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  • Presentation

Radiation Therapy and the Skin: Uses and Toxicities

Description

The presentation covers the use of radiation therapy for various dermatologic diseases, emphasizing both malignant (non-melanoma skin cancers) and benign conditions like keloids. The speaker outlines how radiation is utilized when surgical options may compromise patient function or cosmetic outcomes, particularly in elderly or medically frail patients. The discussion includes insights on different treatment modalities, including hypofractionated and brachytherapy approaches, underscoring their benefits in terms of shorter treatment courses and improved patient compliance. The speaker reviews data from meta-analyses comparing radiation to conventional surgeries, noting that radiation can be effective for localized control while preserving aesthetics. He also discusses indications for postoperative radiation in cases with high recurrence risks, such as perineural invasion or positive margins. Although there is no consensus clinical guideline yet, a task force has been formed to address key areas regarding radiation therapy for skin cancers. The presentation further addresses the toxicity associated with radiation treatment, including acute and chronic side effects, with an emphasis on skin care measures to manage adverse reactions effectively. Overall, the session aims to inform attendees about the nuances of radiation therapy in skin-related conditions, advocating for its role in enhancing treatment outcomes.

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Conclusions

  • Radiation therapy (RT) is an effective treatment option for both benign and malignant dermatologic diseases, particularly when surgery is not possible or would compromise cosmesis.
  • Definitive RT is recommended for patients with basal cell carcinoma (BCC) and squamous cell carcinoma (cSCC) who cannot undergo surgery or have anatomical considerations affecting surgical options.
  • Adjuvant RT after surgical resection can improve outcomes in cases with close or positive margins, particularly in cSCC with perineural invasion or recurrent disease.
  • Meta-analysis suggests that local recurrence rates for conventional excision and RT are low, indicating RT's effectiveness, especially in challenging locations.
  • Hypofractionated RT can offer similar tumor control with improved patient compliance due to shorter treatment durations and fewer visits required, although it may lead to slightly worse cosmetic outcomes compared to conventional fractionation.
  • Brachytherapy provides a targeted approach with limited exposure to surrounding healthy tissue, making it beneficial for treating small, superficial tumors.
  • A shared decision-making approach to treatment plans between patients and healthcare providers yields better satisfaction and compliance.
  • Higher biologically effective dose (BED) correlates with better tumor control rates, supporting increased doses in select cases for enhanced efficacy.
  • Drucker AM, Adam GP, Rofeberg V, et al. Treatments of Primary Basal Cell Carcinoma of the Skin: A Systematic Review and Network Meta-analysis. Ann Intern Med. 2018;169(7):456-466.
  • Charles T. Lee, PharmD, MD ID1; Eric J. Lehrer, MD, MS (ID2; Abhishek Aphale, MD3; Miriam Lango, MD4; Thomas J. Galloway, MD1; and Nicholas G. Zaorsky, MD, MS ID 1,5,6. Surgical Excision, Mohs Micrographic Surgery, External-Beam Radiotherapy, or Brachytherapy for Indolent Skin Cancer: An International Meta-Analysis of 58 Studies With 21,000 Patients. Cancer 2019;125:3582-3594.
  • Likhacheva A, Awan M, Barker CA, Bhatnagar A, Bradfield L, Brady MS. Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin: An ASTRO Clinical Practice Guideline. Practical Radiation Oncology. 2019.
  • Shyam Rao, MD, PhD; Michael G. Moore, MD; D. Gregory Farwell, MD; Arnaud F. Bewley, MD. Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck. JAMA Otolaryngol Head Neck Surg. 2019;145(2):153-158.
  • Zaorsky NG, Lee CT, Zhang E, Keith SW, Galloway TJ. Hypofractionated radiation therapy for basal and squamous cell skin cancer: a meta-analysis. Radiother Oncol. 2017;125(1):13-20. doi:10.1016/j.radonc.2017.08.011.