Similar effectiveness of methyl aminolevulinate and 5-aminolevulinate in topical photodynamic therapy for nodular basal cell carcinoma

Abstract

Background: Photodynamic therapy (PDT) for basal cell carcinoma (BCC) is a treatment modality that is increasingly used in dermato-oncology. Currently, 2 topical photosensitizers, 5-aminolevulinate (ALA) and methyl aminolevulinate (MAL) are widely used, but their efficacy in BCC has not yet been compared in a clinical setting.

Objective: To evaluate the effect, degree of pain, and costs of ALA-PDT versus MAL-PDT in nodular BCC (nBCC).

Methods: Patients suffering from BCC were randomly assigned to either ALA-PDT (n=22) or MAL-PDT (n=21) in a pilot study. In each group, half of the tumors were debulked prior to PDT. Eight weeks after treatment, the therapeutic outcome was checked histologically. Pain scores were assessed using a visual analogue scale.

Results: Residual tumor tissue was detected in 6 BCCs of each study group. No significant difference between ALA-PDT and MAL-PDT was found with regard to therapeutic efficacy and pain scores. Of note, however, the costs of MAL-PDT were 6-fold higher than those of ALA-PDT.

Conclusions: In this study we did not observe any differences in short-term efficacy between ALA-PDT and MAL-PDT. Therefore, both ALA and MAL can be equally recommended as topical photosensitizers in PDT.