Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA.
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA.
Radiother Oncol. 2018 Mar;126(3):386-393. doi: 10.1016/j.radonc.2017.12.029. Epub 2018 Jan 19.
To compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin.
Studies including patients with T1-2 N0 SCCs/BCCs treated with definitive EBRT/BT and ≥10 months follow-up were analyzed. The primary endpoint was post-treatment cosmesis, categorized as "good," "fair," or "poor." The secondary endpoint was LR. Mixed effects regression models were used to estimate weighted linear relationships between biologically equivalent doses with α/β = 3 (BED) and cosmetic outcomes.
A total of 9965 patients received EBRT and 553 received BT across 24 studies. Mean age was 73 years, median follow-up was 36 months, and median dose was 45 Gy/10 fractions at 4.4 Gy/fraction. At BED of 100 Gy, "good" cosmesis was more frequently observed in patients receiving BT, 95% (95% CI: 88-100%) vs 79% (95% CI: 60-82%), p < 0.05. Similar results were found for "good" cosmesis at BED >100 Gy. No difference in "poor" cosmesis was noted at any BED. LR was <7% for both at one year.
BT has favorable cosmesis over EBRT for skin SCCs/BCCs at common fractionation regimens. Prospective studies comparing EBRT vs BT are warranted.
本研究旨在比较惰性基底细胞癌（BCC）和皮肤鳞状细胞癌（SCC）患者接受根治性外束放射治疗（EBRT）与近距离放射治疗（BT）后，美容效果和局部复发（LR）的差异。
本研究纳入了接受根治性 EBRT/BT 治疗且随访时间≥10 个月的 T1-2N0 SCCs/BCCs 患者，主要终点为治疗后美容效果，分为“好”、“一般”或“差”。次要终点为 LR。采用混合效应回归模型估计生物等效剂量（α/β=3 时为 BED）与美容结果之间的加权线性关系。
本研究共纳入了 24 项研究的 9965 例接受 EBRT 治疗的患者和 553 例接受 BT 治疗的患者。患者的平均年龄为 73 岁，中位随访时间为 36 个月，中位剂量为 45 Gy/10 次分割，每次分割 4.4 Gy。在 BED 为 100 Gy 时，BT 组“好”的美容效果更常见，为 95%（95%CI：88-100%），而 EBRT 组为 79%（95%CI：60-82%），p<0.05。在 BED>100 Gy 时也观察到了相似的结果。在任何 BED 水平下，BT 组和 EBRT 组的“差”的美容效果无差异。两组在一年时的 LR 均<7%。
在常见分割方案下，BT 治疗皮肤 SCCs/BCCs 的美容效果优于 EBRT。需要进行 EBRT 与 BT 比较的前瞻性研究。
