Definitive radiotherapy versus Mohs surgery for early stage nonmelanoma skin cancers: a multi‐institutional retrospective comparison of local recurrence

Gasalberti, David; Ogrich, Lauren; Strasser, Jon; Abdelmalek, Mark

doi:10.1111/ijd.14343

Cited by 5 publications

(9 citation statements)

References 5 publications

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“…Further, recurrent BCC and SCC treated with MMS were shown to have control rates of 90–93% and 90%, respectively [ 10 , 21 ]. For newly-diagnosed early-stage BCC and SCC, MMS was found to be superior for the treatment of SCC (local control rate of 98% vs. 75%, p < 0.01), but comparable for the treatment of BCC (98% vs. 96%, p = 0.26), however, only when compared to definitive radiotherapy [ 23 ]. Further, previous studies have examined the efficacy of RT on advanced NMSC, hence cure rates ranged from 50 to 100% [ 12 , 24 , 25 ].…”

Section: Discussionmentioning

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

Moloney

Tran

et al. 2022

Discov Onc

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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.

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Section: Discussionmentioning

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

Moloney

Tran

et al. 2022

Discov Onc

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“…Further, recurrent BCC and SCC treated with MMS were shown to have control rates of 90-93% and 90%, respectively [10, 19]. For newly-diagnosed early-stage BCC and SCC, MMS was found to be superior for the treatment of SCC (local control rate of 98% vs. 75%, p < .01), but comparable for the treatment of BCC (98% vs. 96%, p = 0.26), however, only when compared to definitive radiotherapy [21]. Further, previous studies have examined the efficacy of RT on advanced NMSC, hence cure rates ranged from 50-100% [12, 22, 23].…”

Section: Discussionmentioning

confidence: 99%

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

Yu¹,

Moloney

Tran

et al. 2022

Preprint

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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.

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“…One retrospective study reported on MMS vs. definitive RT as monotherapy. 10 Local control of T1-T2 cSCCs were compared over differential follow-up times for the two treatments. MMS had a superior rate of local control at 5 years compared with RT alone (98 vs. 75%, respectively; P < 0.01).…”

Section: Mohs Micrographic Surgery Vs Radiotherapymentioning

confidence: 99%

“…MMS had a superior rate of local control at 5 years compared with RT alone (98 vs. 75%, respectively; P < 0.01). 10 The authors stated that the RT composition was almost all electrons, mostly at 6 MeV energy with 5-10 mm bolus.…”

Section: Mohs Micrographic Surgery Vs Radiotherapymentioning

confidence: 99%

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A review of Mohs micrographic surgery for skin cancer. Part 3: Squamous cell carcinoma

Hunt

Earp²,

Brown³

et al. 2022

Clinical and Experimental Dermatology

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This review presents and discusses the evidence for MMS to treat cutaneous squamous cell carcinoma (cSCC). The MEDLINE, Embase and Cochrane databases were searched; 39 papers were identified for recurrence and 2 papers for costeffectiveness. We included all clinical trials and observational studies, including retrospective reports, and excluded editorials and systematic reviews or meta-analyses. We categorized the evidence under the following headings: tumour recurrence, specific site outcomes (ear, lip, scalp and periocular), cSCC with perineural invasion, and cost-effectiveness. Although there are many observational studies indicating the potential benefits of MMS in the management of certain cSCCs, no randomized controlled trials (RCT) were identified. The evidence from comparitor studies suggests that MMS has a lower recurrence rate than that of other treatments for cSCC, including standard excision. Many studies identified were single-armed, but did demonstrate a low to very low recurrence rate of cSCC following MMS. A single recent study suggests MMS for intermediate cSCC is highly cost-effective compared with wide local excision when all-in costs are considered. Since the overall quality of included studies was mixed and highly heterogeneous, further methodologically robust studies with comparator arms or comprehensive long-term registry data would be valuable. It would be ideal to employ a definitive multicentre RCT but given the evidence to date and multiple advantages to MMS, the lack of clinical equipoise makes this difficult to justify. Comparison with current modalities would likely not be ethical/achievable on a like-for-like basis given MMS provides 100% margin assessment, enables histological clearance prior to reconstruction, and minimizes the removal of uninvolved tissue.

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Definitive radiotherapy versus Mohs surgery for early stage nonmelanoma skin cancers: a multi‐institutional retrospective comparison of local recurrence

Cited by 5 publications

References 5 publications

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

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

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

A review of Mohs micrographic surgery for skin cancer. Part 3: Squamous cell carcinoma

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