From the Guidelines
Port radiotherapy is not the preferred treatment modality for basal skin cancer, and external beam radiation therapy is typically used instead. The primary treatment for basal cell carcinoma (BCC) is surgical excision with appropriate margins, which provides the highest cure rates 1. For patients who are not surgical candidates, definitive radiotherapy can be used as an alternative treatment modality. When radiotherapy is employed for BCC, it typically involves external beam radiation therapy delivered in multiple fractions over several weeks.
The standard radiotherapy regimen for BCC might include 45-55 Gy delivered in 15-25 fractions over 3-5 weeks, depending on tumor size, location, and patient factors 1. Radiotherapy works by damaging the DNA of cancer cells, preventing them from dividing and ultimately causing cell death. Side effects may include skin irritation, redness, and dryness in the treatment area.
- Key considerations for radiotherapy in BCC include:
- Tumor size and location
- Patient age and overall health
- Presence of high-risk features, such as perineural involvement
- Patient preferences and functional and cosmetic outcomes
- Alternative treatment options for high-risk or recurrent BCC include:
- Mohs micrographic surgery
- Topical therapies (imiquimod, 5-fluorouracil)
- Targeted therapies like vismodegib for advanced cases
- The treatment choice should be individualized based on tumor characteristics, patient preferences, and functional and cosmetic outcomes 1.
From the Research
Port Radiotherapy in Basal Skin Cancer
- Radiotherapy is a treatment option for basal cell carcinoma (BCC), especially for patients older than 60, with non-sclerodermiform histology, and located in non-sensitive areas 2
- The dose of radiotherapy for BCC usually ranges from 60 to 70Gy, and must be modulated to the size of the lesions 2
- Radiotherapy can provide a high rate of local control with low rates of complications that are comparable with surgery 3
- The overall cure rates for BCC treated with radiotherapy range from 79·2% to 100% 3
- More than 90% of patients reported good or excellent aesthetic outcome from radiotherapy 3
Indications and Contraindications
- Indications of radiotherapy for BCC include contra-indications of surgery, such as patients older than 60, non-sclerodermiform histology, and located in non-sensitive areas 2
- Radiotherapy may not be suitable for patients with sensitive areas or those who require surgery 2
- Advanced BCC may require alternative treatment options, such as hedgehog pathway inhibitors 4, 5, 6
Treatment Outcomes
- Radiotherapy can provide a good local control for BCC, but surgery is more efficient and less toxic 2
- The role of radiotherapy in the treatment of advanced BCC is still being investigated, with emerging trends in the use of hedgehog pathway inhibitors 4, 6
- Combined treatment approaches, including neoadjuvant and combined treatment with hedgehog and immune-checkpoint inhibitors, are being explored for advanced BCC 6