Topical Chemotherapy Research Articles

Primary penile cancer organ sparing treatment.

IntroductionSurgical treatment of penile cancer is usually associated with mutilation; alterations in self-esteem and body image; affecting sexual and urinary functions; and declined health-related quality of life. Recently, organ sparing treatment has appeared and led to limiting these complications.Material and methodsAn extensive review of the literature concerning penile-preserving strategies was conducted. The focus was put on indications, general principles of management, surgical options and reconstructive techniques, the most common complications, as well as functional and oncological outcomes.ResultsAnalyzed methods, e.g.: topical chemotherapy, laser ablation therapy, radiotherapy, Moh’s microscopic surgery, circumcision, wide local excision, glans resurfacing and glansectomy are indicated in low-stage tumors (Tis, Ta-T2). After glansectomy, reconstruction is also possible.ConclusionsOrgan sparing techniques may achieve good anatomical, functional, and psychological outcomes without compromising local cancer control, which depends on early diagnosis and treatment. Penile sparing strategies are acceptable treatment approaches in selected patients with low-stage penile cancer after establishing disease-risk and should be considered in this population.

Topical Mitomycin-C Chemotherapy in Ocular Surface Squamous Neoplasia.

A 60-year-old male patient presented with slowly growing mass lesion in both eyes. Best Corrected Visual Acuity (BCVA) was 6/60, N18 in Right eye Oculus Dexter (OD) and finger counting 1 meter, <N36 in left eye Oculus Sinister (OS). Examination revealed localized gelatinous mass lesion at temporal limbus in OD [Table/Fig-1a] and diffuse mass lesion involving more than 9 clock hours of cornea in OS [Table/Fig-2a]. Biopsy of the lesion was done and diagnosis of localized Ocular Surface Squamous Neoplasia (OSSN) in OD and diffuse OSSN in OS was made.

Superficial Basal Cell Carcinoma on the Face is a Diagnostic Challenge.

Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer. The incidence of BCC is rising. The nodular, superficial spreading, and infiltrating variants are the three most commonly encountered types of BCC in descending order of prevalence. Superficial spreading basal cell carcinoma (SSBCC) accounts for 15-26% of all cases of BCC. It usually occurs on the trunk and upper extremities, but may be seen on the face. Surgical excision is the most commonly used treatment for BCC. Topical chemotherapy agents such as imiquimod or 5-fluorouracil (5-FU) may be various alternatives or adjuvants in the treatment of SSBCC. characteristically shows areas of uninvolved skin between tumor nests.[7]

Adjuvant therapy and interdisciplinary follow-up care of conjunctival melanoma

Despite microscopically controlled tumor excision, malignant melanomas of the conjunctiva have a propensity for local recurrence, lymphatic spread and distant metastases. This review outlines the options of adjuvant therapy as well as the structure of interdisciplinary follow-up care for patients with conjunctival melanoma. The study provides a PubMed literature review and own clinical results. In conjunctival melanoma complete tumor excision using a minimal touch technique should always be combined with adjuvant therapy, such as cryotherapy, radiotherapy, topical chemotherapy and/or immunotherapy. For locally circumscribed lesions of the bulbar conjunctiva adjuvant brachytherapy can be supplemented and for non-bulbar, extensive, diffuse or multilocular tumor growth, complementary adjuvant topical mitomycin C therapy or proton radiotherapy can be used. Novel adjuvant approaches include topical interferon alpha-2b immunotherapy, topical vascular endothelial growth factor (VEGF) inhibitors or in cases of BRAF mutations personalized therapy using selective BRAF inhibitors or in combination with mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase (ERK), MAPK/ERK (MEK) inhibitors. All patients should be integrated into an interdisciplinary follow-up care program including quarter yearly checkups in the first 5 years and psycho-oncological healthcare. Following microscopically controlled tumor excision, adjuvant treatment using cryotherapy, radiotherapy, topical chemotherapy and/or immunotherapy as well as interdisciplinary follow-up care are mandatory for the modern management of patients with conjunctival melanoma.

Development and in vitro assessment of alginate bilayer films containing the olive compound hydroxytyrosol as an alternative for topical chemotherapy

Topical chemotherapy is the application of cancer drugs directly onto the skin, which has become a standard treatment for basal cell carcinoma. Due to the promising results in the treatment of skin cancer, topical chemotherapy has recently been applied to breast cancer patients because some breast cancer tissues are only superficial. Hydroxytyrosol, a phenolic compound from olives that is present in high amounts in Hidrox® olive extract, has been shown to have a protective effect on normal cells and selective antitumor activities on cancerous cells. The aims of the present study were to develop an alginate bilayer film containing Hidrox® and to investigate its potential use as a topical chemotherapeutic agent. Alginate films were characterized for swelling and for physical, thermal, rheological, and mechanical properties. Drug content uniformity and in vitro drug release tests were also investigated. The alginate bilayer films containing Hidrox®, HB2, showed controlled release of hydroxytyrosol at a flux of 0.094±0.009mg/cm2/h. The results of the cytotoxic assay showed that the HB2 films were dose-dependent and could significantly reduce the growth of breast cancer cells (MCF-7) at 150μg/mL for a cell viability of 29.34±4.64%. In conclusion, an alginate bilayer film containing Hidrox® can be a potential alternative for topical chemotherapeutic agent for skin and breast cancer treatment.

Eyelid and ocular surface carcinoma: Diagnosis and management

Eyelid cancers account for 5% to 10% of all cutaneous malignancies. The incidence of eyelid cancer is approximately 15 cases per 100,000 individuals per year. Basal cell carcinoma is by far the most common cutaneous malignancy in the periocular area; other cutaneous malignancies that occur in this area include, in decreasing order of frequency, squamous cell carcinoma, sebaceous carcinoma, melanoma, and Merkel cell carcinoma. The most common treatment for eyelid carcinomas is surgical resection with frozen section examination for margin control, but exenteration may be needed when there is orbital invasion. Adjuvant radiotherapy may be needed in patients at high risk for local recurrence; sentinel lymph node biopsy may be considered in patients at high risk for lymph node metastasis. Primary or residual in situ disease of the conjunctiva can be treated with topical chemotherapy, such as mitomycin C, 5-fluorouracil, or interferon alpha-2 b. For patients with metastatic or locally advanced basal cell or squamous cell carcinoma not amenable to surgical excision or radiotherapy, targeted therapy against the hedgehog pathway (for basal cell carcinoma) or epidermal growth factor receptor (for squamous cell carcinoma) has been shown to be effective in preventing disease progression. Patients with eyelid and ocular surface malignancies need to be monitored with careful clinical examination for at least 5years after surgical treatment, and additional investigations may be warranted in some cases.

Management of Psoriasis in Children: a Narrative Review

Psoriasis is an inherited chronic inflammatory papulosquamous disorder with a variable clinical spectrum affecting about 0.5% to 2% of children and adolescence. In spite of all performed researches around the world for seeking better treatments with fewer adverse effects to control the disease, there is still no cure for psoriasis. Treatment of psoriasis in children is very conservative and many therapies used for adults may not be appropriate for children due to possible long-term or delayed adverse effects. A wide range of therapeutic options are existed including; topical therapy, phototherapy, chemotherapy, systemic therapies and biologic therapies. Here in, because of the lack of data in this specific field of dermatology, we decided to review the current therapies of childhood psoriasis.

Korneal ve Konjonktival İntraepitelyal Tümörün Topikal İnterferon Alfa-2b ile Başarılı Tedavisi

Corneal and conjunctival intraepithelial neoplasia (CCIN) is a premalignant lesion of the corneal epithelium and limbus and the most common tumor of the ocular surface. Management of these lesions includes wide local excision followed by supplemental cryotherapy, and topical chemotherapy with antineoplastic drugs. As shown by past research, CCIN has a high recurrence rate after excision alone. Consequently, new chemotherapeutic agents have begun to be used in recent years to reduce the risk of recurrence in recent years. In this case, after a clinical and histopathological diagnosis of CCIN, an interferon alfa-2b (IFN α 2b) eye drop was prepared and used four times daily and complete tumor resolution was noted at the first year. We aimed to present our successful treatment of a case of CCIN with topical IFN α 2b.

Conjunctival squamous cell neoplasia: the Liverpool Ocular Oncology Centre experience.

To report the outcome of patients with conjunctival squamous cell neoplasia (CSCN)--including conjunctival squamous cell carcinoma (SCC), conjunctival squamous intraepithelial neoplasia (C-SIN) and carcinoma in situ (CIS)-treated at the Liverpool Ocular Oncology Centre (LOOC). Patients treated between January 1993 and September 2011 were identified and categorised as having 'primary' or 'salvage' treatment, according to whether they had undergone a surgical procedure before referral to our centre. Invasive SCC was treated by excision with adjunctive ruthenium plaque radiotherapy. C-SIN or CIS was treated with topical 5-fluorouracil (5-FU), and in a few cases, cryotherapy. Primary treatment was administered to 20 patients (16 males, four females). Mean age was 62 years (range, 33-85). Histological examination revealed C-SIN/CIS in ten patients and invasive SCC in nine. Median follow-up was 69 months (range, 34-168). Three patients required further topical chemotherapy for persistent/recurrent C-SIN. Salvage therapy was administered to 21 patients (15 males, six females). Mean age was 63 years (range, 26-82). Histology showed C-SIN/CIS in 11 patients and invasive SCC in ten. Median follow-up was 54.5 months (range, 36-120). At the close of this audit, there was no recurrence of invasive or metastatic disease in either the primary or salvage groups. Our established protocol for treatment of CSCN has proven successful in local tumour control, and avoids ocular complications. We advocate adjunctive radiotherapy in patients with invasive SCC and chemotherapy in C-SIN/CIS. For improved patient outcome, prompt referral to a specialist centre is encouraged.

Management of Ocular Surface Tumors: Excision vs. Topical Treatment

Ocular surface squamous neoplasia (OSSN) encompasses a range of corneal and conjunctival lesions from intraepithelial dysplasia to invasive squamous cell carcinoma. The mainstay of treatment for OSSN has traditionally been surgical excision with wide margins and cryotherapy. Increasing evidence on the efficacy and safety of medical therapy and the avoidance of surgical complications has made topical chemotherapy increasingly popular among corneal specialists. The most common topical agents used for the treatment of OSSN include mitomycin C, 5-fluorouracil, and interferon a 2b. Herein, we review recent advances in the surgical and medical management of OSSN and discuss advantages and disadvantages of each approach. The role of ultra highresolution optical coherence tomography in the diagnosis and treatment of primary and recurrent OSSN lesions is also discussed.

Photodynamic therapy with methyl-aminolevulinic acid for paucilesional mycosis fungoides: A prospective open study and review of the literature

Publications reporting photodynamic therapy (PDT) in mycosis fungoides (MF) are rare, involve small samples, and are difficult to compare because of a lack of technical standardization. We sought to assess PDT effectiveness and tolerability in early-stage MF using a strict reproducible procedure. This was a prospective study conducted in Nantes University Hospital, France, including patients older than 18 years with histologically proven MF (stage IA or IB). Methyl-aminolevulinic acid-PDT sessions were repeated monthly for 6 months. Clinical and histologic responses were assessed 1 month after the last session. Patient satisfaction was assessed by telephone survey. Twelve patients (with 29 lesions) were treated with PDT. An objective response in target lesions was obtained in 75% of patients. Response rates were similar between plaques and patches but higher in sun-protected compared with sun-exposed areas (trend without reaching significance). During PDT, new lesions appeared in 5 of 12 patients in untreated areas. Most patients were highly satisfied and preferred PDT to the topical chemotherapy previously used. PDT procedure criteria selection was partially arbitrary. In early-stage MF, PDT is effective and appreciated (especially when compared with conventional topical chemotherapy). Unilesional and paucilesional forms and lesions in sun-protected areas are to be preferred.

Penoscrotal Extramammary Paget's Disease with Multiple Lymph Node Metastasis

Penoscrotal Extramammary Paget's Disease with Multiple Lymph Node Metastasis

Upper tract urothelial carcinoma

Upper tract urothelial carcinoma (UTUC) accounts for approximately 5% of all urothelial carcinoma. There are many risk factors for UTUC, including environmental and genetic risk factors, some of which are in common with bladder cancer. The gold standard surgical management of UTUC is radical nephroureterectomy (RNU) with excision of bladder cuff, which is increasingly being performed laparoscopically or robotically with various methods used for the distal ureter. There are increasing numbers of patients being treated endoscopically, with excellent oncological outcomes in low-grade disease. The use of topical BCG and chemotherapy agents has been extrapolated from bladder cancer and may be an adjunct to endoscopic management in those patients in whom it is imperative to avoid RNU.

Topical and Intralesional Treatment of Nonmelanoma Skin Cancer: Efficacy and Cost Comparisons

Topical chemotherapy, topical immunomodulators, or intralesional chemotherapy may be used to treat nonmelanoma skin cancer (NMSC). To review the cost and efficacy of topical and intralesional therapies for NMSC. Literature search assessing the efficacy of NMSC treatment with topical imiquimod, topical 5-fluorouracil (5FU) intralesional 5FU, methotrexate, bleomycin, and interferon (IFN). Single-lesion case reports were excluded. Aggregate cure rates and the estimated cost of treatment (including excision and repair of recurrent lesions) for a sample 1-cm lesion on an extremity were calculated. Cure rates ranged from 65% to 100% for topical imiquimod and 61% to 92% for 5FU. For intralesional agents, cure rates varied considerably according to medication used and NMSC subtype treated. Keratoacanthomas had high cure rates with intralesional agents: 98% for 5FU, 91% for methotrexate, 100% for bleomycin, 100% for IFN alpha (α)-2, 83% for IFN α-2a, and 100% for IFN α-2b. Estimated costs (excluding medication cost) ranged from $205 (intralesional methotrexate for keratoacanthoma) to $1,174 (IFN α-2a for superficial basal cell carcinoma). Nonsurgical management of NMSC remains a viable and relatively cost effective treatment option in select cases. Providers should consider the relative efficacy and cost of each medication when using nonsurgical modalities.

English

Conjunctival Ocular surface squamous neoplasia OSSN has been described as a slow growing, well differentiated tumor of low grade malignancy often confused with more benign conditions of conjunctiva like pterygium, pinguecula, papilloma and limbal dermoid. OSSN are common in elderly males living in areas with high ambient solar radiations. Aggressive OSSN are usually seen at younger age in HIV positive individuals of Sub- Saharan region. Here we report a case of a 39 year old HIV negative, immunocompetent male presented with rapidly growing mass arising from conjunctiva and covering entire cornea. Tumor was diagnosed as invasive squamous cell carcinoma on histopathology, positive for HPV on Chromogenic insitu hybridization (CISH) and has a high proliferative index. Patient had to undergo enucleation and was put on topical chemotherapy. INTRODUCTION: The term ocular surface squamous neoplasia (OSSN) was first described in 1995 by Lee and Hirst to denote a spectrum of neoplasm originating from squamous epithelium and ranging from a localized lesion confined to the surface epithelium (conjunctival intraepithelial neoplasia) to invasive squamous cell carcinoma that has broken through the basement membrane and invaded the underlying stroma1. OSSN accounts for only 5% of all ocular malignancies1 invasive squamous cell carcinoma is still rarer1. Geographic incidences of OSSN vary from 0.2 to 3.5 per 100,000, with greater frequency near the equator 1 . OSSN was noted to occur predominantly in the elderly with a mean age at presentation of 60 years and increased incidence in males (75%) vs females (25%) 2 , OSSN associated with human immunodeficiency virus (HIV) is seen at younger ages (average 35 years, usually not in a bulbar location, and is more aggressive from a clinical point of view1.

Topical chemotherapy for ocular surface squamous neoplasia

Ocular surface squamous neoplasia (OSSN) is an umbrella term for a spectrum of epithelial dysplasias of the cornea, conjunctiva, and limbus. Treatment for OSSN has historically been surgery, but nonsurgical interventions have been increasingly adopted. Advantages of medical treatments include the ability to treat the entire ocular surface and prevention of surgical complications. The primary medical treatments for OSSN include mitomycin C, 5-fluorouracil, and interferon α2b. Mitomycin C has been shown in studies to be highly effective but has short-term and long-term side-effects that may be intolerable. 5-Fluorouracil and interferon α2b have been found to be similar in efficacy to mitomycin, with interferon being extremely well tolerated in the majority of patients. Most recently, other chemotherapeutic agents have been tried for OSSN including antivascular endothelial growth factor agents and vitamin A. The data regarding these latter treatment strategies are still limited. An understanding of the recent literature, with respect to the efficacy, advantages, and disadvantages of the various therapies for OSSN will allow us to tailor treatment to each patient.

Pectin-coated chitosan microgels crosslinked on superhydrophobic surfaces for 5-fluorouracil encapsulation

5-Fluorouracil (5-FU)-loaded chitosan microgels for oral and topical chemotherapy were prepared applying a superhydrophobic surface-based encapsulation technology. Drug-loaded chitosan dispersions were cross-linked and then coated with drug-free chitosan or pectin layers at the solid-air interface in a highly efficient and environment-friendly way. The size of the microgels (with diameters of ca. 280 and 557μm for the chitosan seeds and pectin-coated microgels respectively) was the lowest obtained until now using similar biomimetic methodologies. The microgels were characterized regarding 5-FU release profiles in vitro in aqueous media covering the pH range of the gastrointestinal tract, and cytotoxicity against two cancer cell lines sensitive to 5-FU. Owing to their control of 5-FU release in acidic medium, calcium pectinate-coated microgels can be considered as suitable for oral administration. Growth inhibition of cancer cells by 5-FU was greater when incorporated to chitosan microgels; these being potentially useful for treatment of skin and colorectal tumors.

Review of the Treatment of Mycosis Fungoides and SéZary Syndrome : A Stage-Based Approach

Mycosis fungoides (MF) and Sézary Syndrome (SS) are the most common subtypes of cutaneous T-cell lymphomas. Most of patients have indolent and incurable course of disease. Therefore, treatment should be reaching the optimal benefit with minimizing the toxicity as much as possible. To achieve this aim, the management should follow a -stage-based-approach. Treatment of early-stage MF (IA-IIA) involves skin-directed therapy (SDT) including topical corticosteroids, phototherapy, topical chemotherapy, topical retinoids and radiotherapy. For aggressive/recalcitrant early-stage MF or advanced-stage MF, systemic therapy should be considered including interferone-alpha, oral retinoids including bexarotine and more recently acitretin, histone deacetylase inhibitors (HDACi), fusion toxin denileukin diftitox and chemotherapy drugs. Combined drug regimens can be considered in some situations to get the synergistic effect while lowering the individual drug's doses on the other hand. By exception of aggressive stages, chemotherapy should always come after other systemic drugs have been tried or contraindicated. Novel drugs should be considered in situations when all systemic drugs have failed.

Retrograde Chemoinfusion of the Upper Tract: Standardizing the Delivery of Topical Adjuvant Therapy

Upper tract urothelial carcinoma has a high recurrence rate after endoscopic treatment. Immediate postoperative topical chemotherapy may reduce recurrences, as in bladder cancer. A reliable delivery method to the upper tract does not exist. We propose a new infusion pump technology for the delivery of topical chemotherapeutic agents to the upper tract. With the patient under general anesthesia, contrast is infused into the upper collecting system using a standard infusion pump. An optimal infusion rate is determined based on fluoroscopic filling of the upper collecting system and transduced intrapelvic pressures. Using this rate, the infusion is repeated postoperatively with the chemotherapeutic agent. We report one case of successful execution to demonstrate proof of concept. We are the first to describe retrograde upper tract chemotherapeutic irrigation with an intravenous pump. This technique may facilitate and standardize the delivery of intracavitary chemotherapy. Further investigation to determine whether it translates into improved safety and/or efficacy is warranted.

Basal cell carcinoma epidemiology in the UK: the elephant in the room

UK Cancer registries have difficulties in recording the incidence of basal cell carcinoma (BCC). To estimate the total numbers of BCCs in the UK requiring surgical treatment. The histopathology records of each year from 1999 to 2010 were examined to estimate the total annual numbers of BCCs and of people with BCC in the East Norfolk and Waveney area of the UK. Over this period, the numbers of patients with surgically treated BCCs increased by 81%, and the numbers of BCCs by 70%. The ratio of BCCs recorded by the cancer registry was 2-2.2 times lower than that recorded in the histopathology data. Extrapolating the data to the UK population suggests that in 2010, approximately 200,000 patients had 247,000 BCCs treated surgically (this estimate does not include those treated by other means such as cryotherapy, topical chemotherapy, photodynamic therapy or radiotherapy, without histology). In 2008, 114,000 nonmelanoma skin cancers were registered in England and Wales and 309,000 total cancers (excluding nonmelanoma skin cancers) were registered in the UK. These data indicate that in the UK, BCC is nearly as common as all other cancers in all other body sites combined.