Journal ArticleDOI
Photodynamic therapy versus topical imiquimod versus topical fluorouracil for treatment of superficial basal-cell carcinoma: a single blind, non-inferiority, randomised controlled trial
Aimee H.M.M. Arits,Aimee H.M.M. Arits,Klara Mosterd,Klara Mosterd,Brigitte A. B. Essers,Eefje Spoorenberg,Anja Sommer,Anja Sommer,Michette J. M. De Rooij,Han P. A. van Pelt,Patricia J. F. Quaedvlieg,Gertruud A. M. Krekels,Pierre A. F. A. van Neer,Joris J. Rijzewijk,Adrienne J. van Geest,P.M. Steijlen,P.M. Steijlen,Patty J. Nelemans,Nicole W.J. Kelleners-Smeets,Nicole W.J. Kelleners-Smeets +19 more
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Topical fluorouracil was non-inferior and imiquimod was superior to MAL-PDT for treatment of superficial basal-cell carcinoma and all aspects affecting treatment choice should be weighted to select the best treatment for patients.Abstract:
Summary Background Superficial basal-cell carcinoma is most commonly treated with topical non-surgical treatments, such as photodynamic therapy or topical creams. Photodynamic therapy is considered the preferable treatment, although this has not been previously tested in a randomised control trial. We assessed the effectiveness of photodynamic therapy compared with imiquimod or fluorouracil in patients with superficial basal-cell carcinoma. Methods In this single blind, non-inferiority, randomised controlled multicentre trial, we enrolled patients with a histologically proven superficial basal-cell carcinoma at seven hospitals in the Netherlands. Patients were randomly assigned to receive treatment with methylaminolevulinate photodynamic therapy (MAL-PDT; two sessions with an interval of 1 week), imiquimod cream (once daily, five times a week for 6 weeks), or fluorouracil cream (twice daily for 4 weeks). Follow-up was at 3 and 12 months post-treatment. Data were collected by one observer who was blinded to the assigned treatment. The primary outcome was the proportion of patients free of tumour at both 3 and 12 month follow up. A pre-specified non-inferiority margin of 10% was used and modified intention-to-treat analyses were done. This trial is registered as an International Standard Randomised controlled trial (ISRCTN 79701845). Findings 601 patients were randomised: 202 to receive MAL-PDT, 198 to receive imiquimod, and 201 to receive fluorouracil. A year after treatment, 52 of 196 patients treated with MAL-PDT, 31 of 189 treated with imiquimod, and 39 of 198 treated with fluorouracil had tumour residue or recurrence. The proportion of patients tumour-free at both 3 and 12 month follow-up was 72·8% (95% CI 66·8–79·4) for MAL-PDT, 83·4% (78·2–88·9) for imiquimod cream, and 80·1% (74·7–85·9) for fluorouracil cream. The difference between imiquimod and MAL-PDT was 10·6% (95% CI 1·5–19·5; p=0·021) and 7·3% (–1·9 to 16·5; p=0·120) between fluorouracil and MAL-PDT, and between fluorouracil and imiquimod was −3·3% (–11·6 to 5·0; p=0·435. For patients treated with MAL-PDT, moderate to severe pain and burning sensation were reported most often during the actual MAL-PDT session. For other local adverse reactions, local skin redness was most often reported as moderate or severe in all treatment groups. Patients treated with creams more often reported moderate to severe local swelling, erosion, crust formation, and itching of the skin than patients treated with MAL-PDT. In the MAL-PDT group no serious adverse events were reported. One patient treated with imiquimod and two patients treated with fluorouracil developed a local wound infection and needed additional treatment in the outpatient setting. Interpretation Topical fluorouracil was non-inferior and imiquimod was superior to MAL-PDT for treatment of superficial basal-cell carcinoma. On the basis of these findings, imiquimod can be considered the preferred treatment, but all aspects affecting treatment choice should be weighted to select the best treatment for patients. Funding Grant of the Netherlands Organization for Scientific Research ZONMW (08-82310-98-08626).read more
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Journal ArticleDOI
Oncologic photodynamic therapy: Basic principles, current clinical status and future directions
Demian van Straten,Vida Mashayekhi,Henriëtte S. de Bruijn,Sabrina Oliveira,Dominic J. Robinson +4 more
TL;DR: An overview of the clinical trials conducted over the last 10 years is provided, illustrating how PDT is applied in the clinic today, and the factors that hamper the exploration of this effective therapy and what should be changed to render it a more effective and more widely available option for patients.
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Diagnosis and treatment of Merkel Cell Carcinoma. European consensus-based interdisciplinary guideline
Céleste Lebbé,Jürgen C. Becker,Jean-Jacques Grob,Josep Malvehy,Véronique Del Marmol,Hubert Pehamberger,Ketty Peris,Philippe Saiag,Mark R. Middleton,Lars Bastholt,Alessandro Testori,Alexander J. Stratigos,Claus Garbe +12 more
TL;DR: A collaborative group of multidisciplinary experts form the European Dermatology Forum (EDF), The European Association of Dermato-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on MCC diagnosis and management.
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Guidelines of care for the management of cutaneous squamous cell carcinoma
Murad Alam,April W. Armstrong,Christian L. Baum,Jeremy S. Bordeaux,Marc D. Brown,Klaus J. Busam,Daniel B. Eisen,Vivek Iyengar,Clifford W. Lober,David J. Margolis,Jane L. Messina,Alexander R. Miller,Stanley J. Miller,Eliot N. Mostow,Christen M. Mowad,Kishwer S. Nehal,Kristi Schmitt-Burr,Aleksandar Sekulic,Paul A. Storrs,Joyce M.C. Teng,Siegrid S. Yu,Conway C. Huang,Kevin Boyer,Wendy Smith Begolka,Christopher K. Bichakjian,John Y.S. Kim,Jeffrey H. Kozlow,Bharat B. Mittal,Jeffrey S. Moyer,Thomas Olenecki,Phillip Rodgers +30 more
TL;DR: The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cS CC is noted, as is general information on the management of patients with metastatic disease.
Journal ArticleDOI
Guidelines of care for the management of basal cell carcinoma.
Christian L. Baum,Jeremy S. Bordeaux,Marc Brown,Klaus Busam,Daniel B. Eisen,Vivek Iyengar,Clifford W. Lober,David J. Margolis,Jane Messina,Alexander R. Miller,Stanley J. Miller,Eliot N. Mostow,Christen Mowad,Kishwer S. Nehal,Kristi Schmitt-Burr,Aleksandar Sekulic,Paul A. Storrs,Joyce M.C. Teng,Siegrid Yu,Conway C. Huang,Kevin Boyer,Wendy Smith Begolka,Murad Alam,John Y.S. Kim,Jeffrey H. Kozlow,Bharat B. Mittal,Jeffrey S. Moyer,Thomas Olencki,Phillip Rodgers +28 more
TL;DR: Recommendations for the management of patients with BCC and recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy are provided.
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Basal cell carcinoma: pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management.
Alexander Marzuka,Samuel E. Book +1 more
TL;DR: The pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management of BCC will be discussed in this review.
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