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

Background/PurposeThis 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). MethodsA 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. ResultsEight 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. ConclusionsPDT 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.