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Clinical Trial
. 2019 Jan-Dec;26(1):1073274819856885.
doi: 10.1177/1073274819856885.

Overall Results for a National Program of Photodynamic Therapy for Basal Cell Carcinoma: A Multicenter Clinical Study to Bring New Techniques to Social Health Care

Hilde Harb Buzzá  1 , Lilian Tan Moriyama  1 , José Dirceu Vollet-Filho  1 , Natalia Mayumi Inada  1 , Ana Paula da Silva  1 , Mirian Denise Stringasci  1 , Michelle Barreto Requena  1 , Cintia Teles de Andrade  2 , Kate C Blanco  1 , Dora Patricia Ramirez  1 , Cristina Kurachi  1 , Ana Gabriela Salvio  3 , Vanderlei S Bagnato  1
Affiliations
Clinical Trial

Overall Results for a National Program of Photodynamic Therapy for Basal Cell Carcinoma: A Multicenter Clinical Study to Bring New Techniques to Social Health Care

Hilde Harb Buzzá et al. Cancer Control. 2019 Jan-Dec.

Abstract

Along the past years, a national program to implement photodynamic therapy (PDT) for nonmelanoma skin cancer (NMSC) was performed over the Brazilian territory. Using a strategy involving companies, national bank, and medical partners, equipment, medication, and protocols were tested in a multicenter study. With results collected over 6 years, we could reach a great deal of advances concerning the use of PDT for skin cancer. We present the overall reached results of the program and discuss several aspects about it, including public politics of treatment. A discussion about advantages of this technique within conditions of health care is placed, comparing PDT with surgery, including an analysis about the implementation of PDT in countries in development as Brazil, considering not only technical but social aspects, as the distribution of medical doctor in the Brazilian territory. The program resulted in a huge dissemination of PDT in Brazil and many countries in Latin America, in a partnership among public politics, universities, companies, and hospitals and clinics and in the insertion of national technologies as option to treat NMSC. Consequence of the program is mainly the continuation of the use of PDT in Brazil and many countries in Latin America.

Keywords: BCC; PDT; basal cell carcinoma; nonmelanoma skin cancer; photodynamic therapy.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Distribution of medical doctor in Brazil. (A) Number of medical doctor for each 1000 inhabitant separated for region. (B) Distribution of medical doctors in Brazilian territory with the percentage for each region. (C) Population density with the percentage of each region. (D) Distribution of dermatologists in entire Brazilian territory.
Figure 2.
Figure 2.
Strategy model including the relationship among university, companies, and clinical partners.
Figure 3.
Figure 3.
Geographic distribution of partner centers (A) trained for this program and (B) that still active, respectively.
Figure 4.
Figure 4.
Distribution of the population included in this study, according to age intervals.
Figure 5.
Figure 5.
Percentage of complete response for BCC lesions treated with PDT according to the center experience. It is showed the percentage obtained (A) in the beginning of the project, published before and (B) in the end of the project, with the current data. Amaral Carvalho Hospital is considered only the current data because it is the most experienced center. BCC indicates basal cell carcinoma; PDT, photodynamic therapy.
Figure 6.
Figure 6.
Percentage of complete response for BCC superficial and nodular lesions according to the center experience. BCC indicates basal cell carcinoma.
Figure 7.
Figure 7.
L.M.P.M, female, 75 years old, nodular BCC lesion in auricular region, before and 30 days after the PDT procedure. The circle shows the region that was treated and the arrows indicate previous surgery that the patient had to remove others BCC lesions. BCC indicates basal cell carcinoma; PDT, photodynamic therapy.
Figure 8.
Figure 8.
Percentage of complete response according to the lesion size after 6 months of the treatment.
Figure 9.
Figure 9.
A.C.S., male, 49 years old, nodular BCC lesion in zygomatic region, before and 30 days after the PDT procedure. The circle shows the region that was treated. BCC indicates basal cell carcinoma; PDT, photodynamic therapy.
Figure 10.
Figure 10.
A 72-year-old patient with Alzheimer who could not undergo surgery and was submitted to PDT. (A) Before treatment. (B) After 15 sessions. PDT indicates photodynamic therapy.
See this image and copyright information in PMC

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