Management of skin cancer in the frail elderly: time for a rethink?

Schofield, Julia; Linos, Eleni; Callander, J.

doi:10.1111/bjd.15057

Cited by 9 publications

(6 citation statements)

References 4 publications

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“…It is estimated that in the US at least 200,000 elderly (defined as >85 years old) undergo a procedure for a skin cancer annually . There is broad acknowledgement that elderly, often unwell patients, need to be carefully considered when making management decisions following a diagnosis of NMSC …”

Section: Introductionmentioning

confidence: 99%

“…4 There is broad acknowledgement that elderly, often unwell patients, need to be carefully considered when making management decisions following a diagnosis of NMSC. 5 Radiotherapy is a highly effective non-surgical option available to patients with NMSC. 6 NMSC is radioresponsive and most patients treated with definitive RT can expect excellent local control rates exceeding 95%.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of hypofractionated radiotherapy in patients with non‐melanoma skin cancer: Results of a systematic review

Gunaratne

Veness

2018

J Med Imag Rad Onc

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Radiation oncologists are increasingly tasked with the management of elderly patients with non-melanoma skin cancer, unsuitable for surgical intervention due to inoperable lesions and/or poor performance status. In this cohort, hypofractionated radiotherapy, delivered either daily, alternative daily or once weekly is highly effective. A systematic literature search was conducted of PUBMED, MEDLINE and EMBASE databases using the algorithm ('radiotherapy' OR 'radiation therapy' OR 'brachytherapy') AND ('hypofraction' OR 'hypofractionated' OR 'hypofractionation') AND ('skin neoplasms' OR 'carcinoma' OR 'malignancy') AND ('skin' OR 'epidermis' OR 'epidermal' OR 'cutaneous'). Forty relevant publications (1983-2017) encompassing 12,337 irradiated lesions were retrieved. Studies documented a mean age of 71.73 years and male predilection (54.5%). Both external beam radiotherapy and brachytherapy were utilized. Tumour subtype was squamous cell carcinoma (23.5%), basal cell carcinoma (75.2%) or others (1.3%). Irradiated lesions were primary (or denovo) (92.6%), located on the head and neck (95.7%) and received definitive therapy (96.5%). Analysis demonstrated a mean weighted total radiotherapy dose (38.15 Gy), dose per fraction (7.95 Gy) and treatments per week (2.98). Despite significant heterogeneity in the study population, the radiotherapy delivered and follow-up, local recurrence rate (crude or Kaplan-Meier analysis) did not exceed 7.9% in all but three of the 36 publications providing these data. Twenty-nine publications documented local control exceeding 90%. There is a body of evidence documenting the efficacy of hypofractionated radiotherapy as an option that confers no obvious disadvantage in local control when compared to traditional more protracted radiotherapy schedules.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of hypofractionated radiotherapy in patients with non‐melanoma skin cancer: Results of a systematic review

Gunaratne

Veness

2018

J Med Imag Rad Onc

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“…A recent article published in the BJD based on the research of two expert groups in the management of non-melanoma skin cancer proposes the evaluation of important points before making a therapeutic decision: limited life expectancy, therapeutic targets, cognitive deterioration, disability for granting consent, comorbidities, risks, complications, costs, etc. 36 . The objective of this review is not to detail the clinical and histological characteristics or molecular pathogenesis of these neoplasms, but to assess the risks and benefits granted to a fragile patient where risk factors are added to the detriment of their integrity.…”

Section: Malignant Neoplasmsmentioning

confidence: 99%

Geriatric dermatology, changes related to aging

Sánchez-Álvarez

Arellano-Mendoza

García

2019

HGMX

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Due to the population growth in our country, it is extremely important to disclose the different medical specialties that cater to primary care and treatment, in addition to those related to secondary care. Many are the skin diseases that mostly affect elderly people; hence, we summarize the most common ones and those diseases causing the greatest impact on life quality. The present study aims to provide an approach to the physiological changes and main characteristics of the skin of elderly people; furthermore, it lists the main benign skin conditions whose diagnosis represents a great deal of intervention in these patients. The most prevalent bullous diseases and neoplasms have also been added. We conclude that the Mexican primary health-care sector needs more in-depth training about the changes in the elderly population and their main skin diseases.

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“…6 Neglect of patients can be considered an additional risk factor, as it leads to delays in diagnosis and prompt treatment, given the tendency of these lesions to grow slowly. 7 Moreover, frailty due to diabetes, vascular disorders, and advanced age must also be considered. In particular, aging skin appears to be predisposed to develop destructive lesions, as it undergoes progressive and degenerative changes of the supporting dermis, as well as vascular disorders, leading to decreased ability to repair skin damage.…”

Section: Introductionmentioning

confidence: 99%

Electron beam radiotherapy in giant non- melanoma skin cancers of the head in elderly inoperable patients: a single centre retrospective study

Lazzari¹,

Perri²,

Vittoria³

et al. 2020

JCPCR

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Background: Electron beam three-dimensional conformal radiotherapy (3D-CRT) may be an alternative effective option for the treatment of giant nonmelanoma skin cancers (NMSCs) of the head in older patients unfit for surgery. Here, we present a retrospective study of older patients with giant NMSCs of the head treated with 3D-conformal electron beam radiotherapy, including analysis of clinical outcomes and factors impacting local control.Materials and methods: Fifty older patients with sixty T3-T4 giant and aggressive NMSC lesions of the head, irradiated between 2005 and 2015, were retrospectively studied. Treatment consisted of one or two fields of customized electron beams planned using 3D conformal radiotherapy. Univariate analysis with Chi-square, Cox proportional hazard ratio, and Pearson's covariance for multivariate analyses, assuming P<0.05 for statistical significance, were used to assess the impact of clinical and dosimetric parameters on local control.Results: Complete response (CR) occurred in 15 patients and 25 lesions. Bleeding control was obtained for all symptomatic lesions. Cumulative local progression free survival rates at 2 and 5 years were 85% and 78%, respectively. On univariate analysis several factors were found to significantly impact local progression, including diabetes (P<0.001) and primary site (P<0.03), with scalp being significant for durable local control (P<0.02). On multivariate analysis, both factors were confirmed as significant prognostic indicators of local control. Treatment was well-tolerated with acceptable acute and late toxicity and good palliation effect. Conclusion:Customized electron beam 3D CRT for giant NMSCs of the head not amendable to surgery in frail older patients can be considered an effective and safe option in both curative and palliative settings.

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Management of skin cancer in the frail elderly: time for a rethink?

Cited by 9 publications

References 4 publications

Efficacy of hypofractionated radiotherapy in patients with non‐melanoma skin cancer: Results of a systematic review

Efficacy of hypofractionated radiotherapy in patients with non‐melanoma skin cancer: Results of a systematic review

Geriatric dermatology, changes related to aging

Electron beam radiotherapy in giant non- melanoma skin cancers of the head in elderly inoperable patients: a single centre retrospective study

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