背景:经常观察到角质形成细胞肿瘤(KT)。手术是治疗的金标准。在某些情况下,手术方法可能不是最佳选择.放射治疗(RT)和全身治疗通常会引起副作用或禁忌。甲氨蝶呤(MTX)可以是保守但有效的替代方案。我们决定评估MTX病灶内化疗治疗鳞状细胞癌(SCC)的有效性和安全性,角化棘皮瘤(KA),和基底细胞癌(BCC)。
方法:所有患者经组织学证实诊断为BCC,SCC,或KA,没有手术或RT的指征。从病变的外周向中心皮下注射MTX。剂量方面的不同方案,频率,和治疗时间进行比较。在肿瘤大小减小方面评价治疗功效。患者分为三组:反应者(改善超过50%),部分反应者(<50%),和无反应者(没有改善或恶化)。所有数据均采用卡方检验(χ2)进行分析。
结果:纳入35例患者。21名患者患有SCC,12来自KA,和2来自BCC。KA显示出比SCC和BCC更高的应答率。对于AK,92%的患者有完全缓解;8%是部分应答者。对于SCC,47.6%的病例是应答者,14.3%的病例是部分应答者,而38%的人没有反应。所有BCC均无改善。每周注射的治疗方案,进行了4到6周,是最有效的。每次25mg/ml的剂量似乎是最有效的。大约三分之一的患者出现副作用,轻度贫血是最常见的。
结论:对于选定的病例,病灶内MTX是治疗KT的一种安全有效的选择,尤其是在KA和,在较小程度上,SCC。
BACKGROUND: Keratinocyte tumors (KT) are frequently observed. Surgery is the treatment gold standard. In some cases, a surgical approach might not be the best option. Radiotherapy (RT) and systemic treatments can frequently cause side effects or be contraindicated. Intralesional methotrexate (MTX) can be a conservative yet effective alternative. We decided to evaluate the effectiveness and safety of intralesional chemotherapy with MTX for the treatment of squamous cell carcinoma (SCC),
keratoacanthoma (KA), and basal cell carcinoma (BCC).
METHODS: All patients had a histologically confirmed diagnosis of BCC, SCC, or KA and no indication to surgery or RT. MTX was injected subcutaneously proceeding from the periphery of the lesion toward the center. Different protocols in terms of dose, frequency, and length of treatment were used to compare them. Treatment efficacy was evaluated in terms of tumor size reduction. Patients were divided into three groups: responders (improvement of more than 50%), partial responders (< 50%), and non-responders (no improvement or worsening). All data were analyzed using the chi-squared test (χ2).
RESULTS: Thirty-five patients were included. Twenty-one patients suffered from SCC, 12 from KA, and 2 from BCC. KA showed a higher response rate than SCC and BCC. For AK, 92% of patients had a complete resolution; 8% were partial responders. For SCC, 47.6% of cases were responders and 14.3% partial responders, while 38% non-responders. All BCCs showed no improvement. A treatment protocol of weekly injections, performed for 4 to 6 weeks, was the most efficient. Doses of 25 mg/ml per session seemed to be most effective. About one third of our patients developed side effects with mild anemia being the most frequent.
CONCLUSIONS: For selected cases, intralesional MTX can be a safe and effective option for the treatment of KT, especially in case of KA and, to a lesser extent, SCC.