Photodynamic therapy in the treatment of basal cell carcinoma: a systematic review and meta-analysis.

Abstract

This meta-analysis was designed to compare the efficacy, cosmetic outcome and safety of photodynamic therapy (PDT) with other procedures for the treatment of primary basal cell carcinoma (BCC). A computerized search through electronic databases was performed to search for relevant randomized controlled trials (RCTs) published before October 2013. Only RCTs that compared PDT to non-PDT for patients with BCC were selected. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Eight studies with a total of 1583 patients met the inclusion criteria. PDT was associated with lower complete clearance rate (RR: 0.93, 95% CI: 0.89-0.98), higher 1-year recurrence rate (RR: 12.42, 95% CI: 2.34-66.02) and 5-year recurrence rate (RR: 6.79, 95% CI: 2.43-18.96) when compared with surgical excision. There was no statistically significant difference in complete clearance rate (RR: 0.92, 95% CI: 0.85-1.00), 1-year recurrence rate (RR: 1.04, 95% CI: 0.46 to 2.39) or 5-year recurrence rate (RR: 1.08, 95% CI: 0.62-1.86) when PDT was compared with cryotherapy. PDT had higher complete clearance rate compared with placebo but no statistically significant difference in complete clearance rate and 1-year recurrence rate when compared with pharmacologic treatment (topical imiquimod and 5-fluorouracil). PDT had a significantly better cosmetic outcome than surgery and cryotherapy. PDT is a useful method for the treatment of BCC, more efficient than placebo and with a similar efficiency to cryosurgery and pharmacologic treatment. Even though it is less effective than surgical excision, PDT has cosmetic advantages over surgery and cryosurgery.