Laser-assisted photodynamic therapy for actinic keratosis: A systematic review and meta-analysis

Publication date: Available online 27 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Theresa Steeb, Justin Gabriel Schlager, Christoph Kohl, Thomas Ruzicka, Markus V. Heppt, Carola Berking

Abstract

Background

Photodynamic therapy (PDT) is an effective intervention for actinic keratosis (AK) and field-cancerization. Ablative fractional laser may facilitate the delivery of photosensitizers and thereby improve the effects of PDT.

Objective

To summarize the current evidence on the efficacy and safety of laser-assisted PDT.

Methods

We performed a systematic literature research in Medline, Embase, and CENTRAL and hand-searched pertinent trial registers for eligible randomized controlled trials (RCTs). Results from individual studies were pooled using a random-effects model. The risk of bias was estimated with the Cochrane Risk of Bias Tool and the quality of evidence of the outcomes with the GRADE approach.

Results

Out of 817 records initially identified, 7 RCTs were included in the qualitative analysis and 4 in the meta-analysis. Laser-assisted PDT showed significantly higher clearance rates compared to PDT monotherapy (risk ratio 1.33, 95% CI 1.24 to 1.42, I²=25%, p<0.01). There was no difference in pain intensity between laser-assisted PDT and other interventions (mean difference 0.31, 95% CI to 0.12 to 0.74, I²=0%, p=0.16). The included studies showed a high risk of bias.

Limitations

The clinical heterogeneity of included studies.

Conclusion

Laser-assisted PDT is more efficient but not more painful than PDT or laser treatment only.