The Role of Radiation Therapy in the Treatment of Non-Melanoma Skin Cancer

Abstract

Non-melanoma skin cancer (NMSC) is the most common malignancy in the United States. While surgery is considered as the main treatment modality for both cutaneous basal cell carcinoma (cBCC) and cutaneous squamous cell carcinoma (cSCC), radiotherapy plays an important role in the treatment of NMSC, both in the adjuvant setting for cases considered high-risk for recurrence, and in the definitive setting, when surgery is not feasible or desired by the patient. The last years have seen the emergence of immunotherapy treatment for cases of advanced cSCC in the palliative, and possibly neoadjuvant settings, making the treatment paradigm more complex. In this review, we attempt to describe the different radiation modalities available for the treatment of NMSC, the indications for adjuvant post-operative treatment with radiotherapy for cSCC, the role of radiotherapy in elective neck treatment, and the efficacy, safety, and toxicity profile of this treatment in these different settings. Furthermore, we aim to describe the efficacy of radiotherapy combined with immunotherapy as a promising horizon for treating advanced cSCC. We also aim to describe the ongoing clinical studies that attempt to examine future directions for the role of radiation treatment in NMSC.

Randomized phase II selection trial of FLASH and conventional radiotherapy for patients with localized cutaneous squamous cell carcinoma or basal cell carcinoma: A study protocol

“…Regarding efficacy in each of the two arms, if the safety question is satisfied then the hierarchically tested primary endpoint local tumor control rate (π e ; number of lesions without relapse over the total number of randomized lesions) will be evaluated in the 48 lesions in the specific arm, assuming that the targeted local tumor control rate is ≥ 90 % [9] .…”

Definitive superficial radiotherapy for challenging skin cancers – a case series of experiences and learnings

“…Keratinocyte cancers, or non-melanoma skin cancers such as basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), are the most common cancers in Australia and the United States. 1,2 Known risk factors for developing keratinocyte cancers include fair complexion, advancing age, immunosuppression, and chronic ultraviolet radiation. 3 While surgery remains the main treatment modality for keratinocyte cancers, definitive radiotherapy (RT) has a significant role.…”