Jackson D N, Hogarth F J, Sutherland D, Holmes E M, Donnan P T, Proby C M
Department of Dermatology, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK.
Tayside Clinical Trials Unit, University of Dundee, DD1 9SY, Scotland, UK.
Br J Dermatol. 2020 Aug;183(2):222-230. doi: 10.1111/bjd.18935. Epub 2020 Mar 23.
Actinic keratosis (AK) is a common premalignant skin lesion that can progress to cutaneous squamous cell carcinoma (cSCC). Microwave therapy is an established cancer treatment and has been used for plantar viral warts.
To evaluate the efficacy and feasibility of microwave as a treatment for AK.
Stage I was a dose-setting study, in which seven participants had the dielectric properties of 12 thick and 22 thin AKs assessed for optimization of the microwave dose used for treatment in Stage II. Stage II was a randomized, internally controlled trial evaluating 179 AKs in 11 patients (93 treated, 86 untreated controls) on the scalp/forehead or dorsal hand. Participants received one treatment initially and a repeat treatment to unresolved AKs at week 4. The response was assessed at six visits over 4 months. The primary outcome was partial or complete resolution of the treated AKs.
A significantly higher proportion of treated AK areas responded than untreated (90% vs. 15%; P < 0·001). Thin AKs were more responsive than thick AKs. The site did not affect efficacy. Pain was severe, but brief (80% reported pain lasting 'a few seconds only'). Adverse effects were minimal (erythema, n = 6; flaking, n = 3; itch, n = 3). All participants who would chose microwave therapy over their current treatment cited the shorter discomfort period.
Microwave therapy is a portable, safe and effective treatment for AK. An easy-to-deliver, acceptable therapy for AK is attractive as a prevention strategy. While these results are promising, a larger randomized controlled trial is needed against an effective comparator to confirm clinical efficacy and patient acceptability. What is already known about this topic? Actinic keratoses (AKs) are common precancerous skin lesions. Successful treatment of AK can prevent cutaneous squamous cell carcinoma (cSCC). Most topical therapies for AK require repeated application over weeks and drive local skin inflammation, leading to poor compliance. An easy-to-deliver and effective treatment for AK, suitable for use in primary care, could reduce cSCC. What does this study add? Microwave therapy is a feasible, effective treatment for AK. Ninety per cent of treated AKs showed full or partial resolution at 120 days post-treatment. Microwave therapy was painful, but the pain was short-lived (seconds) and this short discomfort period was cited as the main reason that microwave was preferred to their current treatment.
光化性角化病（AK）是一种常见的皮肤癌前病变，可发展为皮肤鳞状细胞癌（cSCC）。微波治疗是一种既定的癌症治疗方法，已用于治疗足底病毒性疣。
评估微波治疗AK的疗效和可行性。
第一阶段是剂量设定研究，7名参与者的12个厚型和22个薄型AK的介电特性被评估，以优化第二阶段治疗中使用的微波剂量。第二阶段是一项随机、自身对照试验，评估11例患者头皮/前额或手背部的179个AK（93个接受治疗，86个未治疗作为对照）。参与者最初接受一次治疗，4周时对未消退的AK进行重复治疗。在4个月内进行6次访视评估反应。主要结局是治疗的AK部分或完全消退。
接受治疗的AK区域有反应的比例显著高于未治疗区域（90%对15%；P<0.001）。薄型AK比厚型AK反应更明显。部位不影响疗效。疼痛严重，但持续时间短（80%报告疼痛仅持续“几秒钟”）。不良反应轻微（红斑，n=6；脱屑，n=3；瘙痒，n=3）。所有表示会选择微波治疗而非当前治疗的参与者都提到不适期较短。
微波治疗是一种用于AK的便携、安全且有效的治疗方法。一种易于实施、可接受的AK治疗方法作为预防策略很有吸引力。虽然这些结果很有前景，但需要针对有效对照进行更大规模的随机对照试验，以确认临床疗效和患者可接受性。关于该主题已知的信息有哪些？光化性角化病（AK）是常见的皮肤癌前病变。成功治疗AK可预防皮肤鳞状细胞癌（cSCC）。大多数AK的局部治疗需要数周重复用药，并引发局部皮肤炎症，导致依从性差。一种易于实施且有效的AK治疗方法，适用于初级保健，可减少cSCC。本研究增加了什么内容？微波治疗是一种用于AK的可行、有效治疗方法。90%接受治疗的AK在治疗后120天显示完全或部分消退。微波治疗有疼痛，但疼痛持续时间短（数秒），而这种短暂的不适期被认为是微波治疗优于当前治疗的主要原因。
