14. PDT to Treat Basal-Cell Skin Cancer in the Periorbital Area
Basal-cell skin cancer is one of the most spread cancer forms, and in 80 % of cases it is localized on the face, including the periorbital area. The areas of eye corners and eyelids are among the so-called inconvenient localizations, and unfortunately, the opportunities of using standard methods of treatment (surgical excision, radiotherapy) turn out to be rather limited.
Nowadays, close-focus X-ray therapy and intratissular gammatherapy are quite wide-spread and are used as separate methods of treatment for basal-cell skin cancer in the periorbital area. Recurrences after radiotherapy make about 20 % and are accompanied by the development of local radio-reactions in normal tissues for the irradiated zone. Radiotherapy of periorbital area may often lead to the risk of various complications like dermatitis, conjunctivitis, cataract, general weakness, loss of appetite, headaches and faintness, leuko- and lymphopenia, thrombocytopenia etc. These complications limit the efficiency of treatment, cause more sufferings in patients, make it impossible to treat a recurrent tumor by subsequent radiotherapy.
In the past decade photodynamic therapy (PDT) became one of alternative methods of treatment for skin cancer in inconvenient localizations, which shows high recovery results and excellent cosmetic results.
As far as treatment for skin cancer in the periorbital area is concerned, PDT as an organ-preserving method of treatment, opens new opportunities.
We observed 108 patients with basal-cell skin cancer in the periorbital area.
We have got the experience of using second-generation photosensitizers from the group of chlorin derivatives (Russian drug substances Radachlorin and Photoditazine) and from the group of synthetic derivatives (Russian drug substance Photosense) for PDT to treat skin cancer.
The drug doses for Photoditazine and Radachlorin were 0.6 to 0.8 mg/kg, the drug-light interval (DLI) was 1 and 3 hours respectively, the light dose was 100 to 200 J/cm2. The drug dose for Photosense was 0.4 to 0.6 mg/kg, the DLI was 24 hours, the corresponding light dose was 150 to 200 J/cm2.
Therapeutic effect was achieved in 108 treated patients. Due to the healing of a tissue defect after tumor resorption by type of reparation, but not scarring, absolute majority of patients got good cosmetic results.
The data we got give us a reason to conceive PDT as a comprehensive, alternative, organ-preserving and protective method of treatment for skin cancer in the periorbital area, which shows good and excellent cosmetic results. One of the advantages of PDT is that it is possible to conduct it on an outpatient basis and to carry out numerous subsequent sessions in case of recurrences.