Leus A J G, Frie M, Haisma M S, Terra J B, Plaat B E C, Steenbakkers R J H M, Halmos G B, Rácz E
Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
J Eur Acad Dermatol Venereol. 2020 Sep;34(9):1932-1943. doi: 10.1111/jdv.16268. Epub 2020 Mar 30.
A large percentage of the patients with keratinocyte carcinoma (KC, formerly known as non-melanoma skin cancer) is of advanced age and often too frail for standard therapies. However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the current literature on the best practice for the treatment of elderly patients with KC. A literature search was performed in MEDLINE, using 'keratinocyte carcinoma', 'elderly', 'treatment' and various synonyms. Case reports, reviews, comments, non-English literature and studies with a sample size <15 were excluded. After selection, a total of 47 studies were reviewed. Two types of studies were identified, focusing on (I) the effect of age on treatment outcomes and (II) alternative treatment schedules for elderly patients. Studies on surgery, the gold standard, describe larger lesions and defect size in the elderly population. Recurrence rate, complication rate and disease-specific survival were not affected by age. Depending on the expected morbidity of a suggested (re-)excision and patient preferences, a conservative watchful waiting policy can be agreed upon as a shared decision. Other common treatment modalities, such as adjuvant radiotherapy, photodynamic therapy and systemic therapy for basal cell carcinoma (BCC), show comparable results in the elderly and younger population. Alternative treatment schedules for elderly patients include primary hypofractionated radiotherapy, which seems effective and well-tolerated, although research is limited to case series. Additionally, localized and topical treatments seem safe and effective especially for low-risk tumours. Data are lacking on the efficacy of systemic therapies of metastatic KC in elderly patients. Efficacy of most treatments (with the exception of photodynamic therapy) is not dependent on age. There is need for more research on the efficacy of adjusted treatment modalities, such as hypofractionated radiotherapy and palliative or curative systemic treatment.
很大比例的角质形成细胞癌（KC，以前称为非黑色素瘤皮肤癌）患者年龄较大，往往身体过于虚弱，无法接受标准治疗。然而，对于这一人群并没有给出具体的治疗建议。本综述旨在概述目前关于老年KC患者最佳治疗实践的文献。在MEDLINE中进行了文献检索，使用了“角质形成细胞癌”“老年”“治疗”以及各种同义词。排除了病例报告、综述、评论、非英文文献以及样本量<15的研究。筛选后，共审查了47项研究。确定了两种类型的研究，重点关注（I）年龄对治疗结果的影响以及（II）老年患者的替代治疗方案。关于手术这一金标准的研究描述了老年人群中更大的病变和缺损大小。复发率、并发症率和疾病特异性生存率不受年龄影响。根据建议的（再次）切除的预期发病率和患者偏好，可以商定采取保守的观察等待策略作为共同决策。其他常见的治疗方式，如辅助放疗、光动力疗法和基底细胞癌（BCC）的全身治疗，在老年人群和年轻人群中显示出类似的结果。老年患者的替代治疗方案包括初始低分割放疗，尽管研究仅限于病例系列，但似乎有效且耐受性良好。此外，局部和局部治疗似乎安全有效，尤其是对于低风险肿瘤。老年患者转移性KC全身治疗的疗效缺乏数据。大多数治疗（光动力疗法除外）的疗效不取决于年龄。需要更多关于调整治疗方式疗效的研究，如低分割放疗以及姑息性或根治性全身治疗。
