Case and Research Letter
Multimodal Therapy With Vismodegib and Radiotherapy in the Treatment of Locally Advanced Basal Cell Carcinoma: A Series of 4 Cases
Terapia multimodal con vismodegib y radioterapia en el tratamiento del carcinoma basocelular localmente avanzado: reporte de cuatro casos
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Un estudio observacional prospectivo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "268" "paginaFinal" => "270" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "What Do Medical Students Think About Dermatology? A Prospective Observational Study" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 942 "Ancho" => 2925 "Tamanyo" => 195032 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Opinión sobre los dermatólogos: A) antes del inicio del curso; B) tras finalizar el curso.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Montero-Vilchez, M. Molina-Cabrerizo, R. Ortega-Olmo, S. Serrano-Ortega, S. Arias-Santiago, A. Buendia-Eisman" "autores" => array:6 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Montero-Vilchez" ] 1 => array:2 [ "nombre" => "M." 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"apellidos" => "Buendia-Eisman" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022002563?idApp=UINPBA000044" "url" => "/00017310/0000011400000003/v1_202303051528/S0001731022002563/v1_202303051528/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0001731022008067" "issn" => "00017310" "doi" => "10.1016/j.ad.2021.10.020" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "3211" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2023;114:264-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTAS CIENTÍFICO CLÍNICAS</span>" "titulo" => "Terapia multimodal con vismodegib y radioterapia en el tratamiento del carcinoma basocelular localmente avanzado: reporte de cuatro casos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "264" "paginaFinal" => "267" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Multimodal Therapy With Vismodegib and Radiotherapy in the Treatment of Locally Advanced Basal Cell Carcinoma: A Series of 4 Cases" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1130 "Ancho" => 2007 "Tamanyo" => 355599 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Compromiso tumoral antes de la intervención quirúrgica por parte de oftalmología oncológica para resección local a nivel de canto y párpado (A), tumor residual confirmado por biopsia a nivel temporal y ciliar izquierdo asociado a márgenes quirúrgicos comprometidos previo al inicio de vismodegib (B), respuesta clínica completa al finalizar ocho ciclos de vismodegib e inicio de radioterapia externa (C), remisión completa sostenida luego de 30 meses de seguimiento (D), extensión del tumor antes de iniciar terapia con vismodegib (E), respuesta completa luego de tres ciclos de tratamiento (F), respuesta completa luego de ocho ciclos de vismodegib previo a radioterapia (G), remisión completa luego de 34 meses de seguimiento posterior a la radioterapia (H).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. 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Pulido Prieto, J.A. Esguerra Cantillo, N.A. Toquica Díaz, M.A. Ospina Delgado" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Pulido Prieto" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Esguerra Cantillo" ] 2 => array:2 [ "nombre" => "N.A." "apellidos" => "Toquica Díaz" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Ospina Delgado" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022008067?idApp=UINPBA000044" "url" => "/00017310/0000011400000003/v1_202303051528/S0001731022008067/v1_202303051528/es/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => " Multimodal Therapy With Vismodegib and Radiotherapy in the Treatment of Locally Advanced Basal Cell Carcinoma: A Series of 4 Cases" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T264" "paginaFinal" => "T267" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Pulido Prieto, J.A. Esguerra Cantillo, N.A. Toquica Díaz, M.A. Ospina Delgado" "autores" => array:4 [ 0 => array:3 [ "nombre" => "L." "apellidos" => "Pulido Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J.A." "apellidos" => "Esguerra Cantillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "N.A." "apellidos" => "Toquica Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:4 [ "nombre" => "M.A." "apellidos" => "Ospina Delgado" "email" => array:1 [ 0 => "maodsio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatología Oncológica, Instituto Nacional de Cancerología, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Radioterapia Oncológica, Instituto Nacional de Cancerología, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia multimodal con vismodegib y radioterapia en el tratamiento del carcinoma basocelular localmente avanzado: reporte de cuatro casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1448 "Ancho" => 2341 "Tamanyo" => 453509 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Tumor before initiation of vismodegib. B, Partial response in the region of the nasal dorsum and cheek, but progression to the inner canthus of the right eye. C, Tumor cytoreduction with local destructive methods. D, Complete response sustained for 36 months after radiotherapy. E, Tumor before initiation of targeted therapy with vismodegib. F, Increased tumor volume on the wings of the nose and inner canthus after 13 cycles. G, Results after curettage-electrodessication in larger tumor areas and cryosurgery on the wings of the nose. H, Complete remission sustained for 15 months after discontinuation of vismodegib and 33 months after radiotherapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Advanced basal cell carcinomas (BCCs) are thought to account for approximately 1 to 10% of all BCCs, with metastatic tumors accounting for 0.0028 to 0.5%.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Patients with locally advanced BCC (laBCC) not amenable to surgery or radiotherapy with curative intent are eligible for treatment with targeted agents with palliative intent, such as vismodegib. Treatment discontinuation rates, however, lie around 90%; 33% of discontinuations are due to disease progression and 25% to adverse effects.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–4</span></a> One option in such cases is external beam radiotherapy at a median dose of 55<span class="elsevierStyleHsp" style=""></span>Gy (range, 47–85<span class="elsevierStyleHsp" style=""></span>Gy), which has an associated effectiveness of 70%. Response rates in tumors larger than 30<span class="elsevierStyleHsp" style=""></span>mm, however, are just 55%, suggesting that treatment is less effective in larger tumors.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> Cytoreductive treatment prior to radiotherapy in patients with laBCC might thus be desirable. Options include vismodegib, surgery, or other destructive strategies such as cryosurgery and curettage-electrodessication.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recurrence rates of up to 37% have been observed within 6 months of vismodegib discontinuation in complete responders.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4,7</span></a> Consolidation radiotherapy could be considered not only in these patients but also in those who experience disease progression after a partial response.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We describe the cases of 4 patients treated at the National Cancer Institute in Colombia who experienced a complete or partial response or disease progression during treatment with vismodegib. They subsequently achieved complete remission after cytoreductive targeted therapy, combined or not with local destructive methods, and maintained this response after consolidation radiotherapy (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Patient #1 developed secondary resistance to vismodegib and was treated with a combination of cryosurgery and curettage-electrodessication followed by consolidation radiotherapy at a total dose of 66<span class="elsevierStyleHsp" style=""></span>Gy. He achieved a complete clinical and radiologic response and showed no signs of recurrence during 36 months of follow-up. In patient #2, targeted therapy with vismodegib led to stabilization of tumor size with occasional grade 3 muscle spasms. The patient was also treated with concurrent cytoreductive cryosurgery and curettage-electrocoagulation followed by concurrent vismodegib and radiotherapy at a total dose of 55<span class="elsevierStyleHsp" style=""></span>Gy. He achieved a complete clinical and radiologic response and showed no signs of recurrence during follow-up (33 months after radiotherapy and 15 months after discontinuation of vismodegib).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Induction therapy with vismodegib achieved a complete response in patients #3 and #4, but the drug was discontinued due to grade 3 muscle spasms. The patients were treated with sequential schedules of consolidation radiotherapy at a total dose of 55<span class="elsevierStyleHsp" style=""></span>Gy. They both achieved complete remission, with no recurrences observed during 30 and 34 months of follow-up, respectively.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Several series performed in different settings and with follow-up times of up to 15 months have reported complete responses to combination therapy with radiotherapy and vismodegib in patients with laBCC. One of the modalities comprised concurrent vismodegib and radiotherapy followed by oral vismodegib. The combination did not result in an exacerbation of adverse effects. Another modality was a combination trimodal regimen consisting of induction vismodegib followed by radiotherapy and local surgical resection. Induction therapy with vismodegib followed by radiotherapy has also been described.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Yom Sue and colleagues started a phase 2 clinical trial (<a href="ctgov:NCT01835626">NCT01835626</a>) in May 2013 to demonstrate the efficacy of a combination approach consisting of induction vismodegib for 12 weeks followed by radiotherapy administered for 5 days over a period of 7 weeks. The results, however, are pending publication.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The cases described in the present series illustrate the viability of a multimodal approach combining induction vismodegib, with or without local cytoreductive strategies, and consolidation radiotherapy. Such an approach may be an excellent option for patients with laBCC and might even achieve lasting complete remission. Studies with greater methodological validity, however, are needed to clarify our findings and draw more solid conclusions on the feasibility of this and expanded indications.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1448 "Ancho" => 2341 "Tamanyo" => 453509 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Tumor before initiation of vismodegib. B, Partial response in the region of the nasal dorsum and cheek, but progression to the inner canthus of the right eye. C, Tumor cytoreduction with local destructive methods. D, Complete response sustained for 36 months after radiotherapy. E, Tumor before initiation of targeted therapy with vismodegib. F, Increased tumor volume on the wings of the nose and inner canthus after 13 cycles. G, Results after curettage-electrodessication in larger tumor areas and cryosurgery on the wings of the nose. H, Complete remission sustained for 15 months after discontinuation of vismodegib and 33 months after radiotherapy.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1131 "Ancho" => 2009 "Tamanyo" => 342417 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Tumor before local resection by ocular oncology department at the level of the canthus and eyelid. B, Residual tumor with biopsy-proven positive margins in the left temporal and eyelid region before initiation of vismodegib. C, Complete clinical response after 8 cycles of vismodegib and initiation of external beam radiotherapy. D, Complete remission sustained after 30 months of follow-up. E, Tumor before treatment with vismodegib. F, Complete response after 3 cycles. G, Complete response after 8 cycles and prior to radiotherapy. H, Complete remission after radiotherapy and 34 months of follow-up.</p>" ] ] 2 => 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:1 [ "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" 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" style="border-bottom: 2px solid black">Patient \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" style="border-bottom: 2px solid black">Age, y/sex \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" style="border-bottom: 2px solid black">Tumor location/greatest diameter \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" style="border-bottom: 2px solid black">Treatment before vismodegib \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" style="border-bottom: 2px solid black">Vismodegib cycles, no. \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" style="border-bottom: 2px solid black">Response to vismodegib \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" style="border-bottom: 2px solid black">Adverse effects and grade \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" style="border-bottom: 2px solid black">Cytoreductive treatments \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" style="border-bottom: 2px solid black">Radiotherapy type and 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" style="border-bottom: 2px solid black">Response after radiotherapy/follow-up \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">1(<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A–D) \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">69/M \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">Centrofacial laBCC extending to right orbit/55<span class="elsevierStyleHsp" style=""></span>mm \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">None \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \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">Progression due to secondary resistance \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">Grade 2 muscle spasms, grade 1 dysgeusia \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">Cryosurgery, curettage-electrodessication, topical imiquimod 5%, high intralesional interferon \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">External beam radiotherapy (66<span class="elsevierStyleHsp" style=""></span>Gy in 33 fractions) after vismodegib discontinuation \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">Complete clinical and radiologic response/no recurrences during 36 mo of follow-up postradiotherapy (Fig. D) \t\t\t\t\t\t\n \t\t\t\t</td></tr><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">2<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> E–H) \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">82/M \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">Centrofacial laBCC extending to right orbit/90<span class="elsevierStyleHsp" style=""></span>mm \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">None \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \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">Initial partial response followed by disease stabilization (drug discontinued due to toxicity) \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">Grade 3 muscle spasms, grade 1 dysgeusia \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">Curettage-electrodessication, cryosurgery, topical imiquimod 5% \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">External beam radiotherapy (55<span class="elsevierStyleHsp" style=""></span>Gy in 22 fractions) with concurrent vismodegib \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">Complete clinical response with histologic and radiologic evidence/sustained during 33 mo of follow-up after radiotherapy and 15 mo of follow-up after vismodegib discontinuation (Fig. H) \t\t\t\t\t\t\n \t\t\t\t</td></tr><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">3<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A–D) \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">62/M \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">laBCC in left temporal region extending to outer canthus and lower eyelid of the left eye/50<span class="elsevierStyleHsp" style=""></span>mm \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">Laser ablation 10 y earlier, local resection plus Mustardé flap with histologically confirmed positive margins 2 mo earlier \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \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">Complete (drug discontinued due to toxicity) \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">Grade 3 muscle spasms \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">None \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">External beam radiotherapy (55<span class="elsevierStyleHsp" style=""></span>Gy in 20 fractions) after vismodegib discontinuation \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">Complete clinical and radiologic response/sustained during 30 mo of follow-up postradiotherapy (Fig. D) \t\t\t\t\t\t\n \t\t\t\t</td></tr><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">4<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E–H) \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">82/F \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">laBCC in skin of upper lip skin/25<span class="elsevierStyleHsp" style=""></span>mm \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">None \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \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">Complete (drug discontinued due to toxicity) \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">Grade 3 muscle spasms, grade 1 dysgeusia \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">None \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">External beam radiotherapy (55<span class="elsevierStyleHsp" style=""></span>Gy in 22 fractions) after vismodegib discontinuation \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">Complete clinical and radiologic response/sustained during 34 mo of follow-up postradiotherapy (Fig. H) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristics of Patients with Locally Advanced Basal Cell Carcinoma (laBCC) Treated with Multimodal Combination Therapy and Clinical Responses.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advanced basal cell carcinoma: epidemiology and therapeutic innovations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.V. Mohan" 1 => "A.L.S. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13671-014-0069-y" "Revista" => array:6 [ "tituloSerie" => "Curr Dermatol Rep" "fecha" => "2014" "volumen" => "3" "paginaInicial" => "40" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24587976" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinoma: epidemiology; pathophysiology; clinical and histological subtypes; and disease associations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Cameron" 1 => "E. Lee" 2 => "B.P. Hibler" 3 => "C.A. Barker" 4 => "S. Mori" 5 => "M. Cordova" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2018.03.060" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2019" "volumen" => "80" "paginaInicial" => "303" "paginaFinal" => "317" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29782900" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term safety and efficacy of vismodegib in patients with advanced basal cell carcinoma: final update of the pivotal ERIVANCE BCC study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sekulic" 1 => "M.R. Migden" 2 => "N. Basset-Seguin" 3 => "C. Garbe" 4 => "A. Gesierich" 5 => "C.D. Lao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12885-016-3022-6" "Revista" => array:6 [ "tituloSerie" => "BMC Cancer" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "1" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28049525" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vismodegib in patients with advanced basal cell carcinoma: Primary analysis of STEVIE, an international, open-label trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Basset-Séguin" 1 => "A. Hauschild" 2 => "R. Kunstfeld" 3 => "J. Grob" 4 => "B. Dréno" 5 => "L. Mortier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejca.2017.08.022" "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "2017" "volumen" => "86" "paginaInicial" => "334" "paginaFinal" => "348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29073584" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatologic radiotherapy in the treatment of extensive basal cell carcinomas: a retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Piccinno" 1 => "S. Benardon" 2 => "F.M. Gaiani" 3 => "M. Rozza" 4 => "M. Caccialanza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/09546634.2016.1274365" "Revista" => array:6 [ "tituloSerie" => "J Dermatolog Treat" "fecha" => "2017" "volumen" => "28" "paginaInicial" => "426" "paginaFinal" => "430" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28132575" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinoma review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.P. Kim" 1 => "K.J.B. Kus" 2 => "E. Ruiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hoc.2018.09.004" "Revista" => array:6 [ "tituloSerie" => "Hematol Oncol Clin North Am" "fecha" => "2019" "volumen" => "33" "paginaInicial" => "13" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30497670" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term efficacy of vismodegib after its withdrawal and patients’ health-related quality of life using the Dermatology Life Quality Index (DLQI)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Villani" 1 => "M. Megna" 2 => "G. Fabbrocini" 3 => "M. Cappello" 4 => "M.A. Luciano" 5 => "C. Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13555-019-00323-4" "Revista" => array:6 [ "tituloSerie" => "Dermatol Ther (Heidelb)" "fecha" => "2019" "volumen" => "9" "paginaInicial" => "719" "paginaFinal" => "724" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31506916" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combination trimodality therapy using vismodegib for basal cell carcinoma of the face" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.M. Block" 1 => "F. Alite" 2 => "A.Z. Diaz" 3 => "R.W. Borrowdale" 4 => "J.I. Clark" 5 => "M. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Case Rep Oncol Med" "fecha" => "2015" "volumen" => "2015" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhibitor der Hedgehog-Signalkaskade in Kombination mit Bestrahlung beim Basalzellkarzinom der Kopf-Hals-Region: Erste klinische Erfahrungen mit Vismodegib bei lokal fortgeschrittener Erkrankung" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Schulze" 1 => "M. Meissner" 2 => "S. Ghanaati" 3 => "I. Burck" 4 => "C. Rödel" 5 => "P. Balermpas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00066-015-0902-7" "Revista" => array:6 [ "tituloSerie" => "Strahlenther Onkol" "fecha" => "2016" "volumen" => "192" "paginaInicial" => "25" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26449347" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Induction Hedgehog pathway inhibition followed by combined-modality radiotherapy for basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.R. Raleigh" 1 => "A. Algazi" 2 => "S.T. Arron" 3 => "I.M. Neuhaus" 4 => "S.S. Yom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.13748" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2015" "volumen" => "173" "paginaInicial" => "544" "paginaFinal" => "546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25702621" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000003/v1_202303051528/S0001731023000753/v1_202303051528/en/main.assets" "Apartado" => array:4 [ "identificador" => "6160" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científico-clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000003/v1_202303051528/S0001731023000753/v1_202303051528/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023000753?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
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