The role of radiotherapy in the management of non‐melanoma skin cancer

Abstract

The global incidence of non-melanoma skin cancer continues to increase as the global population ages with the highest incidence in the world occurring in Australian and New Zealand patients. There are numerous treatment options available for non-melanoma skin cancer patients of which radiotherapy is an efficacious and versatile tissue preserving nonsurgical (or medical) option. In patients where excision may not be an option (medically/technically inoperable) or considered less ideal (e.g. cosmetic outcome), radiotherapy offers an excellent option. Following surgery, adjuvant radiotherapy in patients with unfavourable pathology can decrease the risk of recurrence and associated morbidity. Elderly and co-morbid patients with poor performance status can benefit from short-course hypofractionated radiotherapy in the setting where surgery is not an option. As with any modality, radiotherapy has advantages and disadvantages and it is therefore important for clinicians to appreciate these. We aim to present an update for clinicians that manage patients with non-melanoma skin cancer on the role of radiotherapy.

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment

“…Prescribed dose must encompass all visible tumour plus an appropriate variable margin (clinical target volume), sparing as much as possible of the surrounding healthy structures [52,53]. Irrespective of treatment intent (definitive, adjuvant and palliative), dosimetric and technical considerations should be surveyed by a certified radiation oncologist.…”

Merkel Cell Carcinoma Treatment in Finland in 1986–2016—A Real-World Data Study

“…MCC is a radiosensitive tumour [21]. Several studies have found that RT as an adjuvant treatment to MCC improves both locoregional control and patient overall and disease-free survival, regardless of excision margin status [14,21,22]. However, RT is not given to all MCC patients, often because the treatment can be strenuous, and the patients are usually elderly and may be suffering from comorbidities.…”

HDR brachytherapy with individual epithetic molds for facial skin cancer: techniques and first clinical experience

“…3 In addition, definitive RT can be considered as a viable alternative in nonsurgical patients with malignant melanoma in situ or lentigo maligna with dosing regimens ranging from 32 to 70 Gy. 5 Despite its curative potential, 6 definitive EBRT is associated with some technique-specific aspects that should be taken into account: Standard fractionated EBRT takes several weeks, which may challenge treatment adherence especially in frail elderly patients. Furthermore, in anatomical locations of close proximity to critical organs at risk (OARs) and irregular shape or strong curvatures, such as the perinasal/periorbital region, EBRT cannot achieve sufficient target coverage without compromising conformity leading to unavoidable higher dose exposure of healthy surrounding structures.…”

“…For anatomical locations difficult to access with standard applicators, individually adapted molds have been described. 7,8 Even if several BRT trials have reported excellent local control and good cosmetic outcome for NMSC, 6,9 NCCN guidelines recommend BRT only for highly selected cases without further defining dose and fractionation. 10,11 Filling this gap, the ESTRO recommendations for skin BRT suggest treatment schedules at 3-5 Gy per fraction, twicedaily to twice-weekly, up to a total physical dose of 40-60 Gy.…”