Which nonexcisional treatment modality is best for squamous cell carcinoma?

Use of photodynamic therapy, 5-fluorouracil, or imiquimod is not as effective as electrodessication and cryotherapy, in combination with curettage, in the treatment of squamous cell carcinoma in situ (SCCIS) and squamous cell carcinoma (SCC), results of a study have shown.

“SCCIS and SCC are prevalent conditions that are increasing in incidence worldwide,” the investigators said. “Many nonexcisional treatments are commonly used, but the efficacy of these treatments has not been well delineated.”

A systematic review and meta-analysis were performed to assess the recurrence rates of SCCIS and SCC treated with nonexcisional treatment modalities, including 5-fluorouracil, imiquimod, curettage, electrodessication, photodynamic therapy, ablative lasers, or cryotherapy.

A total of 186 studies that examined the treatment of 9,336 tumours met the eligibility criteria. The meta-analysis revealed substantially lower recurrence rates of SCC and SCCIS following electrodessication with curettage (2.0 percent, 95 percent confidence interval [CI], 1.1‒3.0) or following cryotherapy with curettage (1.6 percent, 95 percent CI, 0.4‒2.8) compared with those managed with other treatments, such as photodynamic therapy (29.0 percent, 95 percent CI, 25.0‒33.0), 5-fluorouracil (26.6 percent, 95 percent CI, 16.9‒36.4), or imiquimod (16.1 percent, 95 percent CI, 10.3‒21.8).

“Electrodessication and cryotherapy, in combination with curettage, are more effective than photodynamic therapy, 5-fluorouracil, or imiquimod in treating SCCIS and SCC,” the investigators said.

The study, however, was limited by a publication bias in mostly observational data and by heterogeneity of treatment regimens.