ASTRO releases new radiation therapy guidelines to treat skin cancers

The American Society for Radiation Oncology (ASTRO) has updated its clinical guidelines for using radiation therapy to treat two of the most common types of skin cancers.

More than 5 million people are diagnosed with skin cancer in the U.S. each year, and more than 95% are categorized as basal or cutaneous squamous cell carcinoma (BCC or cSCC), according to ASTRO. The society’s new recommendations focus on when to use radiation treatment as a stand-alone approach or after surgery, and hopes to clear up some long-standing confusion.

"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," Phillip Devlin, MD, chair of the guideline task force and a radiation oncologist at Brigham and Women’s Hospital, in Boston, said in a statement.

Surgery is typically the approach used to remove cancerous lesions, but, unlike melanomas, BCC and cSCC can respond well to radiation therapy, making it a potentially viable option in the “curative and post-operative setting.”

The following are ASTRO’s clinical recommendations:

Radiation is “strongly” recommended in the definitive/curative setting for those with BCC or cSCC who can’t undergo surgical resection. Patients with certain genetic conditions may be sensitive to radiation and shouldn’t receive the therapy.

Patients in the adjuvant/ post-operative setting at high risk of recurrence following surgery are recommended to receive radiation. ASTRO also suggests the treatment should be used in those at high risk of recurrence after surgical resection, with some caveats.

In patients with BCC or cSCC that has spread to surrounding lymph nodes, ASTRO “strongly” recommends removing those affected nodes and then administering radiation. Therapy should not be given to patients with one small involved lymph node without “extracapsular spread.”

The “Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin: An ASTRO Clinical Practice Guideline” was created by a multidisciplinary group of experts who conducted a literature review of more than 1,500 articles. The document was published online Dec. 9 in Practical Radiation Oncology, where it is available for free.