Skin CanceR Brachytherapy vs External beam radiation therapy (SCRiBE) meta-analysis

Zaorsky, Nicholas G.; Lee, Charles T.; Zhang, Eddie; Galloway, Thomas J.

doi:10.1016/j.radonc.2017.12.029

Cited by 41 publications

(36 citation statements)

References 54 publications

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“…In total, the meta‐analysis included 21,371 patients across 58 separate studies published from 1985 to 2017. Compared with the previous meta‐analyses by Zaorsky et al, there are more than twice the number of included patients and studies because of the inclusion of surgical modalities. The studies were from the United States, Canada, Brazil, the United Kingdom, Denmark, France, Germany, Italy, Spain, the Netherlands, Switzerland, Australia, and Japan .…”

Section: Resultsmentioning

confidence: 94%

“…Individual patient‐level data are not available, and most studies did not report the number of patients with T1 versus T2 tumors; thus, we are unable to assess outcomes across stage. Table was extrapolated from the meta‐analysis by Zaorsky et al, with the addition of studies by Garcia‐Martin et al, Kharofa et al, and Lipman et al…”

Section: Resultsmentioning

confidence: 99%

“…Methods of evidence acquisition for the current study were similar to those used for the previously published meta‐analyses by Zaorsky et al, which focused on sole RT techniques for skin BCC and SCC . Surgical terms were added to the search strategy, and a comprehensive literature review was performed.…”

Section: Methodsmentioning

confidence: 99%

“…The primary endpoint was cosmesis because, as shown by Zaorsky et al in previously published meta‐analyses, recurrences are uncommon . As such, cosmesis is the main factor that decides treatment choice.…”

Section: Methodsmentioning

confidence: 99%

“…In a previous meta‐analysis by the authors, Zaorsky et al demonstrated that, with improved targeting and dose‐selection methods of modern RT, short‐course treatments can offer similarly highly rated cosmesis to long‐course treatments . Furthermore, surface‐applicator brachytherapy (BT) use has increased since the 2000s and, although external‐beam RT (EBRT) and BT have not been directly compared, in a separate publication, Zaorsky et al suggest that BT has improved cosmesis compared with fractionated EBRT for indolent skin BCCs and SCCs . Therefore, given the evolutions in treatment techniques, it is possible that contemporary cosmetic outcomes and control rates have improved since the 1980s …”

Section: Introductionmentioning

confidence: 99%

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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

Lee

Lehrer

Aphale

et al. 2019

Cancer

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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. Cancer 2019;125:3582-3594.

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