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ASTRO issues new clinical guideline on radiation therapy for basal and squamous cell skin cancers

Press releases may be edited for formatting or style | December 10, 2019 Rad Oncology
ARLINGTON, Va., December 10, 2019 — A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides recommendations on the use of radiation therapy to treat patients diagnosed with the most common types of skin cancers. The guideline details when radiation treatments are appropriate as stand-alone therapy or following surgery for basal and cutaneous squamous cell carcinomas (BCC, cSCC), and it suggests dosing and fractionation for these treatments. The executive summary and full-text version of ASTRO's first guideline for skin cancer are published online in Practical Radiation Oncology.

Skin cancer is the most prevalent cancer in the United States, with more than 5 million cases diagnosed each year. More than 95% of these diagnoses are BCC or cSCC, which, in contrast to melanomas, respond well to radiation therapy if treated promptly and properly. Although surgery to remove the lesion is considered the primary approach for definitive/curative treatment of these non-melanoma skin cancers, radiation therapy can play an integral role in both the curative and post-operative settings.

ASTRO developed the new guideline to provide clarity about treatment options. "There is significant variation in practice about when and how radiation should be used for non-melanoma skin cancers, largely because few randomized studies have compared modern treatment options head-to-head," explained Phillip Devlin, MD, FASTRO, chair of the guideline task force and a radiation oncologist at Brigham and Women's Hospital in Boston.

"For this guideline, we drew on the consensus of a multidisciplinary group of leading experts, as well as a systematic review of the evidence, to help physicians understand when radiation is most likely to benefit their patients and to encourage informed discussion about treatment options," added Anna Likhacheva, MD, MPH, vice chair of the guideline task force and a radiation oncologist with Sutter Medical Group in Sacramento.

Recommendations for Radiation Therapy for BCC and cSCC

The guideline first defines appropriate indications for radiation therapy (1) as definitive/curative treatment for BCC and cSCC, (2) as adjuvant treatment following surgery and (3) as definitive or adjuvant treatment for disease that has spread to a patient's regional lymph nodes. Recommendations are as follows:

In the definitive/curative setting, radiation is strongly recommended for patients with BCC or cSCC who cannot undergo or decline surgical resection. It is conditionally recommended for patients with BCC or cSCC located in anatomically sensitive areas such as the nose or lips, where surgery could compromise function or cosmetic outcomes. Definitive radiation therapy is discouraged, however, for patients with genetic conditions that predispose them to be more sensitive to radiation.

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