Delishaj Durim, Rembielak Agata, Manfredi Bruno, Ursino Stefano, Pasqualetti Francesco, Laliscia Concetta, Orlandi Francesca, Morganti Riccardo, Fabrini Maria Grazia, Paiar Fabiola
Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
Clinical Oncologist, The Christie NHS Foundation Trust, Manchester, M20 4BX, United Kingdom.
J Contemp Brachytherapy. 2016 Dec;8(6):533-540. doi: 10.5114/jcb.2016.64112. Epub 2016 Dec 2.
The incidence of non-melanoma skin cancer (NMSC) has been increasing over the past 30 years. There are different treatment options and surgical excision is the most frequent treatment due to its low rates of recurrence. Radiotherapy is an effective alternative of surgery, and brachytherapy (BT) might be a better therapeutic option due to high radiation dose concentration to the tumor with rapid dose fall-off resulting in normal tissues sparing. The aim of this review was to evaluate the local control, toxicity, and cosmetic outcomes in NMSC treated with high-dose-rate BT (HDR-BT).
In May 2016, a systematic search of bibliographic database of PubMed, Web of Science, Scopus, and Cochrane Library with a combination of key words of "skin cancer", "high dose rate brachytherapy", "squamous cell carcinoma", "basal cell carcinoma", and "non melanoma skin cancer" was performed. In this systematic review, we included randomized trials, non-randomized trials, prospective and retrospective studies in patients affected by NMSC treated with HDR-BT.
Our searches generated a total of 85 results, and through a process of screening, 10 publications were selected for the review. Brachytherapy was well tolerated with acceptable toxicity and high local control rates (median: 97%). Cosmetic outcome was reported in seven study and consisted in an excellent and good cosmetic results in 94.8% of cases.
Based on the review data, we can conclude that the treatment of NMSC with HDR-BT is effective with excellent and good cosmetics results, even in elderly patients. The hypofractionated course appears effective with very good local disease control. More data with large-scale randomized controlled trials are needed to assess the efficacy and safety of brachytherapy.
在过去30年中，非黑色素瘤皮肤癌（NMSC）的发病率一直在上升。有多种治疗选择，手术切除因其低复发率而成为最常用的治疗方法。放射治疗是手术的有效替代方法，近距离放射治疗（BT）可能是更好的治疗选择，因为它能使肿瘤接受高剂量辐射，且剂量迅速下降，从而使正常组织得到保护。本综述的目的是评估高剂量率近距离放射治疗（HDR-BT）治疗NMSC的局部控制、毒性和美容效果。
2016年5月，对PubMed、科学网、Scopus和Cochrane图书馆的文献数据库进行系统检索，关键词组合为“皮肤癌”、“高剂量率近距离放射治疗”、“鳞状细胞癌”、“基底细胞癌”和“非黑色素瘤皮肤癌”。在本系统综述中，我们纳入了接受HDR-BT治疗的NMSC患者的随机试验、非随机试验、前瞻性和回顾性研究。
我们的检索共产生85个结果，经过筛选过程，选择了10篇文献进行综述。近距离放射治疗耐受性良好，毒性可接受，局部控制率高（中位数：97%）。七项研究报告了美容效果，94.8%的病例美容效果极佳或良好。
基于综述数据，我们可以得出结论，即使是老年患者，HDR-BT治疗NMSC也有效，美容效果极佳或良好。短疗程分割放疗似乎有效，局部疾病控制良好。需要更多大规模随机对照试验的数据来评估近距离放射治疗的疗效和安全性。
