Tumor thickness and adnexal extension of superficial basal cell carcinoma (sBCC) as determinants of treatment failure for methylaminolevulinate (MAL)-photodynamic therapy (PDT), imiquimod, and 5-fluorouracil (FU)

Roozeboom, Marieke H.; Kleef, Lotte van; Arits, A.H.M.M.; Mosterd, Klara; Winnepenninckx, Véronique; Marion, Ariënne M W van; Nelemans, Patty J.; Kelleners‐Smeets, Nicole W.J.

doi:10.1016/j.jaad.2015.03.048

Cited by 26 publications

(19 citation statements)

References 16 publications

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“…They found that tumor-free survival at 3 years post-treatment was 58.0% for MAL-PDT (95% confidence interval [CI] = 47.8-66.9), 68.2% for topical fluorouracil (95% CI = 58.1-76.3) and 79.7% for imiquimod (95% CI = 71.6-85.7), with clear evidence that topical imiquimod was superior to MAL-PDT (treatment failure hazard ratio for imiquimod compared with MAL-PDT was 0.50, 95% CI = 0.33-0.76, P = 0.001). Tumour thickness does not seem to predict treatment failure for topical imiquimod, PDT or topical 5-fluorouracil (Roozeboom et al, 2015). We have been unable to identify any further trials comparing topical imiquimod versus other active therapies for the treatment of low risk nodular or superficial BCC, and none with 5 years follow-up.…”

Section: Discussionmentioning

confidence: 85%

Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma: 5-Year Results of the SINS Randomized Controlled Trial

Williams

Bath‐Hextall

Ozolins

et al. 2017

Journal of Investigative Dermatology

119

106

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Abbreviations BCC = basal cell carcinoma; nBCC = nodular basal cell carcinoma sBCC = superficial basal cell carcinoma; PDT = photodynamic therapy RCT = randomised controlled trial Abstract -200 words Main text -2600 words Tables -1 Figures -1 References -23 2 ABSTRACT Background: We previously reported modest clinical 3-year benefit for topical imiquimod compared with surgery for superficial or nodular basal cell carcinoma (sBCC, nBCC) at low risk sites in our non-inferiority randomised controlled SINS trial. Here we report 5-year data.Methods: Participants were randomised to imiquimod 5% cream once daily (sBCC, 6 weeks; nBCC, 12 weeks) or excisional surgery (4 mm margin). Primary outcome was clinical absence of initial failure or signs of recurrence at 3 year dermatology review. Five year success was defined as 3 year success plus absence of recurrences identified through hospital, histopathology and general practitioner records. Results:Of 501 participants randomised, 401 contributed to the modified intention-to-treat analyses at year 3 (primary outcome), 383 (96%) of whom had data at year 5. Five year success rates for imiquimod were 82·5% (170/206) compared to 97·7% (173/177) for surgery (relative risk of imiquimod success 0·84, 95% CI 0·77 to 0·91, p<0.001). These were comparable to year 3 success rates of 83·6% (178/213) and 98.4% (185/188), for imiquimod and surgery, respectively. Most imiquimod treatment failures occurred in year one. Interpretation:Although surgery is clearly superior to imiquimod, this study shows sustained benefit for lesions that respond early to topical imiquimod.

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Section: Discussionmentioning

confidence: 85%

Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma: 5-Year Results of the SINS Randomized Controlled Trial

Williams

Bath‐Hextall

Ozolins

et al. 2017

Journal of Investigative Dermatology

119

106

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“…Tumor dimensions and stage of disease progression may also influence therapy. A study of BCC with a tumor thickness less than 1.0 mm or adnexal extension have not been found to significantly increase treatment failure using methylaminolevulinate, imiquimod and 5‐fluorouracil . Ulceration on BCC may enhance the imiquimod therapeutic response by facilitated entry into the tumor stroma.…”

Section: Discussionmentioning

confidence: 98%

“…A study of BCC with a tumor thickness less than 1.0 mm or adnexal extension have not been found to significantly increase treatment failure using methylaminolevulinate, imiquimod and 5-fluorouracil. 24 Ulceration on BCC may enhance the imiquimod therapeutic response 25 by facilitated entry into the tumor stroma. Future studies may investigate the variation in ulceration features between superficial and nodular BCC subtypes and whether this information may also be incorporated into the therapeutic choice for a given BCC.…”

Section: Discussionmentioning

confidence: 99%

Superficial basal cell carcinoma: A comparison of superficial only subtype with superficial combined with other subtypes by age, sex and anatomic site in 3150 cases

et al. 2017

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“…No association has been found between superficial BCC tumour thickness (up to 1 mm) and PDT failure [40]. Deep curettage prior to PDT may be beneficial for selected tumours, with cosmetic results maintained [41].…”

Section: Basal Cell Carcinomamentioning

confidence: 99%

Photodynamic Therapy and Non-Melanoma Skin Cancer

Griffin

Lear

2016

Cancers

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Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population. Photodynamic therapy (PDT) is gaining popularity for the treatment of basal cell carcinoma (BCC), Bowen’s disease (BD) and actinic keratosis (AK). A topical or systemic exogenous photosensitiser, results in selective uptake by malignant cells. Protoporphyrin IX (PpIX) is produced then activated by the introduction of a light source. Daylight-mediated MAL (methyl aminolaevulinate) PDT for AKs has the advantage of decreased pain and better patient tolerance. PDT is an effective treatment for superficial BCC, BD and both individual and field treatment of AKs. Excellent cosmesis can be achieved with high patient satisfaction. Variable results have been reported for nodular BCC, with improved outcomes following pretreatment and repeated PDT cycles. The more aggressive basisquamous, morphoeic infiltrating subtypes of BCC and invasive squamous cell carcinoma (SCC) are not suitable for PDT. Prevention of “field cancerization” in organ transplant recipients on long-term immunosuppression and patients with Gorlin syndrome (naevoid basal cell carcinoma syndrome) is a promising development. The optimisation of PDT techniques with improved photosensitiser delivery to target tissues, new generation photosensitisers and novel light sources may expand the future role of PDT in NMSC management.

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Tumor thickness and adnexal extension of superficial basal cell carcinoma (sBCC) as determinants of treatment failure for methylaminolevulinate (MAL)-photodynamic therapy (PDT), imiquimod, and 5-fluorouracil (FU)

Cited by 26 publications

References 16 publications

Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma: 5-Year Results of the SINS Randomized Controlled Trial

Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma: 5-Year Results of the SINS Randomized Controlled Trial

Superficial basal cell carcinoma: A comparison of superficial only subtype with superficial combined with other subtypes by age, sex and anatomic site in 3150 cases

Photodynamic Therapy and Non-Melanoma Skin Cancer

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