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A systematic review of photodynamic therapy in the treatment of pre-cancerous skin conditions, Barrett's oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin |
Fayter D, Corbett M, Heirs M, Fox D, Eastwood A |
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CRD summary This 2010 review involving CRD reviewers found very limited evidence that photodynamic therapy was effective for most conditions. Evidence of effectiveness was more robust for actinic keratosis and nodular basal cell carcinoma, compared with placebo, and possibly for Barrett’s oesophagus. High-quality trials were needed. Objectives To assess the clinical effectiveness and safety of photodynamic therapy for Barrett’s oesophagus, pre-cancerous skin conditions, and cancer of the biliary tract (cholangiocarcinoma), brain, head and neck, lung, oesophagus or skin. Review methods Fourteen databases, including DARE, MEDLINE and EMBASE, were searched up to August, 2008 to May, 2009 for randomised controlled trials of photodynamic therapy for Barrett's oesophagus or skin conditions, or non-randomised controlled trials for the specific cancers. The outcomes were mortality, morbidity, quality of life, adverse events, and resource use. Where the trials were similar their results were pooled in random-effects meta-analyses, using intention-to-treat data. Otherwise, a narrative synthesis was reported. Two reviewers independently screened all titles and abstracts, extracted the data, and quality assessed the trials, using standard checklists, with discrepancies resolved by discussion or referral to a third reviewer. Results of the review Eighty-eight trials were included; where reported, range 11 to 346 patients. Twenty-eight were of actinic keratosis, 11 were of Barrett’s oesophagus, 13 were of basal cell carcinoma, five were of cancer of the biliary tract, seven were of Bowen’s disease, two were of brain cancer, four were of head and neck cancer, seven were of lung cancer, and 13 were of oesophageal cancer. Few trials were well conducted. Resource use and quality of life were rarely reported. The reliability of some trials was unclear due to poor reporting. Various photosensitisers were used. For actinic keratosis, photodynamic therapy appeared to be better than placebo. For Bowen’s disease, better outcomes were suggested, compared with cryotherapy or fluorouracil. For basal cell carcinoma, there were similar lesion response rates to surgery or cryotherapy, but with better cosmetic outcomes for photodynamic therapy; for nodular lesions, it appeared to be more effective than placebo, but less effective than surgery, with the suggestion of a better cosmetic outcome. For Barrett’s oesophagus, when added to omeprazole, photodynamic therapy appeared to be more effective than omeprazole alone for the long-term ablation of high-grade dysplasia and slowing or preventing progression to cancer. No firm conclusions could be drawn for oesophageal cancer, and further research was needed for lung cancer. For cancer of the biliary tract, photodynamic therapy could improve survival, compared with stenting alone. There was limited evidence for brain cancer, and head and neck cancer. No serious adverse effects were linked to photodynamic therapy. Conclusions Evidence of effectiveness favouring photodynamic therapy was found for actinic keratosis and nodular basal cell carcinoma, compared with placebo, and possibly for Barrett’s oesophagus. Limited evidence was available for the other conditions. High-quality trials were needed. Funding Funded by the NIHR Health Technology Assessment programme, UK. Bibliographic details Fayter D, Corbett M, Heirs M, Fox D, Eastwood A. A systematic review of photodynamic therapy in the treatment of pre-cancerous skin conditions, Barrett's oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin. Health Technology Assessment 2010; 14(37): 1-129 Indexing Status Subject indexing assigned by NLM MeSH Barrett Esophagus /drug therapy /mortality; Biliary Tract Neoplasms /drug therapy /mortality; Brain Neoplasms /drug therapy /mortality; Clinical Trials as Topic; Esophageal Neoplasms /drug therapy /mortality; Head and Neck Neoplasms /drug therapy /mortality; Humans; Lung Neoplasms /drug therapy /mortality; Neoplasms /drug therapy /mortality; Photochemotherapy /adverse effects /methods; Precancerous Conditions /drug therapy; Quality of Life; Skin Neoplasms /drug therapy /mortality AccessionNumber 12010005945 Date bibliographic record published 29/09/2010 Date abstract record published 04/02/2014 Record Status This is a high quality systematic review involving CRD that meets the criteria for inclusion on DARE. This structured abstract presents a brief summary of the review methods, the results and conclusions. |
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