Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients

Lee, Charles T.; Lehrer, Eric J.; Aphale, Abhishek; Lango, Miriam; Galloway, Thomas J.; Zaorsky, Nicholas G.

doi:10.1002/cncr.32371

Cited by 33 publications

(14 citation statements)

References 94 publications

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“…Patients with NMSC in areas, which are cosmetically sensitive, are not ideal candidates for resection, particularly in cases where an extensive surgical defect may result or if a complex reconstruction is required. Preservation of tissue may be more achievable by radiotherapy for these patients, leading to improved cosmetic outcomes without increasing the risk of local failure [ 39 , 40 ]. A large-scale systematic review and pooled analysis found no statistically significant difference between local recurrence rates of SCC of the skin after Mohs micrographic surgery, external beam radiotherapy, and brachytherapy [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Computed tomography-based flap brachytherapy for non-melanoma skin cancers of the face

Gogineni¹,

Cai²,

Carillo³

et al. 2021

jcb

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Purpose Non-melanoma skin cancers of the face are at high-risk for local recurrence and metastatic spread. While surgical interventions such as Mohs microsurgery are considered the standard of care, this modality has the potential for high rates of toxicity in sensitive areas of the face. Catheter flap high-dose-rate (HDR) brachytherapy has shown promising results, with high rates of local control and acceptable cosmetic outcomes. Material and methods Patients with non-melanoma skin cancers (NMSC) located on the face were treated with 40 Gy in 8 fractions, given twice weekly via catheter flap HDR brachytherapy. Clinical target volume (CTV) included the visible tumor plus a margin of 5 mm in all directions, with no additional planning target volume (PTV) margin. Results Fifty patients with 53 lesions on the face were included, with a median follow-up of 15 months. All were considered high-risk based on NCCN guidelines. Median tumor size and thickness were 18 mm and 5 mm, respectively. Median PTV volume and D 90 were 1.7 cc and 92%, respectively. Estimated rate of local control at twelve months was 92%. Three patients (5%) experienced acute grade 2 toxicity. Two patients (4%) continued to suffer from chronic grade 1 skin toxicity at 12 months post-radiotherapy (RT), with an additional two patients (4%) experiencing chronic grade 2 skin toxicity. Forty-nine lesions (92%) were found to have a good or excellent cosmetic outcome with complete tumor remission. Conclusions CT-based flap applicator brachytherapy is a valid treatment option for patients with NMSC of the face. This modality offers high rates of local control with acceptable cosmetic outcomes and low rates of toxicity.

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Section: Discussionmentioning

confidence: 99%

Computed tomography-based flap brachytherapy for non-melanoma skin cancers of the face

Gogineni¹,

Cai²,

Carillo³

et al. 2021

jcb

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“…RT may be used in first line in patients unable to undergo surgical resection, such as cosmetic or frail patients, to avoid significantly disfiguring surgery or orbital exenteration or in patients too frail to undergo general anaesthesia. A recent meta-analysis involving 21,000 patients showed comparable, extremely low one-year recurrence rates for both surgery and RT: 0.8%, 0.2%, 2%, and 0% for surgical excision, MMS, external beam irradiation, and brachytherapy (BT), respectively, and excellent cosmesis [55]. Different RT techniques, such as external beam RT, BT or electronic low energy sources (ELS), and schedules (i.e., normal fractionation or hypofractionation) can be selected depending on the expertise of the hospital.…”

Section: Role Of Radiotherapymentioning

confidence: 99%

Update on Management Recommendations for Advanced Cutaneous Squamous Cell Carcinoma

Garcı́a-Foncillas

Tejera‐Vaquerizo²,

Sanmartín

et al. 2022

Cancers

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Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, the incidence of which has risen over the last years. Although cSCC rarely metastasizes, early detection and treatment of primary tumours are critical to limit progression and local invasion. Several prognostic factors related to patients’ clinicopathologic profile and tumour features have been identified as high-risk markers and included in the stratification scales, but their association with regional control or survival is uncertain. Therefore, decision-making on the diagnosis and management of cSCC should be made based on each individual patient’s characteristics. Recent advances in non-invasive imaging techniques and molecular testing have enhanced clinical diagnostic accuracy. Surgical excision is the mainstay of local treatment, whereas radiotherapy (RT) is recommended for patients with inoperable disease or in specific circumstances. Novel systemic treatments including immunotherapies and targeted therapies have changed the therapeutic landscape for cSCC. The anti-PD-1 agent cemiplimab is currently the only FDA/EMA-approved first-line therapy for patients with locally advanced or metastatic cSCC who are not candidates for curative surgery or RT. Given the likelihood of recurrence and the increased risk of developing multiple cSCC, close follow-up should be performed during the first years of treatment and continued long-term surveillance is warranted.

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“…With regard to cosmetic outcomes, a meta-analysis of 58 studies and 21,000 patients reported both brachytherapy and MMS as having improved cosmesis over external beam radiation and standard excision; recurrence rates at one year were similar across the modalities [ 82 ]. Another RCT of facial BCCs treated surgically or with RT revealed superior cosmetic results as assessed by dermatologists and patients at 4-years post-treatment [ 83 ].…”

Section: Topical Intralesional and Field Treatmentsmentioning

confidence: 99%

Advances in Management and Therapeutics of Cutaneous Basal Cell Carcinoma

Chen

Kim²,

Steele³

et al. 2022

Cancers

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Basal cell carcinoma (BCC), the most common cancer in humans, is a malignant neoplasm of cells derived from the basal layer of the epidermis. Tumor characteristics such as histologic subtype, primary versus recurrent tumor, anatomic location, size, and patient attributes determine the risk level and acceptable treatment options. Surgical options offer histologic confirmation of tumor clearance. Standard excision provides post-treatment histologic assessment, while Mohs micrographic surgery (MMS) provides complete margin assessment intraoperatively. Additional treatment options may be employed in the correct clinical context. Small and low-risk BCCs, broad field cancerization, locally-advanced disease, metastatic disease, cosmetic concerns, or morbidity with surgical approaches raise consideration of other treatment modalities. We review herein a range of treatment approaches and advances in treatments for BCC, including standard excision, MMS, electrodesiccation and curettage, ablative laser treatment, radiation therapy, targeted molecular therapies, topical therapies, field therapies, immunotherapy, and experimental therapies.

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Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients

Cited by 33 publications

References 94 publications

Computed tomography-based flap brachytherapy for non-melanoma skin cancers of the face

Computed tomography-based flap brachytherapy for non-melanoma skin cancers of the face

Update on Management Recommendations for Advanced Cutaneous Squamous Cell Carcinoma

Advances in Management and Therapeutics of Cutaneous Basal Cell Carcinoma

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