Intense pulsed light vs. long-pulsed dye laser treatment of telangiectasia after radiotherapy for breast cancer: a randomized split-lesion trial of two different treatments.

摘要

BACKGROUND: Chronic radiodermatitis is a common sequela of treatment for breast cancer and potentially a psychologically distressing factor for the affected women. OBJECTIVES: To evaluate the efficacy and adverse effects of treatments with a long-pulsed dye laser (LPDL) vs. intense pulsed light (IPL) in a randomized split-lesion trial. METHODS: Thirteen female volunteers with radiodermatitis and Fitzpatrick skin types II-III were included in the study. Subjects received a series of three treatments at 6-week intervals with half-lesion LPDL (V-beam Perfecta, 595 nm) and half-lesion IPL (Ellipse Flex); the interventions were randomly assigned to left/right or upper/lower halves. Primary end-points were reduction in telangiectasia, patient satisfaction and preferred treatment. Secondary end-points were pain and adverse effects. Efficacy was registered by blinded photographic evaluations 3 months after the final treatment. RESULTS: Eleven patients completed the study. Telangiectasia cleared with both treatments but the efficacy of LPDL was superior. Blinded photographic evaluations showed median vessel clearances of 90% (LPDL) and 50% (IPL) (P = 0.01). LPDL treatments were associated with lower pain scores than IPL treatments [median visual analogue scale (VAS) score 4.3 and 6.0, respectively, P < 0.01]. Patients were slightly more satisfied with LPDL (median VAS score 8) than IPL treatments (median VAS score 7; P < 0.05) and more preferred LPDL (n = 9) to IPL (n = 2) (P < 0.01). Two patients withdrew from the study because of hypopigmentation of the IPL treated areas, which slowly repigmented within 1 year. CONCLUSIONS: This study was based on two specific laser and IPL devices, and found the LPDL treatment to be advantageous compared with IPL due to superior vessel clearance and less pain.