Enhancing Cosmesis While Achieving High Cure Rates For Early Stage Non-Melanoma Skin Cancer In The Outpatient Dermatology Clinic Using A Novel Non-Invasive Modality

Zheng

et al. 2022

Preprint

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Background: Non-image-guided forms of radiotherapy (external radiation therapy [XRT], including superficial radiation therapy [SRT]), have been used to treat non-melanoma skin cancer (NMSC) for over a century. More recently, image-guided superficial radiation therapy (IGSRT), which allows visualization of tumor configuration and depth throughout treatment, is being used to treat NMSC with high local control (LC) rate. Methods: Two recent studies report the results of IGSRT. Further, the American Society of Radiation Oncology (ASTRO) has published a comprehensive review of studies examining XRT/SRT outcomes of which four high-quality, recent, evidence-based, large (with more than 100 cases), United States (U.S.) based studies exist. Using information from these six studies, we employ logistic regression to compare basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and squamous cell carcinoma in situ (SCCIS) treatment outcomes between IGSRT and XRT/SRT. Findings: IGSRT local control (LC) was statistically superior to each of the four large non-image-guided radiotherapy studies individually, collectively, and stratified by histologic subtype. Interpretation: IGSRT LC is superior to non-image guided radiotherapy LC for the treatment of early-stage epithelial cancers. We propose that because lower recurrence rates result in less economic, social, and psychological burden on patients, IGSRT could be considered the preferred standard for the non-surgical radiotherapeutic treatment of early-stage NMSC with LC comparable to Mohs micrographic surgery (MMS).

“…Data on the additional 133 histopathologic confirmed NMSC in 94 patients was previously published. 10…”

Section: Methodsmentioning

confidence: 99%

“…Data on the additional 133 histopathologic confirmed NMSC in 94 patients was previously published. 10 IGSRT outcomes included in the present analyses are from a conservative subset of the Yu study patients who have a follow-up of greater than 52 weeks; and are from the entire study population of the Moloney study.…”

Section: Methodsmentioning

confidence: 99%

High resolution dermal ultrasound (US) combined with superficial radiation therapy (SRT) versus non-image guided SRT or external beam radiotherapy (XRT) in early-stage epithelial cancer: a comparison of studies

Zheng

et al. 2022

Preprint

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“…BCC contributes to 65%-75% of skin cancers in whites and 20%-30% in people of color [6]. An estimated 5.03 to 5.23 million BCC lesions and between 200,000 to 400,000 SCC lesions are diagnosed yearly in the United States [4]. Central cancer registries do not generally collect data on basal cell and squamous cell carcinomas [7].…”

Section: Introductionmentioning

confidence: 99%

“…Between 1994-2014, the diagnosis and treatment of NMSC in the United States increased by 77% [2]. NMSC is the most frequently diagnosed cancer, with an 18-20 times higher incidence than melanoma [3, 4, 5]. The most recent estimate in 2012 revealed more than 5.4 million cases of NMSC treated in over 3.3 million patients [4].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Image-Guided Superficial Radiation Therapy (IGSRT) on the Treatment of Early Stage Non-Melanoma Skin Cancer (NMSC) in the Outpatient Dermatology Setting

Tran

Kaczmarski

et al. 2022

Preprint

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Background: Interest in the use of image-guidance superficial radiation therapy (IGSRT) for the treatment of early-stage Non-Melanoma Skin Cancer (NMSC) has resurfaced given its low complication rates, superior cosmesis and local control and cure rates. Additionally, it has been recommended by the American Academy of Dermatology (AAD) for early-stage NMSC in patients who either refuse surgical intervention or are considered poor surgical candidates. Methods: 1899 NMSC lesions were treated with energies ranging from 50 to 100 kilovoltage (kV), for a mean of 20.2 fractions, and treatment dose of 5364.4 centigray (cGy). Lesions were treated for a mean of 7.5 weeks and followed for 65.5 weeks. The Radiation Treatment Oncology Group (RTOG) toxicity scoring system was used to grade acute toxicities. Patients were followed after treatment completion until No Evidence of Disease (NED) was achieved or failure/recurrence. SAS studio was used to conduct Kaplan-Meier analysis to calculate local control rates and account for differences in follow-up intervals. A log-rank test was used to calculate statistical differences between histologies. Results: 71.9% of lesions received a RTOG grade of 1. Absolute lesion control was achieved in 99.7% of the patients after an average of 7.5 weeks of treatment, with a stable control rate of 99.6% when the follow-up duration was over 12 months. Conclusion: IGSRT has a high safety profile, can achieve superior cosmesis and should be considered first-line for treating early-stage NMSC tumors as cure rates have been shown to be effective in all NMSC on early follow-up.

Analysis of image-guided superficial radiation therapy (IGSRT) on the treatment of early-stage non-melanoma skin cancer (NMSC) in the outpatient dermatology setting

Tran

J Cancer Res Clin Oncol

Kaczmarski

et al. 2023

Self Cite

Background Interest in image-guidance superficial radiation therapy (IGSRT) for the treatment of early-stage non-melanoma skin cancer (NMSC) has resurfaced given its low complication rates, superior cosmesis and local control and cure rates. In addition, it has been recommended by the American Academy of Dermatology (AAD) for early-stage NMSC in patients who are considered poor surgical candidates. Methods 1899 NMSC lesions were treated with energies ranging from 50 to 100 kilovoltage (kV), for a mean of 20.2 fractions, and treatment dose of 5364.4 centigray (cGy). Lesions were treated for a mean of 7.5 weeks and followed for 65.5 weeks. SAS studio was used to conduct Kaplan–Meier analysis to calculate local control rates and account for differences in follow-up intervals. A log-rank test was used to calculate statistical differences between histologies. Results Absolute lesion control was achieved in 99.7% of the patients after an average of 7.5 weeks of treatment, with a stable control rate of 99.6% when the follow-up duration was over 12 months. 95% of lesions with toxicity scoring received a Radiation Treatment Oncology Group Toxicity (RTOG) score of 1 or 2. Conclusion IGSRT has a high safety profile, can achieve superior cosmesis and should be considered first-line for treating early-stage NMSC tumors as cure rates have been shown to be effective in all NMSC on early follow-up.