Background: The increase of the number of new cases for year of basal cell carcinoma (BCC) has brought also an increase of BCC difficult to treat (extensive, locally advanced and high risk forms).
...Objective: To evaluate retrospectively the results obtained with dermatologic radiotherapy (RT) for better defining the indications respect to new emerging treatments.
Methods: A series of extensive 115 BCC treated with RT from 1977 to 2014 were selected for the study, since endowed with histological diagnosis on the amount of 181 extensive BCC. RT was performed with conventional energies (50-160 kV) administering a total dose ranging from 47 to 85 Gy (median 55 Gy). The mean follow up was 40.66 months (median 21 months). A statistical evaluation was performed with chi-square test to analyse the possible correlations among therapeutic and cosmetic results and size, localisation and clinical type of the lesions.
Results: A complete remission (CR) was obtained in 70.43%, a partial remission (PR) in 20% of the lesions treated, while in 9.56% a no response (NR) or not evaluable response (NER) was registered. In 19% of the lesions a relapse was observed, with a five-year cure-rate of 55.13%. Cosmetic results were good in 28%, acceptable in 50% and not acceptable in 22% of the lesions in CR. In six lesions, localised at the trunk region, a chronic radiodermatitis developed. A statistically significative correlation was observed between therapeutic results and size, between cosmetic results and size and between therapeutic results and clinical type of BCC.
Conclusion: The treatment of extensive BCC is still a challenge and radiotherapy is one of the possible choices, preferred in the elderly, in relapsing cases, after incomplete excision, and in difficult localisations of the face. Radiotherapy might be included in sequential schedules of treatment to improve final results.
Summary
Background Classic Kaposi sarcoma is a rare angioproliferative neoplasm with varying biological behaviour. Depending on the clinical stage, local or systemic therapy can be used. Vincristine ...has proven to be effective as systemic chemotherapy and in very few reports as intralesional treatment.
Objectives Our aim was to determine the efficacy and safety of intralesional vincristine in the treatment of classic Kaposi sarcoma nodular lesions.
Methods We conducted a prospective, open‐label, single‐centre clinical trial in 151 patients with stage IB classic Kaposi sarcoma. Vincristine was injected in a single nodule (0·3–0·8 mm) on the lower limb. Another similar lesion on the same limb, at a distance of ≥ 10 cm, or on the contralateral limb, was kept under clinical observation as control. Adverse effects were evaluated after 1 week, and efficacy after 4 and 12 weeks.
Results One hundred and fifty‐one patients were enrolled. At final evaluation, 115 patients presented complete response (76·1%), 28 had partial response (18·5%), six had improvement (4%), one had stable disease (0·7%) and only one patient had tumour progression (0·7%). Therefore the total response rate was 98·7% (149 patients). Therapy was generally well tolerated. The most frequently registered adverse events, observed in 21 patients (13·9%), were erythema and itching.
Conclusions Intralesional vincristine is an effective and safe treatment for nodular lesions in classic Kaposi sarcoma and can be recommended as first‐line therapy in initial stages and as support therapy in advanced stages.
Ustekinumab (UST) is an anti-IL12/23 antibody for the treatment of Crohn's Disease (CD). The aim of this study was to compare the efficacy and safety of UST in a large population-based cohort of CD ...patients who failed previous treatment with other biologics.
194 CD patients (108 males and 86 females, mean age 48 years (range 38-58 years) were retrospectively reviewed. 147 patients were already treated with anti-TNFα (75.8%), and 47 (24.2%) patients were already treated with anti-TNFα and vedolizumab. Concomitant treatment with steroids was present in 177 (91.2%) patients.
At week 12, clinical remission was achieved in 146 (75.2%) patients. After a mean follow-up of 6 months, clinical remission was maintained in 135 (69.6%) patients; at that time, mucosal healing was assessed in 62 (31.9%) patients, and it was achieved in 33 (53.2) patients. Three (1.5%) patients were submitted to surgery. Steroid-free remission was achieved in 115 (59.3%) patients. Both serum C-Reactive Protein and Fecal Calprotectin (FC) levels were significantly reduced with respect to baseline levels during follow-up. A logistic regression, UST therapy as third-line therapy (after both anti-TNFα and vedolizumab), FC >200 µg/g, and HBI ≥8 were significantly associated with lack of remission. Adverse events occurred in 5 (2.6%) patients, and four of them required suspension of treatment.
UST seemed to be really effective and safe in CD patients unresponsive to other biologic treatments, especially when used as second-line treatment.
