News | Radiation Therapy | December 11, 2019

ASTRO Issues New Clinical Guideline on Radiation Therapy for Basal and Squamous Cell Skin Cancers

Recommendations define how and when radiation therapy should be used to treat the most common types of skin cancer

Image courtesy of Elekta 

December 11, 2019 — A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides recommendations on the use of radiation therapy to treat patients diagnosed with the most common types of skin cancers. The guideline details when radiation treatments are appropriate as stand-alone therapy or following surgery for basal and cutaneous squamous cell carcinomas (BCC, cSCC), and it suggests dosing and fractionation for these treatments. The executive summary and full-text version of ASTRO's first guideline for skin cancer are published online in Practical Radiation Oncology.

Skin cancer is the most prevalent cancer in the United States, with more than 5 million cases diagnosed each year. More than 95 percent of these diagnoses are BCC or cSCC, which, in contrast to melanomas, respond well to radiation therapy if treated promptly and properly. Although surgery to remove the lesion is considered the primary approach for definitive/curative treatment of these non-melanoma skin cancers, radiation therapy can play an integral role in both the curative and post-operative settings.

ASTRO developed the new guideline to provide clarity about treatment options. "There is significant variation in practice about when and how radiation should be used for non-melanoma skin cancers, largely because few randomized studies have compared modern treatment options head-to-head," explained Phillip Devlin, M.D., FASTRO, chair of the guideline task force and a radiation oncologist at Brigham and Women’s Hospital in Boston.

"For this guideline, we drew on the consensus of a multidisciplinary group of leading experts, as well as a systematic review of the evidence, to help physicians understand when radiation is most likely to benefit their patients and to encourage informed discussion about treatment options," added Anna Likhacheva, M.D., M.Ph., vice chair of the guideline task force and a radiation oncologist with Sutter Medical Group in Sacramento.

Recommendations for Radiation Therapy for BCC and cSCC

The guideline first defines appropriate indications for radiation therapy (1) as definitive/curative treatment for BCC and cSCC, (2) as adjuvant treatment following surgery and (3) as definitive or adjuvant treatment for disease that has spread to a patient's regional lymph nodes. Recommendations are as follows:

  • In the definitive/curative setting, radiation is strongly recommended for patients with BCC or cSCC who cannot undergo or decline surgical resection. It is conditionally recommended for patients with BCC or cSCC located in anatomically sensitive areas such as the nose or lips, where surgery could compromise function or cosmetic outcomes. Definitive radiation therapy is discouraged, however, for patients with genetic conditions that predispose them to be more sensitive to radiation.
  • In the adjuvant/post-operative setting, radiation following surgery is recommended for patients at high risk of cancer recurrence, including a strong recommendation when there is evidence that BCC or cSCC has spread to a patient's nerves. Post-operative radiation is also recommended for patients at high risk of recurrence following surgical resection, including strong recommendations for high-risk patients with cSCC and conditional recommendations for high-risk patients with the relatively less aggressive BCC. Recommendations also outline prognostic features that indicate which patients are at greater risk for recurrence and spread.
  • For patients with BCC or cSCC that has spread to regional lymph nodes, surgical removal of the affected lymph nodes followed by radiation is strongly recommended for both BCC and cSCC, although not for patients with one small involved lymph node without extracapsular spread. The guideline also strongly recommends definitive radiation for patients with regional cSCC spread who cannot undergo surgery.

Recommendations address technical aspects of radiation therapy, suggest dosing and fractionation schedules and include a brief discussion of the different types of radiation delivery methods. The task force concluded that the appropriate use of any of the major radiation modalities results in similar cancer control and cosmetic outcomes. The guideline also considers the use of drug therapies such as chemotherapy, biologic and immunotherapy agents in combination with radiation.

About the Guideline

The guideline was based on a systematic literature review which produced more than 1,500 articles, of which 143 (published from May 1988 through June 2018) were then carefully evaluated. The task force included a multidisciplinary team of radiation, medical and surgical oncologists, a radiation oncology resident, medical physicist, dermatologist and dermatopathologists. The guideline was developed in collaboration with the American Society of Clinical Oncology (ASCO) and the Society of Surgical Oncology (SSO), who provided representatives and peer reviewers.

ASTRO's clinical guidelines are intended as tools to promote appropriately individualized, shared decision-making between physicians and patients. None should be construed as strict or superseding the appropriately informed and considered judgments of individual physicians and patients.

For more information: www.astro.org

Related Content

Novel scanners may open door for prognostic assessment in patients receiving cochlear implants

Iva Speck, MD, explains research showing that novel, fully digital, high-resolution positron emission tomography/computed tomography imaging of small brain stem nuclei can provide clinicians with valuable information concerning the auditory pathway in patients with hearing impairment. The research is featured in The Journal of Nuclear Medicine (read more at http://jnm.snmjournals.org/content/current). Video courtesy of Iva Speck, University Hospital Freiburg, Germany.

News | PET-CT | March 26, 2020
March 26, 2020 — Novel, fully digital, high-resolution...
Varian received FDA clearance for its Ethos therapy in February 2020. It is an adaptive intelligence solution that uses onboard AI in the treatment system to take the cone beam CT imaging on the system, compare it to the treatment plan and deliver an entire adaptive treatment plan in a typical 15-minute treatment time slot, from patient setup through treatment delivery.

Varian received FDA clearance for its Ethos therapy in February 2020, shown here displayed for the first time at ASTRO 2019. It is an adaptive intelligence solution that uses onboard AI in the treatment system to take the cone beam CT imaging on the system, compare it to the treatment plan and deliver an entire adaptive treatment plan in a typical 15-minute treatment time slot, from patient setup through treatment delivery.

Feature | Treatment Planning | March 19, 2020 | Dave Fornell, Editor
The traditional treatment planning process takes days to create an optimized radiation therapy delivery plan, but new
Age‐standardized, delay‐adjusted overall cancer incidence rates for 2012 through 2016 are illustrated among males and females by racial/ethnic group

Age‐standardized, delay‐adjusted overall cancer incidence rates for 2012 through 2016 are illustrated among males and females by racial/ethnic group. Racial/ethnic groups are mutually exclusive. Data for the non‐Hispanic American Indian/Alaska Native (AI/AN) population are restricted to Indian Health Service Purchased/Referred Care Delivery Area (PRCDA) counties. API indicates Asian/Pacific Islander. Chart courtesy of ACS Journals 

News | Radiation Oncology | March 16, 2020
March 16, 2020 — The Ann...
 “Cyclotrons used in Nuclear Medicine Report & Directory, Edition 2020” that describes close to 1,500 medical cyclotrons worldwide
News | Nuclear Imaging | March 10, 2020
March 10, 2020 — MEDraysintell released its new and unique report “...
Accuray Incorporated announced that Mercy Hospital St. Louis continues to demonstrate its commitment to improving patient outcomes with the installation of the first CyberKnife M6 System in Missouri at their state-of-the-art David C. Pratt Cancer Center
News | Stereotactic Body Radiation Therapy (SBRT) | February 27, 2020
February 27, 2020 — Accuray Incorporated announced that Mercy
An example of the MRI scans showing long-term and short-term survival indications. #MRI

An example of the MRI scans showing long-term and short-term survival indications. Image courtesy of Case Western Reserve University

News | Magnetic Resonance Imaging (MRI) | February 21, 2020
February 21, 2020 — ...
Arizona State University researchers (in collaboration with Banner MD Anderson Cancer Center) have discovered a biocompatible cost-effective hydrogel that can be used to monitor therapeutic doses of ionizing radiation by becoming more pink with increasing radiation exposure

Arizona State University researchers (in collaboration with Banner MD Anderson Cancer Center) have discovered a biocompatible cost-effective hydrogel that can be used to monitor therapeutic doses of ionizing radiation by becoming more pink with increasing radiation exposure. This picture shows a circle of hydrogel that was irradiated on the left half, which is slightly pink; whereas the right half of the gel is not irradiated and remains colorless.

News | Radiation Therapy | February 18, 2020
February 18, 2020 — More than half of all cancer patients undergo radiation therapy and the dose is critical.