Efficacy
There is a paucity of randomised data comparing different treatment methods, with a Cochrane review by Bath-Hextall et al. reporting surgery or radiation therapy as the most effective, with surgery demonstrating the lowest recurrence rates for basal cell carcinoma (BCC).r Reported rates following radiation therapy for local control are 90-95% and excellent or good cosmesis in >90% of patients.r
Radiation therapy may be considered as a primary treatment in patients who are not candidates for surgery (e.g. locally advanced disease, comorbidities or patient declines surgery) or in cases when curative surgery is not possible, could be disfiguring or burdened by poor aesthetic outcome.r This includes BCCs located on the face (i.e. eyelid, nose, lip) or large lesions on the ear, forehead or scalp.r
A recent systematic review and network meta-analysis on primary BCC, analysed and compared 40 randomised trials and 5 non-randomised studies with variable follow-up, which reported an estimated recurrence rate of 3.5% after radiation therapy. This is comparable with rates following surgery (3.8%) and Mohs surgery (3.8%).r The role of radiation therapy in the management of early skin cancers is well established when patient and tumour factors favour a better cosmetic and functional outcome when compared to surgical excision. For small tumours (those less than 2 cm), the 5-year cure rates for primary BCC and SCC are 90-93% which are similar to other reported treatment methods.r
Locke et al. reported on a retrospective review of 468 patients with a total of 531 lesions (BCC = 389; SCC = 142). Patients were treated with definitive radiation therapy and the median follow-up was 5.8 years.r Findings included:
- The local control rate for previously untreated lesions (less than 2 cm) was 96% (BCC) and 95% (SCC). For tumours greater than 5 cm (T3), local control rates were 94% (BCC) and 86% (SCC). There was a small number of patients with advanced disease included in this study.
- Recurrent tumours in all categories had lower control rates.
- Multivariate analysis showed that local failure was related to the daily dose fractionation.
- The maximum diameter of the lesion and tumour type were also significant.
Local control based on tumour stage
Tumour stage |
BCC |
SCC
|
T1 |
96% |
95% |
T2 |
90% |
86% |
T3 |
94% |
86% |
T4 |
100% |
75% |
© Int J. Radiat Oncol Biol Phys 2001r