Efficacy of hypofractionated radiotherapy in patients with non‐melanoma skin cancer: Results of a systematic review

Abstract

Radiation oncologists are increasingly tasked with the management of elderly patients with non-melanoma skin cancer, unsuitable for surgical intervention due to inoperable lesions and/or poor performance status. In this cohort, hypofractionated radiotherapy, delivered either daily, alternative daily or once weekly is highly effective. A systematic literature search was conducted of PUBMED, MEDLINE and EMBASE databases using the algorithm ('radiotherapy' OR 'radiation therapy' OR 'brachytherapy') AND ('hypofraction' OR 'hypofractionated' OR 'hypofractionation') AND ('skin neoplasms' OR 'carcinoma' OR 'malignancy') AND ('skin' OR 'epidermis' OR 'epidermal' OR 'cutaneous'). Forty relevant publications (1983-2017) encompassing 12,337 irradiated lesions were retrieved. Studies documented a mean age of 71.73 years and male predilection (54.5%). Both external beam radiotherapy and brachytherapy were utilized. Tumour subtype was squamous cell carcinoma (23.5%), basal cell carcinoma (75.2%) or others (1.3%). Irradiated lesions were primary (or denovo) (92.6%), located on the head and neck (95.7%) and received definitive therapy (96.5%). Analysis demonstrated a mean weighted total radiotherapy dose (38.15 Gy), dose per fraction (7.95 Gy) and treatments per week (2.98). Despite significant heterogeneity in the study population, the radiotherapy delivered and follow-up, local recurrence rate (crude or Kaplan-Meier analysis) did not exceed 7.9% in all but three of the 36 publications providing these data. Twenty-nine publications documented local control exceeding 90%. There is a body of evidence documenting the efficacy of hypofractionated radiotherapy as an option that confers no obvious disadvantage in local control when compared to traditional more protracted radiotherapy schedules.

Cetuximab‐radiotherapy combination in the management of locally advanced cutaneous squamous cell carcinoma

“…Non‐surgical treatment of cSCC is challenging, as patients are often elderly, and present with advanced medical co‐morbidities . In the setting of inoperable disease, patients are often treated with radiotherapy alone, especially hypofractionated radiotherapy which, while efficacious, may provide disease control for only half of this patient population . We prospectively evaluated the safety and efficacy of combining cetuximab with radiation therapy for selected patients with newly diagnosed or recurrent LA‐cSCC, and demonstrate efficacy with acceptable toxicity.…”

Palliative Radiotherapy for Cutaneous Squamous Cell Carcinoma of the Head-and-Neck Region

“…Late toxicities did not exceed grade 1, and cosmetic outcomes were mainly good or excellent (10). In a systematic review of Gunaratne and Veness, total doses of 30-40 Gy with 1-3 fractions of 5-7 Gy per week resulted in excellent local control and tolerable toxicity (15). In 2018, Fogarty et al presented a split-course regimen, which consisted of 5×5 Gy over one week followed by an 8-week break and another course of 5×5 Gy if complete response was not yet achieved (16).…”

A small case series about safety and effectiveness of a hypofractionated electron beam radiotherapy schedule in five fractions for facial non melanoma skin cancer among frail and elderly patients

“…Also the recent review by Gunaratne et al [17] encourages the use of hypofractionation in the frail elderly patient, where the reduction of the overall treatment time is often crucial to comply with prescription directions, and promotes the schedules with 1-3 sessions per week and a dose/fraction of 5-7 Gy for a total dose between 30 and 40 Gy as more effective and tolerable.…”