Cryosurgery combined with topical interventions for actinic keratosis: a systematic review and meta‐analysis

Abstract

Summary Background Actinic keratoses (AKs) are early in situ carcinomas of the skin caused by cumulative sun exposure. Cryosurgery is an easy and practicable lesion‐directed approach for treatment of isolated lesions. Objectives To investigate whether an upfront combination of cryosurgery with a topical intervention is superior to cryosurgery alone for treatment of AK. Methods We performed a systematic literature search in MEDLINE, Embase and CENTRAL and hand searched pertinent trial registers for eligible randomized controlled trials until 17 July 2018. Results from individual studies were pooled using a random effects model. The risk of bias was estimated with the Cochrane Risk of Bias Tool and the quality of evidence of the outcomes with the GRADE approach. Results Out of 1758 records initially identified, nine studies with a total sample size of 1644 patients were included. Cryosurgery in combination with a topical approach showed significantly higher participant complete clearance rates than monotherapy [risk ratio (RR) 1·74, 95% confidence interval (CI) 1·25–2·43, I2 = 73%, eight studies]. The participant partial clearance rate was not statistically different (RR 1·64, 95% CI 0·88–3·03, I2 = 77%, three studies). The number of patients who completed the study protocol and did not withdraw due to adverse events was equal in both groups (RR 0·98, 95% CI 0·95–1·01, I2 = 75%, seven studies). The studies were estimated to have high risk for selective reporting bias. Conclusions Our results suggest the superiority of a combination regimen for AK clearance, with equal tolerability. This study highlights the importance of a field‐directed approach in patients with multiple AKs or field cancerization.

La QUERATOSIS ACTÍNICA Y SUS TRATAMIENTOS EN LOS ÚLTIMOS 4 AÑOS: UNA REVISIÓN.

“…Entre los principales efectos adversos de la crioterapia están el dolor, la hipopigmentación y cicatrización, lo que lleva a los pacientes a preferir la terapia fotodinámica. 5,16 Su principal limitación es en los campos de cancerización donde la terapia tópica ha ganado ventajas. La combinación de crioterapia con medicación tópica logra un mayor porcentaje de curación completa comparado con crioterapia sola según ocho estudios, pero no hubo diferencia significativa en curaciones parciales entre ambos tratamientos según 3 estudios.…”

“…La combinación de crioterapia con medicación tópica logra un mayor porcentaje de curación completa comparado con crioterapia sola según ocho estudios, pero no hubo diferencia significativa en curaciones parciales entre ambos tratamientos según 3 estudios. 16…”

The more the better? An appraisal of combination therapies for actinic keratosis

“…11 We recently investigated in a systematic review and meta-analysis whether an upfront combination of cryosurgery with a topical intervention is superior to cryosurgery alone. 12 We identified nine randomized controlled trials (RCTs) with an overall sample size of n = 1644 participants. The majority investigated cryosurgery followed by imiquimod (n = 4).…”

Innovative devices for actinic keratoses: a hot‐button issue

“…In the era of field‐directed therapies, cryotherapy still remains the most suitable option for single lesions and the most frequently implemented treatment in primary care . Combining both approaches is also promising, and a meta‐analysis found evidence that an upfront combination of cryosurgery followed by a topical intervention was more efficient than cryosurgery alone to obtain complete clearance of AKs . Therefore, lesion‐directed therapies still deserve to remain in the field of investigation.…”