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Gagliardi F, Russo A, Scharf C, Pinto A, Faenza M, D'Ippolito E, Argenziano G, Troiani T, Reginelli A, Nardone V. All for one: Collaboration between dermatologist, radiation oncologist and radiologist in the clinical management of "difficult to treat" non melanoma skin cancer. Clin Transl Radiat Oncol 2024; 46:100774. [PMID: 38596818 PMCID: PMC11001761 DOI: 10.1016/j.ctro.2024.100774] [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: 03/12/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
This series introduces the clinical management of difficult-to-treat non-melanoma skin cancers (NMSCs) through a multidisciplinary approach, emphasizing the integration of dermoscopy and Ultra high-frequency ultrasound (UHFUS) for accurate diagnosis and treatment planning, particularly in cases referred for radiotherapy (RT). Dermoscopy aids in diagnosing both pigmented and non-pigmented skin lesions, guiding treatment margins and reducing the benign-to-malignant biopsy ratio. UHFUS provides valuable insights into tumor size, depth, and vascularity, complementing clinical evaluations and assisting in RT planning. Three challenging cases are presented, highlighting the pivotal role of dermoscopy and UHFUS in decision-making and treatment optimization. Collaboration between dermatologists, radiation oncologists, and radiologists enhances diagnostic accuracy, tailoring treatment plans to individual patient needs and preferences, ultimately improving patient outcomes and experience. The integration of these imaging techniques holds promise for optimizing non-surgical treatments like RT and monitoring treatment progress, offering a personalized approach to NMSC management.
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Affiliation(s)
- Federico Gagliardi
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples 80138, Italy
| | - Anna Russo
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples 80138, Italy
| | - Camila Scharf
- Dematology Unit, University of Campania L.Vanvitelli, Naples, Italy
| | - Alessandro Pinto
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples 80138, Italy
| | - Mario Faenza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Plastic Surgery Unit, Universityof Campania “Luigi Vanvitelli”, Naples, Italy
| | - Emma D'Ippolito
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples 80138, Italy
| | | | - Teresa Troiani
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples 80138, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples 80138, Italy
| | - Valerio Nardone
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples 80138, Italy
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Czajkowska J, Juszczyk J, Bugdol MN, Glenc-Ambroży M, Polak A, Piejko L, Pietka E. High-frequency ultrasound in anti-aging skin therapy monitoring. Sci Rep 2023; 13:17799. [PMID: 37853086 PMCID: PMC10584894 DOI: 10.1038/s41598-023-45126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023] Open
Abstract
Over the last few decades, high-frequency ultrasound has found multiple applications in various diagnostic fields. The fast development of this imaging technique opens up new diagnostic paths in dermatology, allergology, cosmetology, and aesthetic medicine. In this paper, being the first in this area, we discuss the usability of HFUS in anti-aging skin therapy assessment. The fully automated algorithm combining high-quality image selection and entry echo layer segmentation steps followed by the dermal parameters estimation enables qualitative and quantitative evaluation of the effectiveness of anti-aging products. Considering the parameters of subcutaneous layers, the proposed framework provides a reliable tool for TCA-peel therapy assessment; however, it can be successfully applied to other skin-condition-related problems. In this randomized controlled clinical trial, forty-six postmenopausal women were randomly assigned to the experimental and control groups. Women were treated four times at one-week intervals and applied skin cream daily between visits. The three month follow-up study enables measurement of the long-term effect of the therapy. According to the results, the TCA-based therapy increased epidermal (entry echo layer) thickness, indicating that the thinning process has slowed down and the skin's condition has improved. An interesting outcome is the obtained growth in the intensity of the upper dermis in the experimental group, which might suggest a reduced photo-aging effect of TCA-peel and increased water content. The same conclusions connected with the anti-aging effect of TCA-peel can be drawn by observing the parameters describing the contribution of low and medium-intensity pixels in the upper dermis. The decreased share of low-intensity pixels and increased share of medium-intensity pixels in the upper dermis suggest a significant increase in local protein synthesis.
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Affiliation(s)
- Joanna Czajkowska
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800, Zabrze, Poland.
| | - Jan Juszczyk
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800, Zabrze, Poland
| | - Monika Natalia Bugdol
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800, Zabrze, Poland
| | | | - Anna Polak
- Jerzy Kukuczka Academy of Physical Education, Institute of Physiotherapy and Health Sciences, 40-065, Katowice, Poland
| | - Laura Piejko
- Jerzy Kukuczka Academy of Physical Education, Institute of Physiotherapy and Health Sciences, 40-065, Katowice, Poland
| | - Ewa Pietka
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800, Zabrze, Poland
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3
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Wortsman X. Aplicaciones frecuentes de la ecotomografía Doppler color en dermatología que permiten ayudar al diagnóstico y manejo. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Rembielak A, Mansy G, Barnes EA, Licher J, Tselis N. Advances in Skin Brachytherapy: Cosmesis and Function Preservation. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00057-2. [PMID: 36894382 DOI: 10.1016/j.clon.2023.02.010] [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: 10/05/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
Skin brachytherapy represents an excellent alternative treatment for patients with non-melanoma skin cancers. It offers superior conformity of dose distribution with rapid dose fall off, reducing the risk of radiotherapy-related treatment toxicity. A smaller treatment volume in brachytherapy, when compared with external beam radiotherapy, is conducive for hypofractionation, which is an attractive option for decreasing outpatient visits to the cancer centre, especially for elderly and frail patients. Skin brachytherapy is an excellent option to preserve function and cosmesis, especially in skin cancers located in the head and neck region. Electronic brachytherapy, image-guided superficial brachytherapy and 3D printed moulds are all emerging advances in skin brachytherapy.
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Affiliation(s)
- A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - G Mansy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California, USA
| | - E A Barnes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - J Licher
- Department of Radiotherapy and Oncology, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - N Tselis
- Department of Radiotherapy and Oncology, University Hospital Frankfurt am Main, Frankfurt, Germany
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Russo GM, Russo A, Urraro F, Cioce F, Gallo L, Belfiore MP, Sangiovanni A, Napolitano S, Troiani T, Verolino P, Sica A, Brancaccio G, Briatico G, Nardone V, Reginelli A. Management of Non-Melanoma Skin Cancer: Radiologists Challenging and Risk Assessment. Diagnostics (Basel) 2023; 13:diagnostics13040793. [PMID: 36832281 PMCID: PMC9955870 DOI: 10.3390/diagnostics13040793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma are the three main types of nonmelanoma skin cancers and their rates of occurrence and mortality have been steadily rising over the past few decades. For radiologists, it is still difficult to treat patients with advanced nonmelanoma skin cancer. Nonmelanoma skin cancer patients would benefit greatly from an improved diagnostic imaging-based risk stratification and staging method that takes into account patient characteristics. The risk is especially elevated among those who previously received systemic treatment or phototherapy. Systemic treatments, including biologic therapies and methotrexate (MTX), are effective in managing immune-mediated diseases; however, they may increase susceptibility to NMSC due to immunosuppression or other factors. Risk stratification and staging tools are crucial in treatment planning and prognostic evaluation. PET/CT appears more sensitive and superior to CT and MRI for nodal and distant metastasis as well as in surveillance after surgery. The patient treatment response improved with advent and utilization of immunotherapy and different immune-specific criteria are established to standardized evaluation criteria of clinical trials but none of them have been utilized routinely with immunotherapy. The advent of immunotherapy has also arisen new critical issues for radiologists, such as atypical response pattern, pseudo-progression, as well as immune-related adverse events that require early identification to optimize and improve patient prognosis and management. It is important for radiologists to have knowledge of the radiologic features site of the tumor, clinical stage, histological subtype, and any high-risk features to assess immunotherapy treatment response and immune-related adverse events.
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Affiliation(s)
- Gaetano Maria Russo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
- Correspondence:
| | - Anna Russo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Fabrizio Cioce
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Stefania Napolitano
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Teresa Troiani
- Unit of Plastic Surgery, Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80120 Naples, Italy
| | - Pasquale Verolino
- Unit of Plastic Surgery, Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80120 Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Gabriella Brancaccio
- Unit of Dermatology, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Giulia Briatico
- Unit of Dermatology, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Valerio Nardone
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
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Rodríguez Villalba S, Guirado LLorente D, Sanz Cazorla A, Perez-Calatayud J, Rembielak A. HDR brachytherapy in keratinocyte skin carcinomas - Single center experience with analysis of clinical, dosimetric, and radiobiological factors in acute skin toxicity. Brachytherapy 2023; 22:108-119. [PMID: 36376228 DOI: 10.1016/j.brachy.2022.10.003] [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: 06/07/2022] [Revised: 09/09/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Radiotherapy techniques have been utilized to treat keratinocyte skin carcinoma (KSC). The objective of this study was to report the results of patients with KSC treated with HDR brachytherapy, with a variety of techniques and applicators. A statistical analysis of clinical, radiobiological, and technical factors has been made to analyze those factors related to skin acute toxicity, focused on acute epithelitis G3. METHODS AND MATERIALS Between February 2005 and August 2020, 93 patients with 120 histologically proven KSC have been treated in our Institution. BT treatment has been performed using superficial BT/plesiotherapy (Valencia applicator (22%), flaps (48%), customized molds (4%) or interstitial techniques (26%)). The indications of BT were primary/definitive in 38 treatments (32%) or adjuvant/postoperative in 82 (68%). In 14 (17%) of the 82 operated patients a skin graft. Mean comparison t tests were performed for quantitative variables, and percentage comparison Chi2 tests for qualitative. Multivariate binomial logistic regression models were done. RESULTS Median follow-up was 36.5 months (range 5-141). Local control was achieved in 110 treatments (92%). Acute toxicity, dermatitis, was G1 7%; G2, 57% and G3 38%. The main factors statistically associated to the appearance of dermatitis G3 were the total dose, the volume treated, and the use of manufactured flaps. The main protective factor against dermatitis G3 was implant of skin graft. CONCLUSIONS In KSC BT the use of manufactured flap is accompanied by greater EG3, only with a relationship with the volume of treatment and total dose.
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Affiliation(s)
| | - Damian Guirado LLorente
- Instituto de Investigación Biosanitaria (Ibs.Granada). Unidad de Radiofísica, Hospital Universitario Clínico San Cecilio. Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain.
| | | | - José Perez-Calatayud
- Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante, Spain; Radiotherapy Department, La Fe University and Polytechnic Hospital. Valencia, Spain.
| | - Agata Rembielak
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK.
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Yu L, Moloney M, Tran A, Zheng S, Rogers J. Local control comparison of early-stage non-melanoma skin Cancer (NMSC) treated by superficial radiotherapy (SRT) and external beam radiotherapy (XRT) with and without dermal image guidance: a meta-analysis. Discov Oncol 2022; 13:129. [PMID: 36414760 PMCID: PMC9681945 DOI: 10.1007/s12672-022-00593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Various treatments exist for non-melanoma skin cancer (NMSC), but the mainstay is surgical removal. Superficial radiotherapy (SRT) is one non-surgical technique that has been used for over a century but fell out of favor due to the advent of Mohs micrographic surgery (MMS). A new technology that combines a 22 megahertz (MHz) dermal ultrasound with SRT (US-SRT) enables tumor visualization before, during, and after treatment, and demonstrates increased cure rates and reduced recurrences. METHODS We conducted a meta-analysis comparing the local control (LC) of four studies using traditional non-image-guided forms of radiotherapy for NMSC treatment to two seminal studies utilizing high-resolution dermal ultrasound-guided SRT (HRUS-SRT). The four traditional radiotherapy studies were obtained from a comprehensive literature search used in an article published by the American Society of Radiation Oncology (ASTRO) on curative radiation treatment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and squamous cell carcinoma in-situ (SCCIS) lesions. The meta-analysis employed a logit as the effect size indicator with Q-statistic to test the null hypothesis. RESULTS LC rates for the 2 US-SRT studies were statistically superior to the 4 traditional therapies individually and collectively. When stratified by histology, statistically superior outcomes for US-SRT were observed in all subtypes with p-values ranging from p < 0.0001 to p = 0.0438. These results validated an earlier analysis using a logistic regression statistical method showing the same results. CONCLUSION US-SRT is statistically superior to non-image-guided radiotherapies for NMSC treatment. This modality may represent the future standard of non-surgical treatment for early-stage NMSC.
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Affiliation(s)
- Lio Yu
- Director of Radiation Oncology, Laserderm Dermatology, 327 Middle Country Rd, Smithtown, NY, 11787, USA.
| | - Mairead Moloney
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, NY, 11545, USA
| | - Alison Tran
- Menter Dermatology Research Institute, Baylor University Medical Center, 3900 Junius St, Suite 125, Dallas, TX, 75246, USA
| | - Songzhu Zheng
- Department of Applied Mathematics and Statistics, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - James Rogers
- Summit Analytical LLC, 8354 Northfield Blvd., Bldg. G Suite 3700, Denver, CO, 80238, USA
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Czajkowska J, Borak M. Computer-Aided Diagnosis Methods for High-Frequency Ultrasound Data Analysis: A Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22218326. [PMID: 36366024 PMCID: PMC9653964 DOI: 10.3390/s22218326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 05/31/2023]
Abstract
Over the last few decades, computer-aided diagnosis systems have become a part of clinical practice. They have the potential to assist clinicians in daily diagnostic tasks. The image processing techniques are fast, repeatable, and robust, which helps physicians to detect, classify, segment, and measure various structures. The recent rapid development of computer methods for high-frequency ultrasound image analysis opens up new diagnostic paths in dermatology, allergology, cosmetology, and aesthetic medicine. This paper, being the first in this area, presents a research overview of high-frequency ultrasound image processing techniques, which have the potential to be a part of computer-aided diagnosis systems. The reviewed methods are categorized concerning the application, utilized ultrasound device, and image data-processing type. We present the bridge between diagnostic needs and already developed solutions and discuss their limitations and future directions in high-frequency ultrasound image analysis. A search was conducted of the technical literature from 2005 to September 2022, and in total, 31 studies describing image processing methods were reviewed. The quantitative and qualitative analysis included 39 algorithms, which were selected as the most effective in this field. They were completed by 20 medical papers and define the needs and opportunities for high-frequency ultrasound application and CAD development.
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Nanomaterials as Ultrasound Theragnostic Tools for Heart Disease Treatment/Diagnosis. Int J Mol Sci 2022; 23:ijms23031683. [PMID: 35163604 PMCID: PMC8835969 DOI: 10.3390/ijms23031683] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023] Open
Abstract
A variety of different nanomaterials (NMs) such as microbubbles (MBs), nanobubbles (NBs), nanodroplets (NDs), and silica hollow meso-structures have been tested as ultrasound contrast agents for the detection of heart diseases. The inner part of these NMs is made gaseous to yield an ultrasound contrast, which arises from the difference in acoustic impedance between the interior and exterior of such a structure. Furthermore, to specifically achieve a contrast in the diseased heart region (DHR), NMs can be designed to target this region in essentially three different ways (i.e., passively when NMs are small enough to diffuse through the holes of the vessels supplying the DHR, actively by being associated with a ligand that recognizes a receptor of the DHR, or magnetically by applying a magnetic field orientated in the direction of the DHR on a NM responding to such stimulus). The localization and resolution of ultrasound imaging can be further improved by applying ultrasounds in the DHR, by increasing the ultrasound frequency, or by using harmonic, sub-harmonic, or super-resolution imaging. Local imaging can be achieved with other non-gaseous NMs of metallic composition (i.e., essentially made of Au) by using photoacoustic imaging, thus widening the range of NMs usable for cardiac applications. These contrast agents may also have a therapeutic efficacy by carrying/activating/releasing a heart disease drug, by triggering ultrasound targeted microbubble destruction or enhanced cavitation in the DHR, for example, resulting in thrombolysis or helping to prevent heart transplant rejection.
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