Background

Photodynamic therapy (PDT) is an effective intervention for actinic keratosis and field cancerization. Ablative fractional lasers 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 the Cochrane Central Register of Controlled Trials and hand-searched pertinent trial registers for eligible randomized controlled trials. Results from individual studies were pooled by 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 was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation approach.

Results

Of 817 records initially identified, 7 randomized controlled trials were included in the qualitative analysis and 4 were included in the meta-analysis. Laser-assisted PDT showed significantly higher clearance rates than did PDT monotherapy (risk ratio, 1.33; 95% confidence interval, 1.24-1.42; I² = 25%; P < .01). There was no difference in pain intensity between laser-assisted PDT and other interventions (mean difference, 0.31; 95% confidence interval, −0.12 to 0.74; I² = 0%; P = .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.

中文翻译：

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激光辅助光动力疗法治疗光化性角化病的系统评价和荟萃分析

背景

光动力疗法（PDT）是光化性角化病和野外癌变的有效干预措施。烧蚀性分数激光可以促进光敏剂的输送，从而改善PDT的效果。

客观的

总结有关激光辅助PDT的有效性和安全性的当前证据。

方法

我们在Medline，Embase和Cochrane对照试验中央注册簿中进行了系统的文献研究，并对合格的随机对照试验进行了人工搜索相关的试验注册簿。个别研究的结果通过使用随机效应模型进行汇总。偏倚的风险通过Cochrane偏倚风险工具进行估算，结果证据的质量通过“建议分级，评估，制定和评估”方法进行评估。

结果

在最初确定的817条记录中，定性分析中包括7项随机对照试验，荟萃分析中包括4项随机对照试验。激光辅助PDT的清除率显着高于PDT单一疗法（风险比1.33； 95％置信区间1.24-1.42；I ²  = 25％；P  <.01）。激光辅助PDT与其他干预措施之间的疼痛强度没有差异（平均值差异为0.31； 95％置信区间为-0.12至0.74；I ²  = 0％；P  = .16）。纳入的研究显示出偏见的高风险。

局限性

纳入研究的临床异质性。

结论

激光辅助的PDT比仅使用PDT或激光治疗更有效，但也不会更痛苦。