Brachytherapy and Mohs micrographic surgery (MMS) improve cosmesis better than external-beam radiation therapy (EBRT) and conventional excision (CE) in patients with T1-T2N0 skin cancers, study data published in Cancer suggest.
The study was a systematic review and meta-analysis of studies in PubMed that included patients with T1-T2N0 basal cell carcinomas and squamous cell carcinomas. Only studies that featured ≥10 months of follow-up and enrolled patients who received CE, MMS, EBRT, or BT were included. Overall, data from a total of 21,371 patients were pooled into the meta-analysis.
Cosmesis, classified as “good,” “fair,” or “poor” was the primary endpoint. A secondary endpoint of the study was 1-year recurrence. Primary and secondary endpoints were assessed in relation to treatment modality using fixed-effects and random-effects meta-analyses.
Based on the available data, researchers found high summary effect sizes for “good” cosmesis for CE (81%; 95% CI, 70.6%-89.6%), EBRT (74.6%; 95% CI, 63%-84.6%), and brachytherapy (97.6%; 95% CI, 91.3%-100%). The 96.0% good cosmesis summary effect size was only in the 1 MMS study reporting cosmesis, with 4% of patients experiencing a fair cosmesis outcome in this study.
The use of brachytherapy was associated with a greater improvement to “good” cosmesis compared with EBRT (P =.0025). The respective 1-year recurrence rates for CE, MMS, EBRT, and brachytherapy were 0.8% (95% CI, 0.3%-1.6%), 0.2% (95% CI, 0%-0.6%), 2% (95% CI, 1.3%-2.7%), and 0% (95% CI, 0%-0.5%).
Limitations of the study include the subjective nature of cosmesis grading and the relatively short duration of follow-up in the included brachytherapy studies.
While the analysis found a benefit associated with brachytherapy and MMS, the researchers wrote that “it is unclear whether the perceived benefits are because of treatment effectiveness versus selection and reporting bias.”
Lee CT, Lehrer EJ, Aphale A, Lango M, Galloway TJ, Zaorsky NG. Surgical excision, Mohs micrographic surgery, external-beam radiotherapy, or brachytherapy for indolent skin cancer: an international meta-analysis of 58 studies with 21,000 patients. Cancer. 2019;125(20):3582-3594.