Personalised Medicine, Individual Choice and the Common Good

This is a volume of twelve essays concerning the fundamental tension in personalised medicine between individual choice and the common good

Enhancing Cosmesis While Achieving High Cure Rates For Early Stage Non-Melanoma Skin Cancer In The Outpatient Dermatology Clinic Using A Novel Non-Invasive Modality

Introduction: Non-Melanoma Skin Cancer (NMSC) is generally treated in dermatology offices using surgical techniques. Objectives: We evaluate the feasibility, tolerance, effectiveness and cosmesis using an office-based non-surgical modality for NMSC. Methods: 93 patients with 133 pathologically confirmed early stage invasive and in-situ NMSC lesions treated with Image-Guided Superficial Radiation Therapy (IGSRT) were retrospectively analyzed. All lesions received a median of twenty fractions of 50 or 70 kilovoltage(kV) IGSRT. Energy selection and subsequent kV changes were determined by ultrasound imaging. RTOG toxicity scoring was used. Treatment interruption was defined as greater than 2 weeks. Results: Median age was 69. At an average follow-up of 16.23 months, 92 of 93 patients were alive. One patient expired from unrelated causes while no evidence of disease (NED). 132 of 133 lesions achieved local control (LC) with one lesion recurring at 12.9 months. Absolute LC was 99.2%, overall Kaplan-Meier LC (KM LC) was 98.95% at 30.8 months, and Disease Free Survival (DFS) was 100%. Acute toxicities were mild with RTOG grades 0, 1 or 2 in all lesions with no grade 3 or 4 toxicity. Cosmesis was felt to be excellent or very good (VG) by the clinicians with no fair/poor cosmesis. There were no severe toxicities or complications requiring treatment interruptions. Conclusions: Office based IGSRT is feasible, safe, easily tolerable, and highly effective. Patients receiving IGSRT achieve excellent/VG cosmesis and welcome this nonsurgical option. IGSRT is an attractive non-invasive therapeutic option for NMSC and provides another valuable tool for dermatologists