Objectives: To assess the effects of treatments for basal cell carcinoma Methods Systematic review of randomised controlled trials. Main outcome measure: Recurrence of basal cell carcinoma at three years or beyond, as...Objectives: To assess the effects of treatments for basal cell carcinoma Methods Systematic review of randomised controlled trials. Main outcome measure: Recurrence of basal cell carcinoma at three years or beyond, assessed clinically. Studies reviewed Randomised controlled trials of interventions for histologically confirmed basal cell carcinoma (published and unpublished material; no language restrictions). Results: 25 studies were identified, covering seven therapeutic categories. Only one study of surgical excision versus radiotherapy contained primary outcome data, which showed significantly more persistent tumours and recurrences in the radiotherapy group compared with surgery (odds ratio 0.09, 95%confidence interval 0.01 to 0.67), One study compared cryotherapy with surgery, with inconclusive results at one year. In a comparison of radiotherapy with cryotherapy, significantly more recurrences occurred at one year in the cryotherapy group. Preliminary studies suggest a short term success rate of 87-88%for imiquimod cream in the treatment of superficial basal cell carcinoma, although this cream has not been compared with surgery. No consistent evidence was found for the other treatment modalities. Conclusions: Little good quality research has been done on the treatments used for the most common cancer in humans. Most trials have included only people with basal cell carcinoma occurring at low risk sites. Only one trial measured recurrence at four years; recurrence rates at one year should be interpreted with caution. Surgery and radiotherapy seem to be the most effective treatments; surgery showed the lowest failure rates. Other treatments might have some use but need to be compared with surgery.展开更多
Background: There is wide variation in the objective visual variables used to measure atopic eczema severity in clinical trials, making comparison and interpretation of results difficult. Objective: To provide a ratio...Background: There is wide variation in the objective visual variables used to measure atopic eczema severity in clinical trials, making comparison and interpretation of results difficult. Objective: To provide a rationale for simplifying and standardizing objective atopic eczema scoring by investigating which visual variables provide the best measure of disease severity from the patient’ s perspective. Setting: The dermatology outpatient department at the Queen’ s Medical Centre, University Hospital in Nottingham, and 5 local general practices. Patients: One hundred eighty individuals with atopic eczema. Interventions: Clinical examination with scoring of 7 clinical signs and disease extent, followed by regression analyses of visual variable scores against a patient- rated measure of current disease severity. Results: Objective measurements account for only a quarter of the variation in patient- rated disease severity. Three clinical signs were independent predictors of patient- rated disease severity: excoriations, erythema, and edema/papulation. Disease extent measurements do not reflect patient- rated disease severity in a linear manner, with mean severity scores increasing little above 30% body surface area involvement. Conclusions: From the patient’ s perspective, the measurement of 3 clinical signs- excoriations, erythema, and edema/papulation- provides as much information about current atopic eczema severity as more complex scoring systems that measure multiple clinical signs and disease extent. The simplicity of the Three Item Severity score, a previously published atopic eczema score based on measurement of these 3 clinical signs, makes it a suitable tool for research studies or clinical practice.展开更多
文摘Objectives: To assess the effects of treatments for basal cell carcinoma Methods Systematic review of randomised controlled trials. Main outcome measure: Recurrence of basal cell carcinoma at three years or beyond, assessed clinically. Studies reviewed Randomised controlled trials of interventions for histologically confirmed basal cell carcinoma (published and unpublished material; no language restrictions). Results: 25 studies were identified, covering seven therapeutic categories. Only one study of surgical excision versus radiotherapy contained primary outcome data, which showed significantly more persistent tumours and recurrences in the radiotherapy group compared with surgery (odds ratio 0.09, 95%confidence interval 0.01 to 0.67), One study compared cryotherapy with surgery, with inconclusive results at one year. In a comparison of radiotherapy with cryotherapy, significantly more recurrences occurred at one year in the cryotherapy group. Preliminary studies suggest a short term success rate of 87-88%for imiquimod cream in the treatment of superficial basal cell carcinoma, although this cream has not been compared with surgery. No consistent evidence was found for the other treatment modalities. Conclusions: Little good quality research has been done on the treatments used for the most common cancer in humans. Most trials have included only people with basal cell carcinoma occurring at low risk sites. Only one trial measured recurrence at four years; recurrence rates at one year should be interpreted with caution. Surgery and radiotherapy seem to be the most effective treatments; surgery showed the lowest failure rates. Other treatments might have some use but need to be compared with surgery.
文摘Background: There is wide variation in the objective visual variables used to measure atopic eczema severity in clinical trials, making comparison and interpretation of results difficult. Objective: To provide a rationale for simplifying and standardizing objective atopic eczema scoring by investigating which visual variables provide the best measure of disease severity from the patient’ s perspective. Setting: The dermatology outpatient department at the Queen’ s Medical Centre, University Hospital in Nottingham, and 5 local general practices. Patients: One hundred eighty individuals with atopic eczema. Interventions: Clinical examination with scoring of 7 clinical signs and disease extent, followed by regression analyses of visual variable scores against a patient- rated measure of current disease severity. Results: Objective measurements account for only a quarter of the variation in patient- rated disease severity. Three clinical signs were independent predictors of patient- rated disease severity: excoriations, erythema, and edema/papulation. Disease extent measurements do not reflect patient- rated disease severity in a linear manner, with mean severity scores increasing little above 30% body surface area involvement. Conclusions: From the patient’ s perspective, the measurement of 3 clinical signs- excoriations, erythema, and edema/papulation- provides as much information about current atopic eczema severity as more complex scoring systems that measure multiple clinical signs and disease extent. The simplicity of the Three Item Severity score, a previously published atopic eczema score based on measurement of these 3 clinical signs, makes it a suitable tool for research studies or clinical practice.
