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Yoshida K, Akita K, Yoshida A, Yui M, Hirota K, Takegawa H, Anetai Y, Koike Y, Harima Y, Shiga T, Nakajima N, Kazawa N, Komemushi A, Utsunomiya K, Tanigawa N, Noborio R, Nakamura S. Single-Fraction Palliative High-Dose-Rate Brachytherapy for Symptom Management in a 97-Year-Old Patient With Dementia. J Palliat Med 2024. [PMID: 38579134 DOI: 10.1089/jpm.2023.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Background: Delivering cancer treatment to elderly patients with dementia is often challenging. We describe performing palliative surface mold brachytherapy (SMBT) in an elderly patient with advanced dementia for pain control using music therapy to assist with agitation. Case Description: The patient was a 97-year-old Japanese woman with advanced dementia. Exudate was observed from her tumor, and she complained of Grade 2 severity pain using Support team assessment schedule (STAS), especially when undergoing would dressings. Given her advanced dementia, she was not considered a candidate for radical surgery or external beam radiotherapy. We instead treated her with high-dose-rate (HDR) SMBT. Due to her advanced dementia associated with agitation, she could not maintain her position. She was able to remain calm while listening to traditional Japanese enka music, which enables our team to complete her radiation without using anesthetics or sedating analgesics. Her localized pain severity decreased ≤21 days and the exudate fluid disappeared ≤63 days after HDR-SMBT. Her tumor was locally controlled until her death from intercurrent disease 1 year after HDR-SMBT. Discussion: Single fraction palliative HDR-SMBT was useful for successful treatment of skin cancer in an elderly patient. Traditional Japanese music helped reduce her agitation to complete HDR-SMBT. For elderly patients with agitation associated with dementia, we should consider using music and music therapy to facilitate radiation therapy.
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Affiliation(s)
- Ken Yoshida
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Kohiro Akita
- Department of Radiology, Kansai Medical University Hospital, Osaka, Japan
| | - Asami Yoshida
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Midori Yui
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Kazuki Hirota
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Hideki Takegawa
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Yusuke Anetai
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Yuhei Koike
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Yoko Harima
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Toshiko Shiga
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Naomi Nakajima
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Nobukata Kazawa
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Keita Utsunomiya
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University Hospital, Osaka, Japan
| | - Reiko Noborio
- Department of General Medicine, Kansai Medical University Kori Hospital, Osaka, Japan
| | - Satoaki Nakamura
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
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2
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Trotier DC, Huang L, van Landingham SW, Burr AR, Ma VT. Review of recent advances in managing periocular skin malignancies. Front Oncol 2024; 14:1275930. [PMID: 38500654 PMCID: PMC10944901 DOI: 10.3389/fonc.2024.1275930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
Management of cutaneous malignancies can be particularly challenging when they are located in the periocular region. The standard of care for localized disease is complete surgical excision, but this may not be possible without significant disruption to visual structures and facial appearance. Definitive radiation may be an option for some patients who cannot or do not wish to undergo surgery. Advances in systemic treatment options for locally advanced and metastatic skin cancers in the past 10 years have prompted investigation into neoadjuvant treatment of periocular cancers. The use of chemotherapy, immune checkpoint inhibitors, and targeted therapies have all been reported with varying degrees of success. For many patients, targeted therapies or immune checkpoint inhibitors should be considered depending on the cancer type, symptoms, and goals with the input of a multidisciplinary cancer care team. In this article, we systematically review the latest updates in surgical, radiotherapeutic, and medical management of periocular malignancies.
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Affiliation(s)
- Daniel C Trotier
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin-Madison, Madison, WI, United States
| | - Leslie Huang
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Suzanne W van Landingham
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam R Burr
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, United States
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Vincent T Ma
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin-Madison, Madison, WI, United States
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI, United States
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3
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Park SH, Ko H, Choi J. Effect of Jaw Tracking During Volumetric Modulated Arc Therapy for Facial Non-melanoma Skin Cancer. In Vivo 2024; 38:849-854. [PMID: 38418154 PMCID: PMC10905431 DOI: 10.21873/invivo.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM This study aimed to analyze the dosimetric effects of jaw tracking during Volumetric Modulated Arc Therapy (VMAT) planning for facial non-melanoma skin cancer (NMSC). PATIENTS AND METHODS This study included 50 patients with facial NMSC who underwent VMAT planning with or without jaw tracking. The target volume (TV) included the primary skin lesion with a 1-cm margin around the surface and a depth of 4 mm. A total of 55 Gy in 20 fractions was prescribed, and the plans were considered acceptable if the TV was covered by 95-105% of the isodose curve. A dosimetric comparison was performed for the volumes of the low-dose regions, which were defined as <50% of the prescription dose (V10-50%). Target coverage was evaluated using the homogeneity index (HI) and conformity index (CI). RESULTS The patients' mean TV was 5.137 cc (range=1.03-15.89 cc). Jaw tracking resulted in mean volume reduction rates of 3.9%, 6.6% 10.6% and 13.8% for V40%, V30%, V20%, and V10%, respectively (all p<0.001). The volume change in V50% between the two groups was 2.7% (p=0.006). No significant differences were observed in HI (p=0.449) or CI (p=0.127). CONCLUSION The application of jaw tracking during VMAT for facial NMSC is associated with a significant reduction in the volume of low dose delivered in the radiation field (V10-50%), while maintaining target coverage. Future analyses should assess whether this volume difference affects treatment-related cosmetic outcomes.
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Affiliation(s)
- So Hyun Park
- Department of Radiation Oncology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Hyunsoo Ko
- Medical Course, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jinhyun Choi
- Department of Radiation Oncology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea;
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Heck T, Lohana D, Mallela D, Mandil O, Sun L, Saxena P, Decker AM, Wang HL. Hyperbaric oxygen therapy as an adjunct treatment of periodontitis, MRONJ, and ONJ: a systematic literature review. Clin Oral Investig 2024; 28:77. [PMID: 38182685 DOI: 10.1007/s00784-023-05410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/02/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE To review the available prospective literature on hyperbaric oxygen (HBO) therapy for periodontal conditions. MATERIALS AND METHODS A comprehensive electronic and manual search was performed to identify clinical studies on adult patients who underwent hyperbaric oxygen therapy for periodontal treatments. A systematic literature search was conducted in PubMed, Cochrane, and Dentistry Oral Sciences Source databases. RESULTS Fourteen articles were included in the final literature review, of which five were RCTs and 11 were prospective clinical studies. Four studies discussed HBO as an adjunct to nonsurgical treatment of periodontitis, eight reported on HBO and osteoradionecrosis, and one examined HBO in bisphosphonate-related necrosis of the jaws. CONCLUSIONS HBO has shown superior efficacy compared to antibiotics as a prophylactic measure in preventing osteoradionecrosis (ORN) in patients with a history of high mandibular irradiation. Clinicians should consider referring such patients for HBO therapy before and after tooth extractions. However, for the surgical excision of existing ORN lesions, HBO therapy does not yield significant benefits but does not negatively impact outcomes either. Regarding the treatment of periodontitis patients, the variability among studies prevents definitive conclusions. HBO therapy as an adjunct to SRP in periodontitis treatment produces mixed results. CLINICAL RELEVANCE This study's clinical relevance lies in its exploration of the potential benefits of HBO for periodontal conditions. Also, it provides clinicians with insights into when and how to integrate HBO therapy into their treatment approaches, particularly for patients with a history of irradiation and those undergoing complex dental procedures.
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Affiliation(s)
- Teresa Heck
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, 48109-1078, USA
| | - Danyal Lohana
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, 48109-1078, USA
| | - Dhiraj Mallela
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, 48109-1078, USA
| | - Obada Mandil
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, 48109-1078, USA
- Department of Periodontics, Case Western Reserve University School of Dental Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Lu Sun
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, 48109-1078, USA
| | - Pramiti Saxena
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, 48109-1078, USA
| | - Ann M Decker
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, 48109-1078, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, 48109-1078, USA.
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Mizumatsu S, Fujiyama T. Successful Treatment of Facial Merkel Cell Carcinoma Using CyberKnife Radiotherapy Alone: A Case Report. Cureus 2023; 15:e50699. [PMID: 38234949 PMCID: PMC10792345 DOI: 10.7759/cureus.50699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/19/2024] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin tumor. Herein, we present a case of MCC which was successfully treated with radiotherapy alone using CyberKnife® (CK) (Accuray Incorporated, Sunnyvale, California, United States). An 86-year-old female patient presented with multiple painless pink rash skin tumors on the left cheek. The patient was diagnosed with MCC based on a lesion biopsy (T2cN2M0, stage IIIB). The patient was referred for CK radiotherapy (CKR) at our institution because of her advanced age and inoperative lesions. The patient underwent CKR alone, with a planning target volume (PTV) of 14.9 ml, a prescribed dose of 30 Gy, a maximum dose of 46.2 Gy, and an isodose line (the minimum dose of 95% of the PTV) of 65% in 10 fractions for 13 days. The lesions had completely regressed on the last day of CKR. Left cervical lymph node metastasis (CLNM) appeared 10 months after CKR. The patient underwent a second CKR for CLNM, the PTV was 4.6 ml, and the prescribed dose was 27 Gy in three fractions for three days. The CLNM had completely regressed one month later after the second CKR. Primary lesions did not recur for 33 months after the initial CKR, and CLNM did not reappear for 23 months after the second CKR with good cosmetic results. No CKR-related adverse event occurred in our follow-up period. Our present case indicates that CKR is an effective treatment option for patients with MCC, particularly elderly patients who may not be suitable candidates for extensive surgical resection.
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Affiliation(s)
| | - Toshiharu Fujiyama
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JPN
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6
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Nguyen NP, Thariat J, Gorobets O, Vinh-Hung V, Kim L, Blanco SC, Vasileiou M, Arenas M, Mazibuko T, Giap H, Vincent F, Chi A, Loganadane G, Mohammadianpanah M, Rembielak A, Karlsson U, Ali A, Bose S, Page BR. Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2023; 15:4981. [PMID: 37894347 PMCID: PMC10605563 DOI: 10.3390/cancers15204981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Cutaneous skin carcinoma is a disease of older patients. The prevalence of cutaneous squamous-cell carcinoma (cSCC) increases with age. The head and neck region is a frequent place of occurrence due to exposure to ultraviolet light. Surgical resection with adjuvant radiotherapy is frequently advocated for locally advanced disease to decrease the risk of loco-regional recurrence. However, older cancer patients may not be candidates for surgery due to frailty and/or increased risk of complications. Radiotherapy is usually advocated for unresectable patients. Compared to basal-cell carcinoma, locally advanced cSCC tends to recur locally and/or can metastasize, especially in patients with high-risk features such as poorly differentiated histology and perineural invasion. Thus, a new algorithm needs to be developed for older patients with locally advanced head and neck cutaneous squamous-cell carcinoma to improve their survival and conserve their quality of life. Recently, immunotherapy with checkpoint inhibitors (CPIs) has attracted much attention due to the high prevalence of program death ligand 1 (PD-L1) in cSCC. A high response rate was observed following CPI administration with acceptable toxicity. Those with residual disease may be treated with hypofractionated radiotherapy to minimize the risk of recurrence, as radiotherapy may enhance the effect of immunotherapy. We propose a protocol combining CPIs and hypofractionated radiotherapy for older patients with locally advanced cutaneous head and neck cancer who are not candidates for surgery. Prospective studies should be performed to verify this hypothesis.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer Center, 14000 Cain, France;
| | - Olena Gorobets
- Department of Oral Surgery, University of Martinique, 97213 Martinique, France;
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Institut Bergonie, 33076 Bordeaux, France;
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA;
| | - Sergio Calleja Blanco
- Department of Oral and Maxillofacial Surgery, Howard University, Washington, DC 20059, USA;
| | - Maria Vasileiou
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University Hospital, University of Rovira, I Virgili, 43204 Tarragona, Spain;
| | - Thandeka Mazibuko
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System, Lawrenceburg, TN 29425, USA;
| | - Alexander Chi
- Department of Radiation Oncology, Xuanwu Hospital, Capital Medical University, Beijing 101125, China;
| | | | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
| | - Agata Rembielak
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
- Division of Cancer Sciences, Faculty of Biomedicine and Health, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Ahmed Ali
- Division of Hematology Oncology, Howard University, Washington, DC 20059, USA;
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore 21218, MD, USA;
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7
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Hasan N, Nadaf A, Imran M, Jiba U, Sheikh A, Almalki WH, Almujri SS, Mohammed YH, Kesharwani P, Ahmad FJ. Skin cancer: understanding the journey of transformation from conventional to advanced treatment approaches. Mol Cancer 2023; 22:168. [PMID: 37803407 PMCID: PMC10559482 DOI: 10.1186/s12943-023-01854-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/30/2023] [Indexed: 10/08/2023] Open
Abstract
Skin cancer is a global threat to the healthcare system and is estimated to incline tremendously in the next 20 years, if not diagnosed at an early stage. Even though it is curable at an early stage, novel drug identification, clinical success, and drug resistance is another major challenge. To bridge the gap and bring effective treatment, it is important to understand the etiology of skin carcinoma, the mechanism of cell proliferation, factors affecting cell growth, and the mechanism of drug resistance. The current article focusses on understanding the structural diversity of skin cancers, treatments available till date including phytocompounds, chemotherapy, radiotherapy, photothermal therapy, surgery, combination therapy, molecular targets associated with cancer growth and metastasis, and special emphasis on nanotechnology-based approaches for downregulating the deleterious disease. A detailed analysis with respect to types of nanoparticles and their scope in overcoming multidrug resistance as well as associated clinical trials has been discussed.
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Affiliation(s)
- Nazeer Hasan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Arif Nadaf
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Mohammad Imran
- Frazer Institute, Faculty of Medicine, University of Queensland, Brisbane, 4102, Australia
| | - Umme Jiba
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Afsana Sheikh
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Waleed H Almalki
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Umm Al-Qura University, 24381, Makkah, Saudi Arabia
| | - Salem Salman Almujri
- Department of Pharmacology, College of Pharmacy, King Khalid University, 61421, Asir-Abha, Saudi Arabia
| | | | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Kuthambakkam, India.
| | - Farhan Jalees Ahmad
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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8
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Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, Bataille V, Brochez L, Del Marmol V, Dummer R, Forsea AM, Gaudy-Marqueste C, Harwood CA, Hauschild A, Höller C, Kandolf L, Kellerners-Smeets NWJ, Lallas A, Leiter U, Malvehy J, Marinović B, Mijuskovic Z, Moreno-Ramirez D, Nagore E, Nathan P, Stratigos AJ, Stockfleth E, Tagliaferri L, Trakatelli M, Vieira R, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer 2023; 192:113254. [PMID: 37604067 DOI: 10.1016/j.ejca.2023.113254] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
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Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London SE1 7EH, UK
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Ana-Marie Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | | | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nicole W J Kellerners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands; Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, Croatia
| | - Zeljko Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - David Moreno-Ramirez
- Dermatology. Medicine School, University of Seville, University Hospital Virgen Macarena, Seville-Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
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9
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Valve A, Koskenmies S, Tenhunen M, Nurmi H, Hernberg M, Salminen S, Anttonen A. Early clinical experience with a degraded 4 MeV electron beam in radiotherapy of superficial basal cell carcinoma. Phys Imaging Radiat Oncol 2023; 27:100487. [PMID: 37705728 PMCID: PMC10495663 DOI: 10.1016/j.phro.2023.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023] Open
Abstract
The most common non-melanoma skin cancer is basal cell carcinoma (BCC). Surgery is the gold standard treatment but also non-surgical alternatives are needed. The purpose of this work was to present the early clinical experiences of degraded 4 MeV electron beam as a treatment method for superficial BCC. Twelve patients underwent two weeks radiation therapy treatment with either 5 × 7 Gy or 2 × 12 Gy. There were no significant differences in treatment outcome with different fractionations or lesion locations. The degraded beam method is a safe and valid non-surgical solution for suitable patients with superficial lesions.
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Affiliation(s)
- Assi Valve
- Cancer Center, Department of Radiation Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Physics, MATRENA, University of Helsinki, Helsinki, Finland
| | - Sari Koskenmies
- Department of Dermatology and Allergology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko Tenhunen
- Cancer Center, Department of Radiation Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heidi Nurmi
- Department of Oncology, Turku University Hospital, Turku, Finland
| | - Micaela Hernberg
- Cancer Center, Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Samuli Salminen
- Cancer Center, Department of Radiation Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anu Anttonen
- Cancer Center, Department of Radiation Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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10
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Jacques J, Renard S, Demogeot N, Faivre JC, Peiffert D. Hypofractionated radiotherapy for invasive squamous cell carcinoma of the scalp in the elderly: Efficacy and tolerance, preliminary results. Cancer Radiother 2023:S1278-3218(23)00063-X. [PMID: 37179219 DOI: 10.1016/j.canrad.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Skin squamous cells carcinomas (SCC) are frequently tumor, especially in the elderly population. Surgical excision is the standard treatment. But for patients suffering large tumor or/with comorbidity, a conservative approach with irradiation can be proposed. The hypofractionated schedule is used to shorten the overall treatment time with same results and without compromising therapeutic outcomes. The aim of this study is to assess the efficacy and tolerance of hypofractionated radiotherapy for invasive SCC of the scalp in elderly. PATIENTS AND METHODS We included patients suffering from SCC of the scalp and treated by hypofractionated radiotherapy at the Institut de cancérologie de Lorraine or centre Émile-Durkeim d'Épinal, from January 2019 to December 2021. Characteristics of patients, size of the lesion and side effects were collected retrospectively. Tumor size at 6 months corresponded to the primary endpoint. Toxicity was collected for the secondary endpoint. RESULTS Twelve patients with a median age of 85 years old were included. The mean size was 4,5cm with a bone invasion in 2/3 of cases. Radiotherapy was delivered after surgical excision for half of the patient. The dose delivered was 54Gy in 18 daily fractions size. Six months after irradiation: 6/11 patients had no residual lesion, 2/11 had a partial response with a residual lesion of about 1cm. 3 patients presented local recurrence. One patient died within 6 months of radiotherapy because of another comorbidity. In total, 25% had presented a grade 3 acute radiation dermatitis, no grade 4 toxicity. CONCLUSION Short term of moderately hypofractionated schedule radiotherapy was a success with complete or partial response for more than 70% of the patients in squamous cell carcinomas. There is no major side effect.
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Affiliation(s)
- J Jacques
- Radiation Department, institut de cancérologie de Loraine Alexis-Vautrin, Academic Department of Radiation Therapy and Brachytherapy, 6, avenue de Bourgogne, CS 30519, 54511 Vandœuvre-lès-Nancy, France.
| | - S Renard
- Radiation Department, institut de cancérologie de Loraine Alexis-Vautrin, Academic Department of Radiation Therapy and Brachytherapy, 6, avenue de Bourgogne, CS 30519, 54511 Vandœuvre-lès-Nancy, France
| | - N Demogeot
- Radiation Department, institut de cancérologie de Loraine Alexis-Vautrin, Academic Department of Radiation Therapy and Brachytherapy, 6, avenue de Bourgogne, CS 30519, 54511 Vandœuvre-lès-Nancy, France; Radiation Department, centre Émile-Durkheim, Épinal, France
| | - J C Faivre
- Radiation Department, institut de cancérologie de Loraine Alexis-Vautrin, Academic Department of Radiation Therapy and Brachytherapy, 6, avenue de Bourgogne, CS 30519, 54511 Vandœuvre-lès-Nancy, France
| | - D Peiffert
- Radiation Department, institut de cancérologie de Loraine Alexis-Vautrin, Academic Department of Radiation Therapy and Brachytherapy, 6, avenue de Bourgogne, CS 30519, 54511 Vandœuvre-lès-Nancy, France
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11
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Choi J, Park SH. Radiotherapy for older adults with facial non-melanoma skin cancer: Effectiveness in patients aged 80 and older. J Geriatr Oncol 2023; 14:101400. [PMID: 36372725 DOI: 10.1016/j.jgo.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/20/2022] [Accepted: 10/29/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Jinhyun Choi
- Department of Radiation Oncology, Jeju National University Hospital, Jeju University College of Medicine, South Korea
| | - So Hyun Park
- Department of Radiation Oncology, Jeju National University Hospital, Jeju University College of Medicine, South Korea.
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12
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Benkhaled S, Van Gestel D, Gomes da Silveira Cauduro C, Palumbo S, del Marmol V, Desmet A. The State of the Art of Radiotherapy for Non-melanoma Skin Cancer: A Review of the Literature. Front Med (Lausanne) 2022; 9:913269. [PMID: 35833108 PMCID: PMC9272768 DOI: 10.3389/fmed.2022.913269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Due to the general aging population and the fashion trend of sun exposure, non-melanoma skin cancer (NMSC) is rising. The management of NMSC is difficult and necessitates a multidisciplinary team (i.e., pathologists, dermatologists, medical oncologists, surgeons, and radiation oncologists). When surgery is not an option or will cause unacceptably functional morbidity, radiation therapy (RT) may be a preferable tissue-preserving option. Whether used alone or in conjunction with other treatments, RT has been shown to be quite effective in terms of cosmetic results and local control. Contact hypofractionated RT, brachytherapy, and electronic brachytherapy are all promising new treatments. However, rigorous, randomized trials are missing, explaining the disparity in dose, fractionation, and technique recommendations. Therefore, it is essential that interdisciplinary teams better understand RT modalities, benefits, and drawbacks. Our review will provide the role and indications for RT in patients with NMSC.
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Affiliation(s)
- Sofian Benkhaled
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
- *Correspondence: Sofian Benkhaled
| | - Dirk Van Gestel
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | | | - Samuel Palumbo
- Department of Radiation-Oncology, Jolimont Hospital, La Louvière, Belgium
| | - Veronique del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Desmet
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
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13
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Liu KX, Milligan MG, Schoenfeld JD, Tishler RB, Ng AK, Devlin PM, Fite E, Rabinowits G, Hanna GJ, Silk AW, Yoon CH, Thakuria M, Margalit DN. Characterization of clinical outcomes after shorter course hypofractionated and standard-course radiotherapy for stage I-III curatively-treated Merkel cell carcinoma. Radiother Oncol 2022; 173:32-40. [PMID: 35595174 DOI: 10.1016/j.radonc.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Limited data exists regarding the efficacy of curative hypofractionated radiotherapy (hypo-RT) regimens compared to conventionally-fractionated radiotherapy (conv-RT) for Merkel cell carcinoma (MCC). METHODS A retrospective analysis of 241 patients diagnosed with non-metastatic MCC from 2005-2021 and who received RT at Dana-Farber/Brigham & Women's Cancer Center. The primary outcome was cumulative incidence of in-field locoregional relapse using Gray's test with competing risks of death and isolated out-of-field recurrence. Secondary outcomes included overall survival (OS) and MCC-specific survival using log-rank tests, and risk factors of recurrence using Cox-proportional hazards regression. RESULTS There were 50 (20.6%) and 193 (79.4%) courses of hypo-RT and conv-RT, respectively. The hypo-RT cohort was older (≥73 years at diagnosis: 78.0% vs. 41.5%, p<0.01), and received a lower equivalent total RT dose in 2 Gy per fraction (<50 Gy: 58.0% vs. 5.2%, p<0.01). Median follow-up was 65.1 months (range: 1.2-194.5) for conv-RT and 25.0 months (range: 1.6-131.3) for hypo-RT cohorts. Two-year cumulative incidence of in-field locoregional relapse was low in both groups (1.1% conv-RT vs. 4.1% hypo-RT, p=0.114). While two-year OS was lower for the hypo-RT group (62.6% vs. 84.4%, p=0.0008), two-year MCC-specific survival was similar (84.7 vs. 86.6%, p=0.743). On multivariable analysis, immunosuppression, clinical stage III disease, and lymphovascular invasion were associated with any-recurrence when controlling for sex, age, and hypo-RT. CONCLUSIONS AND RELEVANCE There was no difference in cumulative incidence of in-field locoregional relapse or MCC-specific survival between hypo-RT and conv-RT. Prospective studies are needed to confirm hypo-RT as an efficacious treatment option for MCC.
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Affiliation(s)
- Kevin X Liu
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Michael G Milligan
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States; Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States
| | - Roy B Tishler
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States; Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Phillip M Devlin
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Elliott Fite
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Guilherme Rabinowits
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, United States
| | - Glenn J Hanna
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Ann W Silk
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Charles H Yoon
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States; Division of Surgical Oncology, Department of Surgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, United States
| | - Manisha Thakuria
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States; Department of Dermatology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Danielle N Margalit
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States; Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States.
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14
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Tsao M, Barnes E, Karam I, Rembielak A. Hypofractionated Radiation Therapy in Keratinocyte Carcinoma. Clin Oncol (R Coll Radiol) 2022; 34:e218-e224. [DOI: 10.1016/j.clon.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/02/2022] [Accepted: 02/18/2022] [Indexed: 12/20/2022]
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15
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García-Foncillas J, Tejera-Vaquerizo A, Sanmartín O, Rojo F, Mestre J, Martín S, Azinovic I, Mesía R. Update on Management Recommendations for Advanced Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14030629. [PMID: 35158897 PMCID: PMC8833756 DOI: 10.3390/cancers14030629] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, which predominantly occurs on the head and neck. Early detection and treatment of primary tumours is crucial to limit progression and local invasion of deep tissues. While high-risk markers of poor prognosis have been identified, factors predicting regional control or survival remain uncertain. Therefore, diagnosis and management of cSCC should be performed individually, considering patient’s clinicopathological profile and the best available treatment options. Surgical excision, radiotherapy, and/or systemic treatments can be selected depending on patient’s status and tumour stage. Considering that a more comprehensive assessment will be provided by a multidisciplinary team, we aimed to generate a practical document that may assist oncologists and dermatologists on the prognosis, diagnosis, management, and follow-up of patients with advanced cSCC. Abstract Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, the incidence of which has risen over the last years. Although cSCC rarely metastasizes, early detection and treatment of primary tumours are critical to limit progression and local invasion. Several prognostic factors related to patients’ clinicopathologic profile and tumour features have been identified as high-risk markers and included in the stratification scales, but their association with regional control or survival is uncertain. Therefore, decision-making on the diagnosis and management of cSCC should be made based on each individual patient’s characteristics. Recent advances in non-invasive imaging techniques and molecular testing have enhanced clinical diagnostic accuracy. Surgical excision is the mainstay of local treatment, whereas radiotherapy (RT) is recommended for patients with inoperable disease or in specific circumstances. Novel systemic treatments including immunotherapies and targeted therapies have changed the therapeutic landscape for cSCC. The anti-PD-1 agent cemiplimab is currently the only FDA/EMA-approved first-line therapy for patients with locally advanced or metastatic cSCC who are not candidates for curative surgery or RT. Given the likelihood of recurrence and the increased risk of developing multiple cSCC, close follow-up should be performed during the first years of treatment and continued long-term surveillance is warranted.
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Affiliation(s)
- Jesús García-Foncillas
- Departamento de Oncología, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (F.R.); (I.A.)
- Department of Medicine, Faculty of Medicine, Universidad Autónoma de Madrid, 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-900-815-019
| | - Antonio Tejera-Vaquerizo
- Instituto Dermatológico GlobalDerm, Palma del Río, 14700 Cordoba, Spain;
- Unidad de Oncología Cutánea, Hospital San Juan de Dios, 14012 Cordoba, Spain
| | | | - Federico Rojo
- Departamento de Oncología, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (F.R.); (I.A.)
| | - Javier Mestre
- Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | | | - Ignacio Azinovic
- Departamento de Oncología, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (F.R.); (I.A.)
| | - Ricard Mesía
- B-ARGO Group, Medical Oncology Department, Institut Català d’Oncologia (ICO), Badalona, 08908 Barcelona, Spain;
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16
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Mokoala KM, Lawal IO, Vorster M, Sathekge MM. Radionuclide Therapy of Skin Cancers and Bowen's Disease Using A Specially Designed Rhenium Cream. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Abstract
We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of cutaneous cancers. The indications of radiotherapy for skin cancers are not clearly defined because of the lack of randomized trials or prospective studies. For basal cell carcinomas, radiotherapy frequently offers a good local control, but a randomized trial showed that surgery is more efficient and less toxic. Indications of radiotherapy are contra-indications of surgery for patients older than 60, non-sclerodermiform histology and located in non-sensitive areas. Adjuvant radiotherapy could be proposed to squamous cell carcinomas, in case of poor prognostic factors. Dose of 60 to 70Gy are usually required, and must be modulated to the size of the lesions. Adjuvant radiotherapy seems beneficial for desmoplastic melanomas but not for the other histological types. Prophylactic nodal irradiation (45 to 50Gy), for locally advanced tumors (massive nodal involvement), decreases the locoregional failure rate but do not increase survival. Adjuvant radio- therapy (50 to 56Gy) for Merkel cell carcinomas increases also the local control rate, as demonstrated by meta-analysis and a large epidemiological study. Nodal areas must be included, if there is no surgical exploration (sentinel lymph node dissection). Kaposi sarcomas are radiosensitive and could be treated with relatively low doses (24 to 30Gy). Also, cutaneous lymphomas are good indications for radiotherapy: B lymphomas are electively treated with limited fields. The role of total skin electron therapy for T-lymphomas is still discussed; but palliative radiotherapy is very efficient in case of cutaneous nodules.
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18
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Muto P, Pastore F. Radiotherapy in the Adjuvant and Advanced Setting of CSCC. Dermatol Pract Concept 2021; 11:e2021168S. [PMID: 34877076 DOI: 10.5826/dpc.11s2a168s] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction The use of radiotherapy for cutaneous squamous cell carcinoma (CSCC) has solid historical roots. It is used with patients who are not suitable for surgery, with patients with high-risk histological features in the adjuvant setting, and in palliative care. Objectives The aim of this article is to summarize and provide a radiation therapy overview on the indications, effectiveness, and potential adverse events of radiotherapy in the adjuvant and advanced setting of CSCC. Methods We performed a comprehensive literature review on PubMed, adopted as our biomedical literature database. Articles were selected based on their date of publication (in the last 30 years) and relevance. Results Radiotherapy (RT) can safely be used to manage non-surgical patients and high-risk patients in the advanced CSCC setting. The remarkable progress of delivery techniques has greatly improved the effectiveness and toxicity profile of RT treatments. From 2D techniques to intensity modulated radiation therapy (IMRT), and brachytherapy, all RT techniques have greatly advanced. To improve acute and chronic side effects, a deeper care has been used. As regards CSCC, several dose fractionations and schedules have been suggested, in line with the patient's age and medical conditions. Conclusions RT is a fundamental and constantly evolving therapeutic option in the treatment of CSCC, to minimize the risk of recurrence and metastases in the adjuvant setting and in the exclusive treatment for non-surgical patients. Patients' selection is crucial, together with and a collaborative team working approach among the specialists involved in disease management in the perspective of the best multidisciplinary assessment.
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Affiliation(s)
- Paolo Muto
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale - Naples, Italy
| | - Francesco Pastore
- Radiation Oncology, Fondazione Muto Onlus - Emicenter - Naples, Italy
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19
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Laliscia C, Coccia N, Fuentes T, Perrone F, Paiar F. Two different sizes of Valencia applicators in non-melanoma skin cancer treatment with iridium-192 high-dose-rate brachytherapy. J Contemp Brachytherapy 2021; 13:615-619. [PMID: 35079246 PMCID: PMC8782077 DOI: 10.5114/jcb.2021.112111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this retrospective study was to analyze tumor control, toxicity, and aesthetic outcome of patients affected by non-melanoma skin cancer (NMSC) and treated with iridium-192 (192Ir) high-dose-rate (HDR) brachytherapy (BT) using Valencia applicators at the Division of Radiotherapy, University of Pisa. MATERIAL AND METHODS From June 2015 to December 2020, 95 NMSC patients, including 61.5% basal cell carcinoma and 38.5% squamous cell carcinoma patients, with median age of 83 years (range, 32-96 years) were treated. In total, 182 lesions with a diameter ≤ 25 mm (median, 12 mm) and a depth ≤ 4 mm, located in scalp (19.2%), face (20.9%), chest (8.8%), nose (16.5%), ear (15.4%), and extremities (19.2%) were analyzed. All lesions were treated with 192Ir-based HDR afterloader using Valencia applicators. 105 lesions (57.7%) were treated with applicator of 20 mm and 77 lesions (42.3%) with applicator of 30 mm in diameter, depending on the size of lesions. Prescribed dose was 40 Gy in 8 fractions (5 Gy/fraction) delivered 2-3 times a week. Biological effective dose (BED) was ≈ 60 Gy. RESULTS The median follow-up was 14 months (range, 3-59 months). The 2-year local control rate was 96%. According to common terminology criteria for adverse events (CTCAE v. 5.0), G1-G2 acute toxicities included dermatitis (22.0%) and pain (8.2%). The most common G1 late toxicities were hypopigmentation (27.5%) and fibrosis (8.2%), and G2 late toxicity included ulceration (0.5%). No G3 or higher acute or late toxicities were reported. Excellent cosmetic results were observed in 77.5% of the lesions, with one only (0.5%) reported as a poor cosmetic result (ulceration refractory to therapy). CONCLUSIONS HDR-BT using Valencia applicators is a safe, effective, and well-tolerated treatment modality for NMSC, and can be considered a good alternative for treatment, especially in elderly patients who are often unfit for surgery.
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Affiliation(s)
- Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Natalina Coccia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Taiusha Fuentes
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Franco Perrone
- Medical Physics Department, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
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20
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Piccinno R, Berti E, Barei F. Hypofractionated radiotherapy for nonmelanoma skin cancer during the COVID-19 pandemic: experience in 31 cases. TUMORI JOURNAL 2021; 108:394-396. [PMID: 34658271 DOI: 10.1177/03008916211051426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) pandemic, radiation therapies have been modulated to reduce the risk of infection during outpatient activities and hypofractionated regimens or radiotherapy delay for nonmelanoma skin cancer (NMSC) were suggested. Hypofractionated radiotherapy not only may confer no disadvantage in regard to outcome when compared to a more protracted schedule but might also reduce the risk of infection. We report the experience of a dermatologic radiation therapy department concerning a group of patients with a diagnosis of NMSC selected for a radiation treatment plan aimed to minimize the number of their accesses to our department.
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Affiliation(s)
- Roberta Piccinno
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilio Berti
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Francesca Barei
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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21
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Additive manufacturing (3D printing) in superficial brachytherapy. J Contemp Brachytherapy 2021; 13:468-482. [PMID: 34484363 PMCID: PMC8407265 DOI: 10.5114/jcb.2021.108602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
The aim of this work is to provide an overview of the current state of additive manufacturing (AM), commonly known as 3D printing, within superficial brachytherapy (BT). Several comprehensive database searches were performed to find publications linked to AM in superficial BT. Twenty-eight core publications were found, which can be grouped under general categories of clinical cases, physical and dosimetric evaluations, proof-of-concept cases, design process assessments, and economic feasibility studies. Each study demonstrated a success regarding AM implementation and collectively, they provided benefits over traditional applicator fabrication techniques. Publications of AM in superficial BT have increased significantly in the last 5 years. This is likely due to associated efficiency and consistency benefits; though, more evidences are needed to determine the true extent of these benefits.
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22
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Mizumatsu S, Ryu H, Nomura K, Yoshikawa S, Inoue N. Treating Low-Grade Myxofibrosarcoma With Stereotactic Body Radiation Therapy Using CyberKnife®. Cureus 2021; 13:e16393. [PMID: 34408946 PMCID: PMC8363235 DOI: 10.7759/cureus.16393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 12/11/2022] Open
Abstract
Myxofibrosarcoma (MFS) is one of the most common soft tissue sarcomas. Low-grade MFS has a high local recurrence rate, similar to that of high-grade MFS. Hence, appropriate adjuvant therapy is required to control low-grade MFS. In this report, we present a case in which recurrent low-grade MFS was successfully treated with stereotactic body radiation therapy (SBRT) using CyberKnife® (CK) (Accuray Incorporated, Sunnyvale, CA). A 76-year-old man underwent SBRT using CK for recurrent low-grade MFS in the right posterior chest wall after undergoing resection and skin grafting four and three times, respectively. We planned CK treatment separately for each in two parts. For the lesion on the scapula side, the target volume was 109 cm3 and the total prescribed dose was 34.6 Gy, while the lesion on the spinal side had a target volume of 72 cm3 and a total prescribed dose of 36 Gy, both in five fractions. Each SBRT was performed on alternate days in a span of 14 days. The tumors gradually reduced in size with tolerable levels of toxicity. SBRT using CK could be a safe and effective adjuvant therapy for low-grade MFS.
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Affiliation(s)
| | - Hiroshi Ryu
- Cerebrospinal Center, Aoyama General Hospital, Toyokawa, JPN
| | - Kei Nomura
- Cerebrospinal Center, Aoyama General Hospital, Toyokawa, JPN
| | | | - Norio Inoue
- Recovery Rehabilitation Center, Aoyama General Hospital, Toyokawa, JPN
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Staackmann C, Schild SE, Rades D. Palliative Radiotherapy for Cutaneous Squamous Cell Carcinoma of the Head-and-Neck Region. In Vivo 2021; 35:2283-2288. [PMID: 34182507 DOI: 10.21873/invivo.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Cutaneous squamous cell carcinoma (cSCC) is a common type of skin cancer. Options for palliative treatment include systemic agents and radiotherapy. Selection of a radiation regimen should consider the patient's survival prognosis. This study aimed to identify prognostic factors of survival after palliative radiotherapy for cSCC of the head-and-neck. PATIENTS AND METHODS Ten factors were analyzed for survival in 12 patients including age, gender, tumor site, histological grade, primary tumor stage, lymph node involvement, distant metastases, upfront surgery, radiation dose and completion of radiotherapy. RESULTS On univariate analysis, improved survival was significantly associated with lower histological grade (better differentiation) (p=0.022), no distant metastases (p=0.040) and completion of radiotherapy (p=0.014). In the multivariate analysis, lower histological grade (risk ratio=6.05, p=0.100) and completion of radiotherapy (risk ratio=4.87, p=0.115) showed trends. CONCLUSION Predictors of survival were identified that can help design individual treatments. Patients require optimal supportive care as completion of radiotherapy was associated with better survival.
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Affiliation(s)
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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24
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Ferini G, Molino L, Bottalico L, De Lucia P, Garofalo F. A small case series about safety and effectiveness of a hypofractionated electron beam radiotherapy schedule in five fractions for facial non melanoma skin cancer among frail and elderly patients. ACTA ACUST UNITED AC 2021; 26:66-72. [PMID: 33948304 DOI: 10.5603/rpor.a2021.0013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
Background The aim of the study was to evaluate local control and toxicities of strongly hypofractionated electron beam radiotherapy (RT) in elderly and fragile patients with facial nonmelanoma skin cancer (NMSC). Materials and methods We enrolled patients aged ≥ 65 years with facial NMSC, Karnofsky Performance Status (KPS) ≥ 40 and life expectancy ≥ 6 months, amenable neither to daily RT nor surgery. Radiotherapy consisted of 35 Gy, delivered with 6 MeV electron beam, in 5 fractions of 7 Gy/day twice a week (tw). Prescription isodoses were 100% for cT1-cT2 and 90% for cT3-cT4. Objective response was assessed clinically 4 and 8 weeks after the end of RT and then monitored every 6 months. Side effects were assessed according to the CTCAE scale. Results 12 patients of median age 89.5 years with a total of 23 NMSC cN0 achieved a median follow-up time of 6 months (range 1-10), with total treatment compliance. 10/12 patients had a 40 ≤ KPS < 70 and 2/12 a 70 ≤ KPS < 90. 5/12 patients had synchronous lesions. 22/23 lesions were classified as T1-T2 and had complete response (CR), 1/23 as T4 with partial response (PR). Within 4 weeks after the end of treatment, G1 toxicity was reported for 12/23 lesions, G2 for 8/23, G3 for 3/23, G4 for 0/23, all disappeared 8 weeks later, with or without topical therapy. After last follow-up (1 June 2020) 1/12 patients died with PR from senile marasmus, 11/12 are alive with CR and widely tolerated toxicities. Conclusions Extreme hypofractionation of radiotherapy dose for facial NMSC is effective, safe and suitable for elderly patients.
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Affiliation(s)
| | - Laura Molino
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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25
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Katipally R, Agrawal N, Juloori A. Radiation Therapy for Cutaneous Malignancies of the Head and Neck. Otolaryngol Clin North Am 2021; 54:307-327. [PMID: 33602518 DOI: 10.1016/j.otc.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Radiation therapy plays an integral role in the management of cutaneous malignancies of the head and neck. This article highlights the use of radiation therapy in the definitive and adjuvant setting for basal cell carcinoma, cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. Themes that emerge include the overall efficacy of radiation therapy as a local therapy, the relevance of cosmesis, functional outcomes, late toxicities as secondary end points, and the multitude of treatment modalities that are used.
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Affiliation(s)
- Rohan Katipally
- Department of Radiation and Cellular Oncology, Duchossois Center for Advanced Medicine, University of Chicago Medicine, 5758 South Maryland Avenue, MC 9006, Chicago, IL 60637, USA.
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Aditya Juloori
- Department of Radiation and Cellular Oncology, Duchossois Center for Advanced Medicine, University of Chicago Medicine, 5758 South Maryland Avenue, MC 9006, Chicago, IL 60637, USA
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26
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High-Dose-Rate Brachytherapy for the Treatment of Basal and Squamous Cell Carcinomas on Sensitive Areas of the Face: A Report of Clinical Outcomes and Acute and Subacute Toxicities. Adv Radiat Oncol 2020; 6:100616. [PMID: 33912732 PMCID: PMC8071728 DOI: 10.1016/j.adro.2020.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/02/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Basal cell and cutaneous squamous cell carcinoma are common malignancies (keratinocyte carcinomas [KCs]). Surgical resection is the standard of care. Radiation using high-dose rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity. We aim to describe the clinical and cosmetic outcomes as well as posttreatment radiation toxicities associated with HDR-BT in patients who were treated for KCs of the face. Methods and Materials Patients with KCs treated with HDR-BT from 2015 to 2018 were included in the study. Patient medical records and clinical photos were reviewed at multiple time points: start of treatment, end of treatment, short-term (2 week) follow-up, 3-month follow-up, and if needed at 6 months. Radiation toxicity was graded using the Radiation Therapy Oncology Grading (RTOG) acute toxicity scale. Median (range) toxicity grades at follow-up intervals were calculated. Clinical outcomes including local recurrence were evaluated for all patients. Results The study included 19 patients and 20 KCs. The median radiation dose was 42 Gy (39-42 Gy) over 6 fractions. The median toxicity at completion of treatment was RTOG grade 2 (85% of patients). At short-term follow-up, 50% of patients (n = 10) improved to RTOG grade 1 (0-2). At 3 months, 70% of patients (n = 14) had RTOG grade 0, and by 6 months, 100% of patients (n = 18) had RTOG grade 0. No RTOG grade 3 or higher skin toxicity was observed. With a median follow-up of 7.2 months (range, 1.3-54.4 months), the local recurrence-free survival was 95%. Conclusions We demonstrate that HDR-BT can be used as definitive treatment of KCs of the face with excellent cosmetic outcomes and local control. Acute and subacute skin toxicities were most commonly RTOG grade 2 or less with resolution of patient's skin toxicity by 3 months.
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27
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Shah C, Ouhib Z, Kamrava M, Koyfman SA, Campbell SR, Bhatnagar A, Canavan J, Husain Z, Barker CA, Cohen GN, Strasswimmer J, Joshi N. The American Brachytherapy society consensus statement for skin brachytherapy. Brachytherapy 2020; 19:415-426. [PMID: 32409128 DOI: 10.1016/j.brachy.2020.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Keratinocyte carcinoma (KC, previously nonmelanoma skin cancer) represents the most common cancer worldwide. While surgical treatment is commonly utilized, various radiation therapy techniques are available including external beam and brachytherapy. As such, the American Brachytherapy Society has created an updated consensus statement regarding the use of brachytherapy in the treatment of KCs. METHODS Physicians and physicists with expertise in skin cancer and brachytherapy created a consensus statement for appropriate patient selection, data, dosimetry, and utilization of skin brachytherapy and techniques based on a literature search and clinical experience. RESULTS Guidelines for patient selection, evaluation, and dose/fractionation schedules to optimize outcomes for patients with KC undergoing brachytherapy are presented. Studies of electronic brachytherapy are emerging, although limited long-term data or comparative data are available. Radionuclide-based brachytherapy represents an appropriate option for patients with small KCs with multiple techniques available. CONCLUSIONS Skin brachytherapy represents a standard of care option for appropriately selected patients with KC. Radionuclide-based brachytherapy represents a well-established technique; however, the current recommendation is that electronic brachytherapy be used for KC on prospective clinical trial or registry because of a paucity of mature data.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
| | - Zoubir Ouhib
- Lynn Cancer Institute, Boca Raton Regional Hospital, Boca Raton, FL
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Ajay Bhatnagar
- Department of Radiation Oncology, Alliance Oncology, Casa Grande, AZ
| | - Joycelin Canavan
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Zain Husain
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gil'ad N Cohen
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John Strasswimmer
- College of Medicine (Dermatology) and College of Sciences (Biochemistry), Florida Atlantic University, Boca Raton, FL
| | - Nikhil Joshi
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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28
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Rembielak A, Sykes AJ, Fife K, Challapalli A, Nobes JP. Radiotherapy and Systemic Treatment for Non-melanoma Skin Cancer in the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:417-419. [PMID: 32418675 PMCID: PMC7203060 DOI: 10.1016/j.clon.2020.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 01/21/2023]
Affiliation(s)
- A Rembielak
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK.
| | - A J Sykes
- The Christie NHS Foundation Trust, Manchester, UK
| | - K Fife
- Addenbrooke's Hospital, Cambridge, UK
| | - A Challapalli
- Bristol Cancer Institute, UHB NHS Foundation Trust, Bristol, UK
| | - J P Nobes
- Norfolk and Norwich University Hospital, Norwich, UK
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29
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Matsui T, Okano N, Kawamura H, Oike T, Ohno T. Mild Hypofractionated Radiation Therapy for Merkel Cell Carcinoma. Cureus 2020; 12:e6786. [PMID: 32140346 PMCID: PMC7045982 DOI: 10.7759/cureus.6786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine neoplasm. Although surgical resection is the first-line treatment for primary MCCs, the characteristics of this disease (i.e., high prevalence in the elderly and in the head and neck region) generate a considerable number of inoperable cases. Radiation therapy shows potential as a definitive treatment alternative to surgery. In definitive radiation therapy for non-resected MCC, 60-66 Gy administered in 2 Gy per fraction and five fractions per week is recommended. However, such frequent visits to the hospital can be a great burden to elderly patients and family members. In this report, we present the case of an 89-year-old patient with MCC (cT2N0M0, stage IIA) of the left cheek. The patient was treated with radiation therapy using a mild hypofractionated schedule (57 Gy provided in 3 Gy per fraction and three fractions per week) targeting the gross tumor. The treatment led to complete tumor remission with well-tolerated acute toxicities at three months post-irradiation. This case indicates that a mild hypofractionated irradiation schedule may achieve tumor control in MCC patients who are inoperable and who cannot make frequent hospital visits.
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Affiliation(s)
- Toshiaki Matsui
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Naoko Okano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Takahiro Oike
- Heavy Ion Medical Center, Gunma University, Maebashi, JPN
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, JPN
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30
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Likhacheva A, Awan M, Barker CA, Bhatnagar A, Bradfield L, Brady MS, Buzurovic I, Geiger JL, Parvathaneni U, Zaky S, Devlin PM. Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin: Executive Summary of an American Society for Radiation Oncology Clinical Practice Guideline. Pract Radiat Oncol 2019; 10:8-20. [PMID: 31831330 DOI: 10.1016/j.prro.2019.10.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE This guideline reviews the evidence for the use of definitive and postoperative radiation therapy (RT) in patients with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). METHODS The American Society for Radiation Oncology convened a task force to address 5 key questions focused on indications for RT in the definitive and postoperative setting for BCC and cSCC, as well as dose-fractionation schemes, target volumes, basic aspects of treatment planning, choice of radiation modality, and the role of systemic therapy in combination with radiation. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS The guideline recommends definitive RT as primary treatment for patients with BCC and cSCC who are not surgical candidates while conditionally recommending RT with an emphasis on shared decision-making in those situations in which adequate resection can lead to a less than satisfactory cosmetic or functional outcome. In the postoperative setting, a number of indications for RT after an adequate resection are provided while distinguishing the strength of the recommendations between BCC and cSCC. One key question is dedicated to defining indications for regional nodal irradiation. The task force suggests a range of appropriate dose-fractionation schemes for treatment of primary and nodal volumes in definitive and postoperative scenarios. The guideline also recommends against the use of carboplatin concurrently with adjuvant RT and conditionally recommends the use of systemic therapies for unresectable primaries where treatment may need escalation. CONCLUSIONS Defining the role of RT in the management of BCC and cSCC has been hindered by a lack of high-quality evidence. This document synthesizes available evidence to define practice guidelines for the most common clinical situations. We encourage practitioners to enroll patients in prospective trials and to approach care in a multidisciplinary fashion whenever possible.
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Affiliation(s)
- Anna Likhacheva
- Department of Radiation Oncology, Sutter Medical Center, Sacramento, California.
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ajay Bhatnagar
- Department of Radiation Oncology, Alliance Oncology, Casa Grande, Arizona
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Mary Sue Brady
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ivan Buzurovic
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | - Sandra Zaky
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Phillip M Devlin
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
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31
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Chua B, Jackson JE, Lin C, Veness MJ. Radiotherapy for early non-melanoma skin cancer. Oral Oncol 2019; 98:96-101. [DOI: 10.1016/j.oraloncology.2019.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/10/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022]
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32
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Veness MJ, Delishaj D, Barnes EA, Bezugly A, Rembielak A. Current Role of Radiotherapy in Non-melanoma Skin Cancer. Clin Oncol (R Coll Radiol) 2019; 31:749-758. [PMID: 31447088 DOI: 10.1016/j.clon.2019.08.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/07/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022]
Abstract
Non-melanoma skin cancer (NMSC) represents the most frequently diagnosed malignancy worldwide, most being cutaneous basal cell and squamous cell carcinoma. The global incidence of NMSC continues to increase as the global population ages. Numerous treatment options are available for NMSC patients, with radiotherapy an efficacious and tissue-preserving non-surgical option. External beam radiotherapy and brachytherapy are modalities with specific indications and advantages in treating NMSC. Where excision is not an option (medically/technically inoperable) or considered less ideal (e.g. cosmetic or functional outcome), radiotherapy offers an excellent alternative. Inoperable elderly and/or co-morbid patients of poor performance status can benefit from short-course hypofractionated radiotherapy, with very acceptable toxicity. Adjuvant radiotherapy in patients with unfavourable pathology can decrease the risk of local and regional recurrence and associated morbidity and mortality. Radiotherapy has advantages and disadvantages and it is important for clinicians to understand these. Managing patients with NMSC is carried out by clinicians from multiple disciplines but it is imperative that they are all aware of the role of radiotherapy in their patients in various clinical settings. Here we aim to discuss the role and indications for recommending radiotherapy in patients with NMSC.
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Affiliation(s)
- M J Veness
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
| | - D Delishaj
- Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy
| | - E A Barnes
- Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Toronto, Canada
| | - A Bezugly
- Academy of Postgraduate Education of the Russian Federal Medical-Biological Agency, Moscow, Russia
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK
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Lee CT, Lehrer EJ, Aphale A, Lango M, Galloway TJ, Zaorsky NG. Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients. Cancer 2019; 125:3582-3594. [DOI: 10.1002/cncr.32371] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/25/2019] [Accepted: 06/06/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Charles T. Lee
- Department of Radiation Oncology Fox Chase Cancer Center Philadelphia Pennsylvania
| | - Eric J. Lehrer
- Department of Radiation Oncology Icahn School of Medicine at Mount Sinai New York New York
| | - Abhishek Aphale
- Department of Dermatology Fox Chase Cancer Center Philadelphia Pennsylvania
| | - Miriam Lango
- Department of Surgery Fox Chase Cancer Center Philadelphia Pennsylvania
| | - Thomas J. Galloway
- Department of Radiation Oncology Fox Chase Cancer Center Philadelphia Pennsylvania
| | - Nicholas G. Zaorsky
- Department of Radiation Oncology Fox Chase Cancer Center Philadelphia Pennsylvania
- Department of Radiation Oncology Penn State Cancer Institute Hershey Pennsylvania
- Department of Public Health Sciences Penn State College of Medicine Hershey Pennsylvania
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34
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Garbutcheon‐Singh KB, Veness MJ. The role of radiotherapy in the management of non‐melanoma skin cancer. Australas J Dermatol 2019; 60:265-272. [DOI: 10.1111/ajd.13025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/28/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Kieran B Garbutcheon‐Singh
- Department of Radiation Oncology Crown Princess Mary Cancer Centre Westmead Hospital Sydney New South Wales Australia
| | - Michael J Veness
- Department of Radiation Oncology Crown Princess Mary Cancer Centre Westmead Hospital Sydney New South Wales Australia
- University of Sydney Sydney New South Wales Australia
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35
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Nestor MS, Berman B, Goldberg D, Cognetta AB, Gold M, Roth W, Cockerell CJ, Glick B. Consensus Guidelines on the Use of Superficial Radiation Therapy for Treating Nonmelanoma Skin Cancers and Keloids. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2019; 12:12-18. [PMID: 30881578 PMCID: PMC6415702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: The use of superficial radiation therapy (SRT) has experienced a renaissance for treating nonmelanoma skin cancers (NMSCs) and recurrent keloids; however, published treatment guidelines are lacking. Objective: The objective of this work was to provide consensus guidelines on the use of SRT for treating NMSC and recurrent keloids based on a review of the literature and expert opinion. Methods and Materials: A search of the medical literature was performed to obtain published information on the use of SRT for review. A group of qualified dermatologists convened to discuss their views on the use of SRT for the treatment of NMSCs and recurrent keloids. The various guidelines were considered to have consensus based on a supermajority two-thirds vote. The final consensus guidelines are thus based on the medical literature, when available, and expert opinions. Results: Agreement on consensus guidelines was reached for numerous aspects of SRT use, including appropriate tumor types for SRT; anatomical areas suitable for SRT; energy, fractions, and scheduling recommendations for SRT; use of SRT in the presence of comorbidities; safety factors; and treatment recommendations for recurrent keloids, based the literature and on both the opinions of the expert group and a survey of experienced users. Conclusion: Consensus was reached that SRT is a safe and effective treatment for basal cell and squamous cell carcinomas and should be considered as the first-line form of radiation treatment. Postsurgical treatment of keloid excision suture lines with SRT significantly reduces keloid recurrence rates.
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Affiliation(s)
- Mark S Nestor
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Brian Berman
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - David Goldberg
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Armand B Cognetta
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Michael Gold
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - William Roth
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Clay J Cockerell
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Brad Glick
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
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36
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Abstract
Radiotherapy is an available but not well-known treatment for management of basal cell carcinoma. National organizations have established that standard therapy is complete surgical removal and radiation therapy is an option for inoperable tumors or those where the post-operative defect would be cosmetically disfiguring or functionally disabling. These therapeutic options, with histological sample, should be considered in the multidisciplinary management of patients with basal cell carcinoma. There are several types of radiotherapy: external radiation or interstitial brachytherapy, unfortunately, there is no consensus in the literature and the range of radiation regimens in common use is large. Very few randomized studies have been conducted to defi the optimum treatment in terms of recurrence rate, cosmetic outcome and side-eff In most of studies, the overall local control rate was between 80-100% and over 90% of patients reported good or excellent cosmetic outcome. Side-eff of radiotherapy most commonly reported are minor but in young patients one must be alert to the theoretical possibility of the induction of secondary malignancies. Cet article fait partie du numéro supplément Prise en charge des carcinomes basocellulaires difficiles à traiter réalisé avec le soutien institutionnel de Sun Pharma.
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Affiliation(s)
- C Velter
- Service de dermatologie, institut Gustave-Roussy, 94805 Villejuif, France.
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37
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Zaorsky NG, Lee CT, Zhang E, Galloway TJ. Skin CanceR Brachytherapy vs External beam radiation therapy (SCRiBE) meta-analysis. Radiother Oncol 2018; 126:386-393. [PMID: 29370985 PMCID: PMC7548033 DOI: 10.1016/j.radonc.2017.12.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE To compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin. MATERIALS AND METHODS Studies including patients with T1-2 N0 SCCs/BCCs treated with definitive EBRT/BT and ≥10 months follow-up were analyzed. The primary endpoint was post-treatment cosmesis, categorized as "good," "fair," or "poor." The secondary endpoint was LR. Mixed effects regression models were used to estimate weighted linear relationships between biologically equivalent doses with α/β = 3 (BED3) and cosmetic outcomes. RESULTS A total of 9965 patients received EBRT and 553 received BT across 24 studies. Mean age was 73 years, median follow-up was 36 months, and median dose was 45 Gy/10 fractions at 4.4 Gy/fraction. At BED3 of 100 Gy, "good" cosmesis was more frequently observed in patients receiving BT, 95% (95% CI: 88-100%) vs 79% (95% CI: 60-82%), p < 0.05. Similar results were found for "good" cosmesis at BED3 >100 Gy. No difference in "poor" cosmesis was noted at any BED3. LR was <7% for both at one year. CONCLUSION BT has favorable cosmesis over EBRT for skin SCCs/BCCs at common fractionation regimens. Prospective studies comparing EBRT vs BT are warranted.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA.
| | - Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Eddie Zhang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
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