title: Efficacy of skin-directed therapy for cutaneous metastases from advanced cancer: a meta-analysis.
abstract: OBJECTIVE
  To perform the first meta-analysis of the efficacy of skin-directed therapies for cutaneous metastases.
  
  
  METHODS
  MEDLINE, EMBASE, The Cochrane Library, and ClinicalTrials.gov databases were searched for reports of prospective clinical studies published between 1960 and 2013 that assessed the response of skin-directed therapy for cutaneous metastases (47 of 2,955 unique studies were selected). Primary end points of the study were complete and objective response rates. Secondary analyses were preplanned and included subgroup analyses by skin-directed therapy, histology, and recurrence rates. Meta-analyses were performed with random-effect modeling, and extent of heterogeneity between studies was determined with the Cochran Q and I(2) tests.
  
  
  RESULTS
  After applying exclusion criteria, 47 prospective studies of 4,313 cutaneous metastases were assessed. Five skin-directed therapies were identified: electrochemotherapy, photodynamic therapy, radiotherapy, intralesional therapy, and topical therapy. Among all cutaneous metastases, complete response rate was 35.5% (95% CI, 27.6% to 44.3%) and objective response rate was 60.2% (95% CI, 50.6% to 69.0%). Overall recurrence rate was estimated to be 9.2% (95% CI, 3.7% to 21.2%). Melanoma and breast carcinoma comprised 96.8% of all cutaneous metastases studied and had similar objective response rates (54.5% [95% CI, 48.3% to 60.7%] and 54.0% [95% CI, 48.3% to 59.7%], respectively). Grade ≥ 3 toxicity was reported in less than 6% of patients.
  
  
  CONCLUSIONS
  Response to skin-directed therapy for cutaneous metastases is high but heterogeneous across treatment modalities, with low rates of recurrence post-treatment. Treatment was generally well tolerated and conferred improvements in quality of life. Standardization of response criteria for cutaneous metastases and treatment algorithms to optimally use the available skin-directed therapies are needed.
authors.affiliation: Daniel E. Spratt, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacoutre, and Christopher A. Barker, Memorial Sloan-Kettering Cancer Center; Elizabeth A. Gordon Spratt, New York University Langone Medical Center, New York; and Shenhong Wu, Stony Brook University Cancer Center, Stony Brook, NY.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Spratt
authors.affiliation: Daniel E. Spratt, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacoutre, and Christopher A. Barker, Memorial Sloan-Kettering Cancer Center; Elizabeth A. Gordon Spratt, New York University Langone Medical Center, New York; and Shenhong Wu, Stony Brook University Cancer Center, Stony Brook, NY.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Gordon Spratt
authors.affiliation: Daniel E. Spratt, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacoutre, and Christopher A. Barker, Memorial Sloan-Kettering Cancer Center; Elizabeth A. Gordon Spratt, New York University Langone Medical Center, New York; and Shenhong Wu, Stony Brook University Cancer Center, Stony Brook, NY.
authors.forename: Shenhong
authors.initials: S
authors.lastname: Wu
authors.affiliation: Daniel E. Spratt, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacoutre, and Christopher A. Barker, Memorial Sloan-Kettering Cancer Center; Elizabeth A. Gordon Spratt, New York University Langone Medical Center, New York; and Shenhong Wu, Stony Brook University Cancer Center, Stony Brook, NY.
authors.forename: Antonio
authors.initials: A
authors.lastname: DeRosa
authors.affiliation: Daniel E. Spratt, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacoutre, and Christopher A. Barker, Memorial Sloan-Kettering Cancer Center; Elizabeth A. Gordon Spratt, New York University Langone Medical Center, New York; and Shenhong Wu, Stony Brook University Cancer Center, Stony Brook, NY.
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
authors.affiliation: Daniel E. Spratt, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacoutre, and Christopher A. Barker, Memorial Sloan-Kettering Cancer Center; Elizabeth A. Gordon Spratt, New York University Langone Medical Center, New York; and Shenhong Wu, Stony Brook University Cancer Center, Stony Brook, NY.
authors.forename: Mario E
authors.initials: ME
authors.lastname: Lacouture
authors.affiliation: Daniel E. Spratt, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacoutre, and Christopher A. Barker, Memorial Sloan-Kettering Cancer Center; Elizabeth A. Gordon Spratt, New York University Langone Medical Center, New York; and Shenhong Wu, Stony Brook University Cancer Center, Stony Brook, NY. barkerc@mskcc.org.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Barker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D016208:Databases, Factual / Q000706:statistics & numerical data; D062109:Dermatologic Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D012867:Skin / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D012878:Skin Neoplasms / Q000556:secondary / Q000628:therapy*; D016896:Treatment Outcome