Treatments of Primary Basal Cell Carcinoma of the Skin

Autor: Thomas A Trikalinos, Aaron M. Drucker, Valerie Rofeberg, Farah Moustafa, Abhilash Gazula, Gaelen P Adam, Bryant T Smith, Martin A. Weinstock
Rok vydání: 2018
Předmět:
Zdroj: Annals of Internal Medicine. 169:456-466
ISSN: 1539-3704
0003-4819
Popis: Background Most interventions for basal cell carcinoma (BCC) have not been compared in head-to-head randomized trials. Purpose To evaluate the comparative effectiveness and safety of treatments of primary BCC in adults. Data sources English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Embase from inception to May 2018; reference lists of guidelines and systematic reviews; and a search of ClinicalTrials.gov in August 2016. Study selection Comparative studies of treatments currently used in adults with primary BCC. Data extraction One investigator extracted data on recurrence, histologic clearance, clinical clearance, cosmetic outcomes, quality of life, and mortality, and a second reviewer verified extractions. Several investigators evaluated risk of bias for each study. Data synthesis Forty randomized trials and 5 nonrandomized studies compared 18 interventions in 9 categories. Relative intervention effects and mean outcome frequencies were estimated using frequentist network meta-analyses. Estimated recurrence rates were similar for excision (3.8% [95% CI, 1.5% to 9.5%]), Mohs surgery (3.8% [CI, 0.7% to 18.2%]), curettage and diathermy (6.9% [CI, 0.9% to 36.6%]), and external-beam radiation (3.5% [CI, 0.7% to 16.8%]). Recurrence rates were higher for cryotherapy (22.3% [CI, 10.2% to 42.0%]), curettage and cryotherapy (19.9% [CI, 4.6% to 56.1%]), 5-fluorouracil (18.8% [CI, 10.1% to 32.5%]), imiquimod (14.1% [CI, 5.4% to 32.4%]), and photodynamic therapy using methyl-aminolevulinic acid (18.8% [CI, 10.1% to 32.5%]) or aminolevulinic acid (16.6% [CI, 7.5% to 32.8%]). The proportion of patients reporting good or better cosmetic outcomes was better for photodynamic therapy using methyl-aminolevulinic acid (93.8% [CI, 79.2% to 98.3%]) or aminolevulinic acid (95.8% [CI, 84.2% to 99.0%]) than for excision (77.8% [CI, 44.8% to 93.8%]) or cryotherapy (51.1% [CI, 15.8% to 85.4%]). Data on quality of life and mortality were too sparse for quantitative synthesis. Limitation Data are sparse, and effect estimates are imprecise and informed by indirect comparisons. Conclusion Surgical treatments and external-beam radiation have low recurrence rates for the treatment of low-risk BCC, but substantial uncertainty exists about their comparative effectiveness versus other treatments. Gaps remain regarding high-risk BCC subtypes and important outcomes, including costs. Primary funding source Agency for Healthcare Research and Quality. (PROSPERO: CRD42016043353).
Databáze: OpenAIRE
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