Introduction An image-guided form of superficial ionizing radiation therapy (IGSRT) is becoming a commonly used alternative to surgery for non-melanoma skin cancer (NMSC). However, there is little literature evidence evaluating the efficacy and safety of this approach. This study evaluates the efficacy and safety of IGSRT in treating a large number of patients with NMSC. Methods The medical records of 1632 stage 0–II patients with 2917 invasive and in situ NMSC lesions treated from years 2017 to 2020 were reviewed. No patients had clinical evidence of regional lymph node or distant disease at presentation. Results Treatment, guided by pre-treatment ultrasound imaging to adjust radiation energy and dose, combined with a fractionation treatment schedule of 20 or more treatment fractions, was safe and well tolerated. Of 2917 NMSC lesions treated, local tumor control was achieved in 2897 lesions, representing a 99.3% rate of control. Conclusion IGSRT should be considered as a first-line option for treating NMSC tumors in suitable early stage patients. Cure rates observed in this initial period of follow-up are similar, and potentially superior with further follow-up, to traditional superficial radiation therapy (SRT) and surgical options. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-021-00138-4.

Introduction: Non-Melanoma Skin Cancer (NMSC) is generally treated in dermatology offices using surgical techniques.Objectives: We evaluate the feasibility, tolerance, effectiveness and cosmesis using an office-based non-surgical modality for NMSC.Methods: 93 patients with 133 pathologically confirmed early stage invasive and in-situ NMSC lesions treated with Image-Guided Superficial Radiation Therapy (IGSRT) were retrospectively analyzed. All lesions received a median of twenty fractions of 50 or 70 kilovoltage(kV) IGSRT. Energy selection and subsequent kV changes were determined by ultrasound imaging. RTOG toxicity scoring was used. Treatment interruption was defined as greater than 2 weeks. Results: Median age was 69. At an average follow-up of 16.23 months, 92 of 93 patients were alive. One patient expired from unrelated causes while no evidence of disease (NED). 132 of 133 lesions achieved local control (LC) with one lesion recurring at 12.9 months. Absolute LC was 99.2%, overall Kaplan-Meier LC (KM LC) was 98.95% at 30.8 months, and Disease Free Survival (DFS) was 100%. Acute toxicities were mild with RTOG grades 0, 1 or 2 in all lesions with no grade 3 or 4 toxicity. Cosmesis was felt to be excellent or very good (VG) by the clinicians with no fair/poor cosmesis. There were no severe toxicities or complications requiring treatment interruptions.Conclusions: Office based IGSRT is feasible, safe, easily tolerable, and highly effective. Patients receiving IGSRT achieve excellent/VG cosmesis and welcome this nonsurgical option. IGSRT is an attractive non-invasive therapeutic option for NMSC and provides another valuable tool for dermatologists.

Background To compare the effectiveness of high-resolution dermal ultrasound (US) guided superficial radiotherapy (SRT) to non-image-guided radiotherapy in the treatment of early-stage Non-Melanoma Skin Cancer (NMSC). Methods A high-resolution dermal ultrasound (US) image guided form of superficial radiation therapy (designated here as US-SRT) was developed in 2013 where the tumor configuration and depth can be visualized prior to, during, and subsequent to treatments, using a 22 megahertz (MHz) dermal ultrasound (US) with a doppler component. We previously published the results using this technology to treat 2917 early-stage epithelial cancers showing a high local control (LC) rate of 99.3%. We compared these results with similar American studies from a comprehensive literature search used in an article/guideline published by American Society of Radiation Oncology (ASTRO) on curative radiation treatment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and squamous cell carcinoma in-situ (SCCIS) lesions from 1988 to 2018. Only U.S. based studies with greater than 100 cases with similar patient/lesion characteristics and stages treated by external beam, electron, or superficial/orthovoltage radiation therapy were included in the criteria for selection. The resultant 4 studies had appropriate comparable cases identified and the data analyzed/calculated with regard to local control. Logistic regression analysis was performed comparing each study to US-SRT individually and collectively with stratification by histology (BCC, SCC, and SCCIS). Results US-SRT LC was found to be statistically superior to each of the 4 non-image-guided radiation therapy studies individually and collectively (as well as stratified by histology subtype) with p-values ranging from p < 0.0001 to p = 0.0438. Conclusions Results of US-SRT in local control were statistically significantly superior across the board versus non-image-guided radiation modalities in treatment of epithelial NMSC and should be considered a new gold standard for treatment of early-stage cutaneous BCC, SCC, and SCCIS.

Background: Hidradenitis suppurativa (HS) negatively impacts quality of life. Objective: To find how HS Hurley and Severity Assessment of Hidradenitis Suppurativa (SAHS) relate to scores on Dermatology Quality of Life Index (DQLI) and Beck Depression Inventory (BDI). Methods: Cross-sectional study run Oct. 2018-Feb. 2019. Eligibility: age 12+ and a clinical visit for HS. Exclusions: declined involvement; English or French illiteracy; known depression or mental health disorder as defined by DSM-5 criteria. Survey instruments: DLQI and BDI. Results: 50 patients participated. Mean age: 37.94 AE 15.68 years, mostly women (n¼28; 56%), mostly self-identified Caucasian (n¼33; 66%). Hurley staging of the patients showed 12 (24%) stage I, 16 (32%) stage II and 22 (44%) stage III. Mean DLQI score was highest (poor quality of life) for stage III (16.95 AE8.68) followed by stage II (11.00AE7.45) and stage I (5.17AE4.49). One-way ANOVA analysis found no statistically significant differences in the mean BDI scores based on Hurley staging alone, p ¼ 0.32. Linear regression found SAHS score had a statistically significant (p ¼ 0.027) effect on BDI score, with score for severe disease (SAHS !9) significantly higher (p ¼ 0.04) than for mild disease. Visual analogue scale (VAS) for pain did not reach statistical significance (p ¼ 0.075) based on BDI scale. Statistically significant associations existed between DLQI and smoking history (p ¼ 0.04); Hurley stage III disease (p ¼ 0.0004); higher clinical severity based on pain score (p < 0.0001) and SAHS raw score (p ¼ 0.0016). Linear regressions were used to find variables for modeling BDI and DLQI. Variables associated with higher DLQI included Hurley stage III, smoking history, and pain score; disease duration was associated with decreased DLQI. Variables associated with increasing BDI included SAHS score and smoking history, female sex and non-Caucasian origin. Conclusion: BDI-based depression severity does not correlate with clinical severity of HS based on Hurley stages, but advanced stages have greater impact on quality of life using DLQI.

No abstract