From the Guidelines
Image-guided Stereotactic Radiotherapy (SRT) for skin cancer is associated with several problems, including skin toxicity, treatment planning challenges, and limitations in treating certain anatomical locations, which can impact morbidity, mortality, and quality of life. The main issues with SRT for skin cancer include:
- Skin toxicity, which can manifest as redness, irritation, or in severe cases, tissue breakdown at the treatment site 1
- Treatment planning can be challenging due to the superficial nature of skin cancers, requiring precise setup and immobilization to ensure accurate dose delivery 1
- Some patients experience pain or discomfort during or after treatment sessions
- The technology has limitations in treating certain anatomical locations, particularly curved surfaces or areas near critical structures like eyes or lips
- Long-term cosmetic outcomes may include hyperpigmentation, fibrosis, or atrophy of the treated area
- Additionally, the treatment requires specialized equipment and expertise, making it less accessible than other skin cancer treatments 1
- Multiple treatment sessions are typically needed, creating a burden for patients who must attend numerous appointments
- Finally, there may be challenges with insurance coverage as some insurers consider this treatment experimental for certain skin cancer types
According to the most recent and highest quality study, RT is contraindicated in genetic conditions predisposing to skin cancer (eg, basal cell nevus syndrome, xeroderma pigmentosum) and connective tissue diseases (eg, lupus, scleroderma) 1. The study also emphasizes the importance of proper support and training by medical physicists in using intensity-modulated RT (IMRT) technology as primary treatment. Special attention is warranted to ensure adequate surface dose to the target area 1.
In terms of treatment outcomes, RT has been shown to have high 5-year local control, cure, or complete response rates ranging from 93% to 96% for basal cell skin cancer 1. However, the study also notes that RT is often reserved for patients older than 60 years because of concerns about long-term sequelae. The value of postoperative radiation in reducing the rate of recurrence in high-risk patients has been widely accepted, and the panel recommends adjuvant radiotherapy for any BCC that shows evidence of substantial perineural involvement 1.
From the Research
Problems with Image-Guided SRT for Skin Cancer
- There is limited literature evaluating the efficacy and safety of Image-Guided Superficial Radiation Therapy (IGSRT) for non-melanoma skin cancer (NMSC) 2.
- Some studies have reported high cure rates and low complications with IGSRT, but more research is needed to fully understand its effectiveness and potential problems 3, 2, 4, 5, 6.
Common Issues with IGSRT
- Tumor location, tumor stage, and sex may affect freedom from recurrence rates, but overall freedom from recurrence rates are high, exceeding 99% at all stages 4.
- Lesions treated with IGSRT may experience toxicity, but most lesions receive a Radiation Treatment Oncology Group Toxicity (RTOG) score of 1 or 2, indicating mild toxicity 5.
Comparison to Other Treatments
- IGSRT has been shown to have superior cosmesis and local control and cure rates compared to traditional superficial radiation therapy (SRT) and surgical options 3, 2, 5, 6.
- IGSRT offers a paradigm-shifting treatment option for patients with NMSCs, with statistically significantly improved outcomes compared to standard SRT and a more desirable toxicity profile to surgical options 6.