Surgery versus combined treatment with curettage and imiquimod for nodular basal cell carcinoma: One-year results of a noninferiority, randomized, controlled trial - 23/07/20
Abstract |
Purpose |
Nodular basal cell carcinoma (nBCC) is mostly treated with surgical excision. Interest in minimally invasive treatment of these low-risk tumors is increasing. We assessed the effectiveness of nBCC treatment with curettage and imiquimod cream compared with surgical excision.
Methods |
Patients with nBCC included in this randomized, controlled noninferiority trial were randomly assigned to either a curettage and imiquimod cream group or a surgical excision group. The primary endpoint was the proportion of patients free from treatment failure 1 year after the end of treatment. A prespecified noninferiority margin of 8% was used. A modified intention-to-treat and a per-protocol analysis was performed (ClinicalTrials.gov identifier NCT02242929).
Results |
One hundred forty-five patients were randomized: 73 to the curettage and imiquimod cream group and 72 to the surgical excision group. The proportion of patients free of recurrence after 12 months was 86.3% (63/73) for the curettage and imiquimod group and 100% (72/72) for the surgical excision group. The difference in efficacy was −13.7% (95% confidence interval −21.6% to −5.8%; 1-sided P = .0004) favoring surgical excision.
Conclusion |
Noninferiority of curettage and imiquimod cream cannot be concluded. Given the still high efficacy of curettage and imiquimod cream and the indolent growth pattern of nBCC, curettage and imiquimod could still be a valuable treatment option with the possibility to prevent overuse of excisions. However, it cannot replace surgical excision.
Le texte complet de cet article est disponible en PDF.Key words : basal cell carcinoma, imiquimod cream, nonmelanoma skin cancer, skin cancer, surgical excision, therapy, treatment
Plan
Funding sources: None. |
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Conflicts of interest: None disclosed. |
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Reprints not available from the authors. |
Vol 83 - N° 2
P. 469-476 - août 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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