218 Updated results of 3,050 lesions in 1725 patients treated with novel technology using image guided superficial radiotherapy (IGSRT), a multi-institutional study

Tran

et al. 2022

Discov Onc

Background Various treatments exist for non-melanoma skin cancer (NMSC), but the mainstay is surgical removal. Superficial radiotherapy (SRT) is one non-surgical technique that has been used for over a century but fell out of favor due to the advent of Mohs micrographic surgery (MMS). A new technology that combines a 22 megahertz (MHz) dermal ultrasound with SRT (US-SRT) enables tumor visualization before, during, and after treatment, and demonstrates increased cure rates and reduced recurrences. Methods We conducted a meta-analysis comparing the local control (LC) of four studies using traditional non-image-guided forms of radiotherapy for NMSC treatment to two seminal studies utilizing high-resolution dermal ultrasound-guided SRT (HRUS-SRT). The four traditional radiotherapy studies were obtained from a comprehensive literature search used in an article published by the American Society of Radiation Oncology (ASTRO) on curative radiation treatment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and squamous cell carcinoma in-situ (SCCIS) lesions. The meta-analysis employed a logit as the effect size indicator with Q-statistic to test the null hypothesis. Results LC rates for the 2 US-SRT studies were statistically superior to the 4 traditional therapies individually and collectively. When stratified by histology, statistically superior outcomes for US-SRT were observed in all subtypes with p-values ranging from p < 0.0001 to p = 0.0438. These results validated an earlier analysis using a logistic regression statistical method showing the same results. Conclusion US-SRT is statistically superior to non-image-guided radiotherapies for NMSC treatment. This modality may represent the future standard of non-surgical treatment for early-stage NMSC.

Section: Introductionmentioning

confidence: 99%

Local control comparison of early-stage non-melanoma skin Cancer (NMSC) treated by superficial radiotherapy (SRT) and external beam radiotherapy (XRT) with and without dermal image guidance: a meta-analysis

Tran

et al. 2022

Discov Onc

“…The 5-year local recurrence rate for primary BCC lesions treated with MMS is reported to be 1%. Our reported high resolution dermal ultrasound image guided superficial radiotherapy LC is 99.1% (2021 US-SRT study 8 ) and 98.9% (2022 US-SRT study 9 ) for BCC and is 99.3% (2021 US-SRT study 8 ) and 99.2% (2022 US-SRT study 9 ) for SCC, and thus appears to be as good as MMS for BCC and potentially better for SCC.…”

Section: Methodsmentioning

confidence: 70%

“…US-SRT results have been investigated in two seminal studies referenced hereafter as the 2021 US-SRT study and the 2022 US-SRT study. [8] [9] Data from the 2021 US-SRT study was obtained via direct chart analysis of patients with histopathologic confirmed NMSC treated with US-SRT from multiple institutions. Data from the 2022 US-SRT study utilized the same data from the 2021 US-SRT study with the addition of 133 histopathological confirmed NMSC from 94 patients with updated follow-up intervals.…”

Section: Methodsmentioning

confidence: 99%

“…[8] An updated abstract that added 93 patients and 133 lesions for a total of 1725 patients with 3050 early-stage keratinocytic lesions showed a continued high local control (LC) of 99·2%. [9] This suggests that US-SRT can offer comparable cure rates to that of the current “gold standard” treatment modality, namely MMS, for early-stage NMSC without needing surgery and its associated risks, discomfort, and cosmetic sequalae. A…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

High resolution dermal ultrasound (US) combined with superficial radiation therapy (SRT) versus non-image guided SRT or external beam radiotherapy (XRT) in early-stage epithelial cancer: a comparison of studies

Zheng

et al. 2022

Preprint

Background: Non-image-guided forms of radiotherapy (external radiation therapy [XRT], including superficial radiation therapy [SRT]), have been used to treat non-melanoma skin cancer (NMSC) for over a century. More recently, image-guided superficial radiation therapy (IGSRT), which allows visualization of tumor configuration and depth throughout treatment, is being used to treat NMSC with high local control (LC) rate. Methods: Two recent studies report the results of IGSRT. Further, the American Society of Radiation Oncology (ASTRO) has published a comprehensive review of studies examining XRT/SRT outcomes of which four high-quality, recent, evidence-based, large (with more than 100 cases), United States (U.S.) based studies exist. Using information from these six studies, we employ logistic regression to compare basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and squamous cell carcinoma in situ (SCCIS) treatment outcomes between IGSRT and XRT/SRT. Findings: IGSRT local control (LC) was statistically superior to each of the four large non-image-guided radiotherapy studies individually, collectively, and stratified by histologic subtype. Interpretation: IGSRT LC is superior to non-image guided radiotherapy LC for the treatment of early-stage epithelial cancers. We propose that because lower recurrence rates result in less economic, social, and psychological burden on patients, IGSRT could be considered the preferred standard for the non-surgical radiotherapeutic treatment of early-stage NMSC with LC comparable to Mohs micrographic surgery (MMS).

“…However, radiotherapy provides advantages in cosmetic and functional outcomes to patients as NMSC lesions predominantly affect cosmetically sensitive areas, such as the face, nose, and ears [8]. Furthermore, recent advancements incorporating imaging into radiotherapy result in excellent local control (LC) rates similar to MMS [8, 10, 16].…”

Section: Introductionmentioning

confidence: 99%

Local Control Comparison of Early-Stage Epidermal Skin Cancers Treated With and Without Dermal Image Guidance: A Meta-Analysis

Yu¹,

Tran

et al. 2022

Preprint

Background: Various treatments exist for non-melanoma skin cancer (NMSC), but the mainstay is surgical removal. Superficial radiotherapy (SRT) is one non-surgical technique that has been used for over a century but fell out of favor due to the advent of Mohs micrographic surgery (MMS). A new technology that combines a 22 megahertz (MHz) dermal ultrasound with SRT (US-SRT) enables tumor visualization before, during, and after treatment, and demonstrates increased cure rates and reduced recurrences. Methods: We conducted a meta-analysis comparing the local control (LC) of four traditional non-image-guided forms of radiotherapy for NMSC treatment to two seminal studies utilizing high-resolution dermal ultrasound-guided SRT (HRUS-SRT). The four traditional radiotherapy studies were obtained from a comprehensive literature search used in an article published by the American Society of Radiation Oncology (ASTRO) on curative radiation treatment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and squamous cell carcinoma in-situ (SCCIS) lesions. The meta-analysis employed a logit as the effect size indicator with Q-statistic to test the null hypothesis. Results: LC rates for the 2 US-SRT studies were statistically superior to the 4 traditional therapies individually and collectively. When stratified by histology, statistically superior outcomes for US-SRT were observed in all subtypes with p-values ranging from p < 0.0001 to p = 0.0438. These results validated an earlier analysis using a logistic regression statistical method showing the same results. Conclusion: US-SRT is statistically superior to non-image-guided radiotherapies for NMSC treatment. This modality may represent the future standard of non-surgical treatment for early-stage NMSC.