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.

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Abstrakt

Tytuł:: 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.
Autorzy:: Lee CT; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Lehrer EJ; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Aphale A; Department of Dermatology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Lango M; Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Galloway TJ; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Zaorsky NG; 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.
Źródło:: Cancer [Cancer] 2019 Oct 15; Vol. 125 (20), pp. 3582-3594. Date of Electronic Publication: 2019 Jul 29.
Typ publikacji:: Journal Article; Meta-Analysis
Język:: English
Imprint Name(s):: Publication: <2005- >: Hoboken, NJ : Wiley
Original Publication: New York [etc.] Published for the American Cancer Society by J. Wiley [etc.]
MeSH Terms:: Mohs Surgery*
Neoplasm Recurrence, Local/*surgery
Skin Neoplasms/*surgery
Brachytherapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/radiotherapy ; Neoplasm Staging ; Skin Neoplasms/pathology ; Skin Neoplasms/radiotherapy
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Contributed Indexing:: Keywords: Mohs; basal cell carcinoma; brachytherapy; external-beam radiation therapy; meta-analysis; skin cancer; squamous cell carcinoma; surgical excision
Entry Date(s):: Date Created: 20190730 Date Completed: 20200520 Latest Revision: 20200520
Update Code:: 20240105
DOI:: 10.1002/cncr.32371
PMID:: 31355928
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Background: The objective of this study was to compare the cosmesis and recurrence rates of conventional excision (CE), Mohs micrographic surgery (MMS), external-beam radiation therapy (EBRT), or brachytherapy (BT), for basal cell carcinoma and squamous cell carcinoma of the skin.
Methods: Population, Intervention, Control, Outcome, Study Design (PICOS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) methods were used to identify studies on PubMed (from 1985 to 2018), including patients with American Joint Committee on Cancer (AJCC) T1-T2N0 basal cell carcinomas and squamous cell carcinomas and ≥10 months follow-up who received CE, MMS, EBRT, or BT. The primary endpoint was cosmesis, classified as "good," "fair," or "poor." The secondary endpoint was 1-year recurrence. Fixed-effects and random-effects meta-analyses were performed to evaluate primary and secondary outcomes with respect to treatment modality.
Results: In total, 18,095 studies met initial search criteria. There were 24 CE, 13 MMS, 19 EBRT, and 7 BT studies included with a total of 21,371 patients. The summary effect size for "good" cosmesis was 81% (95% CI, 70.6%-89.6%), 74.6% (95% CI, 63%-84.6%), and 97.6% (95% CI, 91.3%-100%) for CE, EBRT, and BT, respectively. Good cosmesis was 96.0% in the only MMS study that reported cosmesis. BT had improved "good" cosmesis over EBRT (P = .0025) and was similar to CE and MMS. No significant differences were seen for "fair" or "poor" cosmesis. One-year recurrence rates were low throughout at 0.8% (95% CI, 0.3%-1.6%), 0.2% (95% CI, 0%-0.6%), 2% (95% CI, 1.3%-2.7%), and 0% (95% CI, 0%-0.5%) for CE, MMS, EBRT, and BT, respectively.
Conclusions: For T1-T2N0 skin cancers, BT and MMS have improved cosmesis over EBRT and CE. It is unclear whether this is because of treatment superiority or selection and reporting bias. Local control is similar among all modalities at 1 year.
(© 2019 American Cancer Society.)

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