、角化过度、光敏剂渗透不足、肢端定位和免疫抑制等因素的限制。激光预处理可以通过破坏表皮屏障和改善光敏剂的递送来增强PDT。目的：总结ak和野区癌PDT前激光预处理的临床证据，并与未激光预处理的PDT结果进行比较。方法：根据PRISMA-ScR指南进行范围综述。Embase、Scopus和PubMed于2026年5月6日检索了评估PDT前激光预处理治疗ak或野区癌的英文人类研究。提取研究设计、人群、激光设备、PDT方案、结局和不良事件的数据。使用混合方法评估工具评估方法学质量。结果：纳入14项研究。7个采用二氧化碳（CO2）烧蚀分数激光预处理，6个采用铒：钇-铝-石榴石（Er:YAG）烧蚀分数激光预处理，1个采用1927-nm分数铥激光预处理。11项研究直接比较了激光预处理的PDT与非激光PDT， 3项研究在没有非激光PDT比较物的情况下提供了支持性证据。总的来说，激光预处理改善了AK清除率，早期病变减少，或持续清除率。在一些试验中，激光预处理也减少了复发率，并保持了较高的病变特异性清除率。对于较厚的病变和治疗抵抗性野，效果最为明显。不良事件通常是局部和短暂的。结论：激光预处理，特别是烧蚀分数Er:YAG或CO2激光，可以改善ak和野区癌的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Photodiagnosis and Photodynamic Therapy ONCOLOGY-

CiteScore

5.80

自引率

24.20%

发文量

509

审稿时长

50 days

期刊介绍： Photodiagnosis and Photodynamic Therapy is an international journal for the dissemination of scientific knowledge and clinical developments of Photodiagnosis and Photodynamic Therapy in all medical specialties. The journal publishes original articles, review articles, case presentations, "how-to-do-it" articles, Letters to the Editor, short communications and relevant images with short descriptions. All submitted material is subject to a strict peer-review process.