Adjuvant radiotherapy may not significantly change outcomes in high-risk cutaneous squamous cell carcinomas with clear surgical margins: A systematic review and meta-analysis

Kim, Yesul; Lehrer, Eric J.; Wirth, Paul; Khesroh, Eiman; Brewer, Jerry D.; Billingsley, Elizabeth M.; Zaorsky, Nicholas G.; Lam, Charlene

doi:10.1016/j.jaad.2021.11.059

Cited by 16 publications

(18 citation statements)

References 55 publications

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“… ( A ) Management of high-risk cSCC with positive surgical margins based on current guidelines. ( B ) Results from recently published studies on the use of adjuvant RT after surgery of high-risk cSCC with negative (clear) surgical margins [ 44 , 46 , 47 , 48 , 49 ]. …”

Section: Post-operative Rt For High-risk Cscc With Residual Disease A...mentioning

confidence: 99%

Section: Adjuvant Treatment For High-risk Cscc With Negative Surgical...mentioning

confidence: 99%

“…Recently published results comparing adjuvant RT to surgery alone have accumulated in patients with high-risk cSCC with clear surgical margins [ 44 , 46 , 47 , 48 , 50 ]. In the meta-analysis of Kim et al, in high-risk non-metastatic cSCC (any high-risk factor present) treated with margin-negative resection (29 retrospective, 2 prospective, 2 case series), there were no statistically significant differences in poor outcomes between surgery only and surgery with adjuvant RT [ 46 ]. On the other hand, the meta-analysis of Zhang et al reported lower recurrence, longer disease-free survival, and longer overall survival with adjuvant radiotherapy, but included primary as well as metastatic cSCC, and the benefit of adjuvant RT may have concerned nodal metastatic cSCC [ 50 ].…”

Section: Adjuvant Treatment For High-risk Cscc With Negative Surgical...mentioning

confidence: 99%

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Recent Advances in the Diagnosis and Management of High-Risk Cutaneous Squamous Cell Carcinoma

Dessinioti

Stratigos

2022

Cancers

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High-risk cSCC is defined as invasive cSCC staged as N0 (without detectable regional lymph nodes) and M0 (without distant metastasis), that has features associated with a higher risk of poorer prognosis. The focus of this review is on the recent advances in the diagnosis and management of high-risk cSCC. The interest in high-risk cSCC relies on its higher risk of progression to advanced cSCC, as it represents the main pool of cSCCs that give rise to advanced tumors. Assessment of the risk is thus particularly relevant for common cSCC to identify the few with a high-risk risk of local recurrence, metastasis, or disease-specific death among all other low-risk tumors. The timely diagnosis and effective treatment of high-risk cSCCs may halt their further progression and aim to prevent and lower the incidence of advanced cSCCs. Clearance of the tumor with negative surgical margins is the main goal of surgery, which is the primary treatment of cSCC. It seems that it is difficult to discern the group of high-risk cSCCs that may benefit from adjuvant RT, as a universal beneficial effect for a cSCC with any high-risk factor which was resected with clear surgical margins has not been established. In the case of a high-risk cSCC with positive margins after surgery, and re-excision not feasible, post-operative radiotherapy is performed when possible. Recommendations on further management are discussed. Regarding the follow-up of patients diagnosed with high-risk cSCC, factors to consider regarding the frequency and intensity of the follow-up schedule include the risk and possible time of occurrence of metastasis from cSCC.

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Section: Post-operative Rt For High-risk Cscc With Residual Disease A...mentioning

confidence: 99%

Section: Adjuvant Treatment For High-risk Cscc With Negative Surgical...mentioning

confidence: 99%

Section: Adjuvant Treatment For High-risk Cscc With Negative Surgical...mentioning

confidence: 99%

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Recent Advances in the Diagnosis and Management of High-Risk Cutaneous Squamous Cell Carcinoma

Dessinioti

Stratigos

2022

Cancers

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“…and indication ("RT was delivered at the discretion of the radiation oncologists") (25). A meta-analysis did not find significant differences in 3.867 (poor outcomes with clear margins) cSCC patients between surgery alone and surgery plus adjuvant RT (26). The effect of adjuvant RT in these highrisk cases of cSCCs remains unclear, and randomized studies are needed.…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

The State of the Art of Radiotherapy for Non-melanoma Skin Cancer: A Review of the Literature

et al. 2022

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Due to the general aging population and the fashion trend of sun exposure, non-melanoma skin cancer (NMSC) is rising. The management of NMSC is difficult and necessitates a multidisciplinary team (i.e., pathologists, dermatologists, medical oncologists, surgeons, and radiation oncologists). When surgery is not an option or will cause unacceptably functional morbidity, radiation therapy (RT) may be a preferable tissue-preserving option. Whether used alone or in conjunction with other treatments, RT has been shown to be quite effective in terms of cosmetic results and local control. Contact hypofractionated RT, brachytherapy, and electronic brachytherapy are all promising new treatments. However, rigorous, randomized trials are missing, explaining the disparity in dose, fractionation, and technique recommendations. Therefore, it is essential that interdisciplinary teams better understand RT modalities, benefits, and drawbacks. Our review will provide the role and indications for RT in patients with NMSC.

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“…1 High-risk cSCC represents a subgroup of this disease with higher risk of metastasis and death, 2 and management remains unclear due to a shortage of randomized controlled trials (RCTs). 3 We undertook Patient and Public Involvement (PPI) consultations with 13 patients and 3 carers with experience of cSCC, to explore their views about a trial that will investigate effectiveness of treating high-risk cSCC using surgical excision alone compared with surgery plus adjuvant radiotherapy. This PPI was crucial to ensure that a proposed trial is not just conducted on but also with patients 4 (representative quotes are provided in Table 1).…”

Section: Dear Editormentioning

confidence: 99%

Adjuvant radiotherapy in patients with high-risk cutaneous Squamous Cell Carcinoma After surgery (SCC-AFTER): patient and carer views regarding a proposed clinical trial

Nwolise

Rembielak

Fitzpatrick

et al. 2022

Clinical and Experimental Dermatology

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Adjuvant radiotherapy may not significantly change outcomes in high-risk cutaneous squamous cell carcinomas with clear surgical margins: A systematic review and meta-analysis

Cited by 16 publications

References 55 publications

Recent Advances in the Diagnosis and Management of High-Risk Cutaneous Squamous Cell Carcinoma

Recent Advances in the Diagnosis and Management of High-Risk Cutaneous Squamous Cell Carcinoma

The State of the Art of Radiotherapy for Non-melanoma Skin Cancer: A Review of the Literature

Adjuvant radiotherapy in patients with high-risk cutaneous Squamous Cell Carcinoma After surgery (SCC-AFTER): patient and carer views regarding a proposed clinical trial

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