Comparing Outcomes of Different Basal Cell Carcinoma Treatments
Posted: Thursday, October 25, 2018
Various treatments for low-risk basal cell carcinoma of the skin result in different recurrence rates and patient-reported cosmetic outcomes, according to a review and network meta-analysis published in the Annals of Internal Medicine. A total of 18 different treatment types, from 40 randomized trials and 5 nonrandomized studies, were analyzed.
“Surgical treatments and external-beam radiation have low recurrence rates for the treatment of low-risk [basal cell carcinoma], but substantial uncertainty exists about their comparative effectiveness versus other treatments,” concluded Aaron M. Drucker, MD, of Women’s College Hospital in Toronto, and colleagues. “Gaps remain regarding high-risk [basal cell carcinoma] subtypes and important outcomes, including costs.”
Researchers estimated recurrence rates were 3.5% with external-beam radiation therapy; 3.8% with both Mohs surgery and excision; 6.9% with curettage and diathermy; 14.1% with imiquimod; 16.6% with photodynamic therapy with aminolevulinic acid (ALA); 18.8% with fluorouracil as well as photodynamic therapy with methyl-ALA; 19.9% with curettage and cryotherapy; and 22.3% with cryotherapy. Self-reported improved cosmetic outcomes were identified in 95.8% of patients treated with photodynamic therapy using ALA, 93.8% of patients treated with photodynamic therapy using methyl-ALA, 77% of patients undergoing excision, 51.1% of patients treated with cryotherapy, and 20% of patients treated with photodynamic therapy and laser preparation of the lesion.
Analysis of recurrence was performed on data from 2,204 lesions, whereas analysis of cosmetic outcomes included data from 739 lesions. A frequentist network meta-analysis was used to estimate relative intervention effects and mean outcome data. Researchers were unable to analyze treatment effects on quality of life or mortality due to insufficient data.
According to the investigators, “For clinicians, patients, and payers to make informed decisions about treating [basal cell carcinoma], new [randomized controlled trial] or high-quality [nonrandomized comparative study] evidence is needed.”