Radiotherapy in the Adjuvant and Advanced Setting of CSCC

Abstract

Introduction: The use of radiotherapy for cutaneous squamous cell carcinoma (CSCC) has solid historical roots. It is used with patients who are not suitable for surgery, patients with high-risk histological features in the adjuvant setting, and in palliative care.
 Objectives: The aim of this article is to summarize and provide a radiation therapy overview on the indications, effectiveness, and potential adverse events of radiotherapy in the adjuvant and advanced setting of CSCC.
 Methods: We performed a comprehensive literature review on PubMed, adopted as our biomedical literature database. Articles were selected based on their date of publication (in the last 30 years) and relevance. 
 Results: Radiotherapy (RT) can safely be used to manage non-surgical patients and high-risk patients in the advanced CSCC setting. The remarkable progress of delivery techniques has greatly improved the effectiveness and toxicity profile of RT treatments. From 2D techniques to intensity modulated radiation therapy (IMRT), and brachytherapy, all RT techniques have greatly advanced. To improve acute and chronic side effects, deeper care has been used. As regards CSCC, several dose fractionations and schedules have been suggested, in line with the patient’s age and medical conditions.
 Conclusions: RT is a fundamental and constantly evolving therapeutic option in the treatment of CSCC, to minimize the risk of recurrence and metastases in the adjuvant setting and in the exclusive treatment for non-surgical patients. Patients’ selection is crucial, together with and a collaborative team working approach among the specialists involved in disease management in the perspective of the best multidisciplinary assessment.

Characteristics and management of skin cancers in very elderly patients: A real‐world challenge for clinicians

“…in the literature, depending on multiple factors, including tumour histotype, location and size. [41][42][43][44] A meta-analysis reported a recurrence rate of 3,5% of BCC after radiation therapy, similar to that after surgery while a systematic review reported an average local recurrence of SCC after radiotherapy of 6.4%, non-significantly higher than thar after Mohs microsurgery (3%) or standard surgical excision (5.4%). 45,46 In elderly patients with multiple comorbidities, hypofractionated schedules are applied to reduce treatment-related toxicity and the impact of treatment on patient's daily life by reducing the number of hospital visits.…”

“…Radiotherapy represents a valid alternative for primary treatment of NMSC in patients older than 60, when surgery is contraindicated, disfiguring or for difficult to access anatomical areas. Different irradiation techniques and schedules have been reported in the literature, depending on multiple factors, including tumour histotype, location and size 41–44 . A meta‐analysis reported a recurrence rate of 3,5% of BCC after radiation therapy, similar to that after surgery while a systematic review reported an average local recurrence of SCC after radiotherapy of 6.4%, non‐significantly higher than thar after Mohs microsurgery (3%) or standard surgical excision (5.4%) 45,46 .…”

Immunotherapy response in patients with cutaneous squamous cell carcinoma of head and neck with cranial nerve involvement

“…BWH considers the cumulative risk of risk factors when they are combined, which may also improve the accuracy of the AJCC-8. 17,18 While some experts suggest that adjuvant RT is fundamental and potentially an exclusive treatment option for patients with high risk cSCC, including those with PNI and who are not surgical candidates, 19 others recommend against RT unless affected nerves are ≥1 mm in diameter, positive or uncertain surgical margins, or other factors that are associated with poor outcomes are present. 10 For treatment of locally advanced, recurrent or metastatic cSCC that are surgically unresectable or not candidates for curative RT, there are two drugs that are approved: cemiplimab and pembrolizumab.…”

Recent Advances in Immunotherapy for Patients with Head and Neck Cutaneous Squamous Cell Carcinoma

“…Delayed toxicities can develop months to years following RT and are more frequently observed at higher dosages. Delayed toxicities may include changes in skin pigmentation, necrosis, atrophy, fibrosis, and secondary cancers [ 36 ].…”