Radiotherapy treatment for nonmelanoma skin cancer

Abstract

Non-melanoma skin cancer is the most common malignancy in the USA, with an estimated 3.5 million cases per year. Treatment options include surgical excision, radiation therapy (RT), photodynamic therapy and topical agents. Although surgical excision remains the mainstay of therapy, RT offers an effective alternative. RT can be used as an adjunct to surgery in high-risk situations, or in cases where surgical excision would lead to impaired cosmesis and/or functional outcomes. Radiation treatment modalities for non-melanoma skin cancers are diverse. Studies in the literature have examined the clinical effects of a wide variety of modalities, areas of the body and dosages. The most common modalities include superficial or orthovoltage RT, electron beam therapy and high dose-rate brachytherapy. This article aims to review the diverse radiotherapy treatment modalities for non-melanoma skin cancers, focusing on tumor control and toxicity.

Keywords:

• brachytherapy
• cosmesis and toxicity
• nonmelanoma skin cancer
• orthovoltage radiotherapy
• superficial radiotherapy

Acknowledgement

We would like to thank Mr. Ben Hemmelgarn for his assistance in the manuscript preparation.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Overall, local control and toxicities are demonstrated to be comparable among the various modalities. Different modalities have their own advantages and limitations.

• Superficial and orthovoltage x-ray radiotherapy treatments are effective for basal cell carcinoma and squamous cell carcinoma, with a more than 90% local control rate in most of clinical series.

• Electron beam radiotherapy provides equivalent local control rates but requires users’ attention to ensure adequate dose coverage and minimize dosimetric variance.

• High-dose rate provides expedite treatment option for patients, with equivalent tumor local control and cosmetic outcomes.