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RF – Intralesional 5-Fluorouracil in the Treatment of Nonmelanoma Skin Cancer
FR – Tratamiento intralesional del cáncer cutáneo no melanoma con 5-fluorouracilo
J. Gil-Lianes, D. Morgado-Carrasco
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Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Se observa también edema en la dermis, intercalado con fibrosis y con escaso infiltrado linfoide perivascular superficial (A). Tinción para podoplanina (D2-40) en la que destacan algunos vasos linfáticos ectásicos dérmicos (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Cruañes-Monferrer, A. Gil Liñan, A. Ramírez Andreo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Cruañes-Monferrer" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Gil Liñan" ] 2 => array:2 [ "nombre" => "A." 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Gil-Lianes, D. Morgado-Carrasco" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Gil-Lianes" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022007815?idApp=UINPBA000044" "url" => "/00017310/0000011400000003/v1_202303051528/S0001731022007815/v1_202303051528/es/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => " RF – Intralesional 5-Fluorouracil in the Treatment of Nonmelanoma Skin Cancer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T255" "paginaFinal" => "T256" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Gil-Lianes, D. Morgado-Carrasco" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Gil-Lianes" ] 1 => array:4 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" "email" => array:1 [ 0 => "morgadodaniel8@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR – Tratamiento intralesional del cáncer cutáneo no melanoma con 5-fluorouracilo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Nonmelanoma skin cancer (NMSC) includes cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). It is the most common cancer in humans and ranks fifth in terms of economic burden.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> The treatment of choice is surgery,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3–5</span></a> but nonsurgical options can be contemplated in selected cases. Intralesional chemotherapy, for example, has been used off label for more than 50 years. The agents include 5-fluorouracil (5-FU) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), methotrexate, bleomycin, and interferon-α.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In 2021, Maxfield et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> published the largest study to date on the use of intralesional 5-FU in SCC. It was a retrospective cohort study of 148 patients with a median age of 74 years and 172 tumors: 164 invasive SCCs and 8 keratoacanthomas. The most common location was the lower extremities (37%). Between 0.2 and 2<span class="elsevierStyleHsp" style=""></span>mL of 5-FU was injected at a concentration of 50<span class="elsevierStyleHsp" style=""></span>mg/mL into the base of the tumors following the administration of lidocaine 1% and adrenaline 1:100<span class="elsevierStyleHsp" style=""></span>000 to anesthetize the area. In total, 92% of the tumors (158/172) showed a complete response, and just 1 dose was needed in 76% of cases. The remaining 24% required at least 2 doses, generally administered 4 weeks apart. The 14 tumors that did not respond were treated surgically without complications. Just 1 recurrence (keratoacanthoma) was observed after a median follow-up of 9.5 months. None of the patients developed moderate or severe adverse effects.</p><p id="par0015" class="elsevierStylePara elsevierViewall">2021 also saw the publication of a systematic review on the use of intralesional 5-FU in NMSC.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The authors analyzed 19 studies involving 283 patients. The complete response rate was higher in SCC (87%) and BCC (91.4%) than in keratoacanthoma (74.5%, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.007), and the times to resolution were similar (9–12 weeks). Previous systematic reviews had shown similar results.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> Most of the BCCs were low risk (<15<span class="elsevierStyleHsp" style=""></span>mm, superficial or nodular), although aggressive subtypes (multifocal, recurrent, morpheaform) also responded. In the different studies reviewed, a volume ranging from 0.5 to 2<span class="elsevierStyleHsp" style=""></span>mL (depending on tumor size) was injected at a concentration of 15–25<span class="elsevierStyleHsp" style=""></span>mg/mL, with a mean of 4–8 injections and a cumulative mean dose of 90<span class="elsevierStyleHsp" style=""></span>mg (up to 612<span class="elsevierStyleHsp" style=""></span>mg in recurrent cases). The patients were followed for between 12 and 24 weeks. The most common adverse effects were local, transient reactions (erythema, edema, erosion, ulceration). None of the patients experienced hematologic or systemic adverse effects.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although surgery remains the treatment of choice for NMSC, intralesional 5-FU may be an effective, safe, and minimally invasive treatment for patients with a high surgical risk or who have tumors in complex locations or do not wish surgery. Its use as a neoadjuvant agent should be explored in clinical studies.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1615308" "palabras" => array:5 [ 0 => "Basal cell carcinoma" 1 => "Squamous cell carcinoma" 2 => "Keratoacanthoma" 3 => "5-Fluorouracil" 4 => "Intralesional" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: BCC, basal cell carcinoma; SCC, squamous cell carcinoma.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Drug \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Mechanism of action \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Administration interval \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Complete response rate \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Contraindications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Adverse effects \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5-Fluorouracil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Uracil analog DNA and RNA alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50<span class="elsevierStyleHsp" style=""></span>mg/mL (0.5–2<span class="elsevierStyleHsp" style=""></span>mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 wk<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCC ><span class="elsevierStyleHsp" style=""></span>90%SCC: <span class="elsevierStyleBold">≈</span><span class="elsevierStyleHsp" style=""></span>90%Keratoacanthoma: 76%–98% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe liver diseasePregnancy or breastfeeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local: pain, erythema, erosion, necrosisSystemic (rare): cytopenia, gastrointestinal effects \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Histologic confirmation is recommended before any nonsurgical treatment.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Most tumors (76%) resolved after just 1 injection.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intralesional Treatment of Nonmelanoma Skin Cancer With 5-Fluorouracil.<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intralesional 5-fluorouracil (FU) as a treatment for nonmelanoma skin cancer (NMSC): a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. 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Murina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.36849/JDD.5518" "Revista" => array:6 [ "tituloSerie" => "J Drugs Dermatol" "fecha" => "2021" "volumen" => "20" "paginaInicial" => "192" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33538569" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000003/v1_202303051528/S0001731023000686/v1_202303051528/en/main.assets" "Apartado" => array:4 [ "identificador" => "34907" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Foro de Residentes" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000003/v1_202303051528/S0001731023000686/v1_202303051528/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023000686?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 28 | 12 | 40 |
| 2024 October | 157 | 68 | 225 |
| 2024 September | 149 | 58 | 207 |
| 2024 August | 173 | 73 | 246 |
| 2024 July | 145 | 63 | 208 |
| 2024 June | 109 | 59 | 168 |
| 2024 May | 100 | 57 | 157 |
| 2024 April | 116 | 54 | 170 |
| 2024 March | 92 | 65 | 157 |
| 2024 February | 88 | 43 | 131 |
| 2024 January | 89 | 34 | 123 |
| 2023 December | 86 | 52 | 138 |
| 2023 November | 94 | 57 | 151 |
| 2023 October | 122 | 74 | 196 |
| 2023 September | 68 | 57 | 125 |
| 2023 August | 61 | 54 | 115 |
| 2023 July | 72 | 50 | 122 |
| 2023 June | 75 | 35 | 110 |
| 2023 May | 72 | 40 | 112 |
| 2023 April | 93 | 51 | 144 |
| 2023 March | 182 | 91 | 273 |
| 2023 February | 90 | 100 | 190 |
| 2023 January | 1 | 3 | 4 |
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