Balancing efficacy and patients experience: A cautious perspective on simulated daylight PDT for superficial BCC
Year: 2025
Type: article
Abstract: Photodynamic therapy (PDT) is an established non-invasive treatment for superficial basal cell carcinoma (sBCC), especially when surgical excision is not feasible, but there is no direct comparison between different approaches of PDT.The study of Sjöholm et al. in this issue tries to fill this knowledge gap by comparing simulated daylight photodynamic therapy (SDL-PDT) with conventional photodynamic therapy (C-PDT) in treating sBCC.(1). 1 This single-centre, non-inferiority RCT involved 193 sBCC lesions diagnosed by dermoscopy.Patients received either SDL-PDT (using white light) or traditional C-PDT (with aminolevulinic acid (ALA) and red light).The study found a significant difference in 1-year clearance rates: 91.8% for C-PDT compared to 62.4% for SDL-PDT, which disproves the non-inferiority hypothesis.However, SDL-PDT caused significantly less pain, with a mean NRS of 0.1 compared to 3.5-3.7 in C-PDT.In fact, 87.5% of those treated with both methods preferred SDL-PDT, likely due to the reduced pain.As clinical effectiveness is crucial in managing oncologic conditions, when we are making choices of different treatment options, patient-reported outcomes should be considered alongside long-term cancer control.These findings confirm that SDL-PDT, under its current protocol, is inferior to C-PDT in treating sBCC.The deeper penetration of red light in C-PDT (635 nm) compared to the broader spectrum of SDL-PDT may further explain the lower tumour clearance in SDL-PDT.Despite the lower 1-year disease clearance, SDL-PDT may still have a role for certain selected patients, particularly those with cosmetically sensitive lesions 2 or in palliative situations where tolerability is crucial.However, the data from Sjöholm et al. clearly suggest that SDL-PDT should be reserved for secondary or adjunctive use until more long-term efficacy data are available.
DOI: 10.1111/jdv.70018
Authors: Davis Yung Chan, Raphael Chan
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4415543335